COMPARATIVE EFFICACY AND SAFETY OUTCOMES OF ENDOSCOPIC ULTRASOUND-GUIDED LUMEN-APPOSING METAL STENTS DRAINAGE FOR PANCREATIC PSEUDOCYSTS AND WALLED-OFF NECROSIS – A SINGLE-CENTER EXPERIENCE

Aims Endoscopic ultrasound (EUS)-guided transmural drainage is considered the first-line treatment of pancreatic fluid collections (PFCs). The results of LAMS drainage for different PFC types remain controversial. This study aimed to compare the outcome and safety of LAMS drainage for walled-off necrosis (WON) and pancreatic pseudocysts (PPC).

Methods Patients with PPC or WON who underwent EUS-guided drainage with LAMS from November 2013 to October 2021 were analysed retrospectively. Efficacy outcomes were technical and clinical success rates and procedure time. Safety outcomes included bleeding rate, stent migration, stent occlusion, perforations, septic complications, hospital stay. Pathogen spectrum analyses of WON vs. PPC were included.

Results 35 and 48 patients with PPC and WON, respectively, underwent drainage with LAMS. The median procedure time for PPC and WON were 42.5min and 50.0min, respectively (P=0.175). Median stent indwell time was 56 days for WON and 66 days for PPC (P=0.349). Technical and clinical success rates did not differ significantly (P=0.635 and P=0.225). 56% of patients in the WON group required subsequent endoscopic necrosectomy. Overall adverse advents after LAMS placement occurred more often in the WON group (37% vs. 12%; P=0.019). Fungal pancreatic infections and enterococcus infections differed significantly between both groups (63% WON vs. 33% PPC; P=0.03 and 50% WON vs. 23.8% PPC, P=0.048, retrospectively). Fungal infections were associated with a significantly longer hospital stay (P=0.029).

Conclusions LAMS placement in WON is associated with more adverse events. Fungal infections are more common in patients with infected WON and indicate patients with higher morbidity and longer hospital stay.

Publication History

Article published online:
14 April 2022