The safety and efficacy of a new 20-mm lumen apposing metal stent (lams) for the endoscopic treatment of pancreatic and peripancreatic fluid collections: a large international, multicenter study

Andrea Anderloni, Carlo Fabbri, Jose Nieto, Will Uwe, Markus Dollhopf, José Ramón Aparicio, Manuel Perez-Miranda, Ilaria Tarantino, Alexander Arlt, Frank Vleggaar, Geoffrey Vanbiervliet, Jochen Hampe, Michel Kahaleh, Juan J. Vila, Barham K.Abu Dayyeh, Andrew C. Storm, Alessandro Fugazza, Cecilia Binda, Antoine Charachon, Sergio Sevilla-RibotaAmy Tyberg, Moran Robert, Sachin Wani, Alessandro Repici, Amrita Sethi, Mouen A. Khashab, Rastislav Kunda

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Lumen apposing metal stent (LAMS) allows an easy access to peripancreatic fluid collections (PPFCs) and the possibility of performing direct endoscopic necrosectomy (DEN). The aim of our study was to evaluate the safety and efficacy of a new 20-mm LAMS in the management of PPFCs. This novel stent represents the largest diameter LAMS available on the market to date. Methods: This is an international, multicenter retrospective study involving 20 centers. Consecutive patients who underwent EUS-guided PPFC drainage using a 20-mm LAMS were included. Primary outcomes were technical and clinical success. Secondary outcomes were rate and the severity of adverse events. Results: A total 105 patients underwent PPFC drainage using the new 20-mm LAMS and 106 LAMS were placed. Technical success was 100% (106/106). 7/105 patients died due to causes not related to the stent. Clinical success was achieved in 92/98 patients (93.9%). Significant adverse events occurred in 8/98 patients (8.16%): 4 cases (4.08%) of bleeding, 3 cases (3.06%) of suprainfection, 1 case of gastric outlet obstruction. Conclusions: This multicenter study demonstrated acceptable rates of technical and clinical success using a new 20-mm LAMS for PPFC, including walled-off pancreatic necrosis (WOPN). The results of our study suggest that a new 20-mm LAMS is non-inferior in terms of safety, efficacy, and adverse events as compared to smaller diameter LAMS in the management of PPFCs, including pancreatic psuedocysts (PP) and WOPN. Randomized controlled studies will be needed to determine the ideal size of LAMS need to achieve the greatest clinical benefit with the minimized risk exposure for this high-risk patient population.

Original languageEnglish (US)
Pages (from-to)1741-1748
Number of pages8
JournalSurgical endoscopy
Volume35
Issue number4
DOIs
StatePublished - Apr 2021

Keywords

  • EUS-guided drainage
  • Lumen apposing metal stent
  • Pancreatic fluid collection
  • Walled-off pancreatic necrosis

ASJC Scopus subject areas

  • Surgery

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