Complications and Clinical Impact of Long-Term Indwelling Plastic Stents in the Management of Pancreatic Fluid Collections

Aims Endoscopic ultrasound (EUS)-guided transmural drainage has revolutionized the management of symptomatic peripancreatic fluid collections (PPFCs). While lumen-apposing metal stents (LAMS) have demonstrated efficacy in initial drainage, their removal often necessitates the placement of double-pigtail stents (DPS) to minimize recurrence risks. However, the long-term safety and efficacy of this practice remain underexplored. This study provides critical insights into the complications and recurrence rates associated with prolonged DPS retention, aiming to guide clinical decision-making in PPFC management.

Methods This retrospective, single-center study included patients who underwent EUS-guided transmural drainage for symptomatic PPFCs with LAMS placement at University Hospital Puerta de Hierro, Madrid, between May 2016 and June 2024. Patients with a follow-up period exceeding three months were included. Primary outcomes were short- and long-term complications of prolonged DPS retention. Secondary outcomes included PPFC recurrence and associated factors

Results A total of 89 patients were included (mean age 60 years), of whom 46,1% required at least one necrosectomy session. LAMS were retained for a mean of 40 days, and 54 patients (60.7%) had at least one DPS left in place, with an average indwelling duration of 257 days. Complications related to prolonged DPS retention occurred in 6 patients (11.54%), including three cases of persistent abdominal pain requiring endoscopic stent removal and three cases of stent migration leading to various complications:

• Jejunal obstruction due to stent embedding in the wall, in a patient with adhesive syndrome, necessitating surgical intervention [1] [2] [3] [4] [5] .

• Previously undiagnosed sigmoid stricture with a proximal PSS causing an ulcer, managed with endoscopic dilation and stent removal.

• Esophageal mucosal injury due to stent migration in a patient with a prior gastrojejunostomy, resolved with endoscopic removal.

Recurrence of PPFCs occurred in 5 patients (9.3%) with retained DPS versus 10 patients (28.6%) without DPS, demonstrating a statistically significant reduction in recurrence with stent retention (p=0.004).

Conclusions This study highlights the benefits and risks of prolonged DPS retention in PPFC management. While maintaining DPS significantly lowers recurrence risk in our study, it is associated with complications such as abdominal pain and complicated stent migration. Importantly, all patients with severe complications had underlying gastrointestinal pathology, highlighting the need for careful patient selection and close monitoring in this population. These findings emphasize the need for individualized treatment strategies, careful patient selection, and tailored follow-up to maximize clinical outcomes.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

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