Outcome assessment of Lumen-Apposing Metal Stents (LAMS) versus double pigtail plastic stents in Endoscopic Ultrasound-Guided Gallbladder Drainage: Results of a Large Bicentric Retrospective Study

Aims Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has emerged as a promising option in patients presenting with cholecystitis, deemed unfit for laparoscopic cholecystectomy. Evidence from comparative trials is lacking on the best stent type to use for EUS-GBD. This study aims to compare the outcomes between lumen-apposing metal stents (LAMS) and double-pigtail plastic stents (DPPS) in EUS-GBD.

Methods We conducted a bicentric retrospective study on patients considered unfit for surgery by an experienced surgeon, presenting with acute cholecystitis. This study reviewed prospectively collected registries of all patients who underwent EUS-GBD using LAMS or DPPS between 2012 and 2023 at two European tertiary care centers. Primary outcomes included technical and clinical success (defined as symptom resolution 15 days post-intervention), and adverse events (using AGREE classification). Secondary outcomes were the reintervention rate, length of hospital stay, and 30-day mortality. Statistical non-parametric tests or Chi-square tests were used for comparisons and Kaplan-Meier analysis for survival and time-to-reintervention outcomes [1] [2] [3] [4].

Results Among the 55 patients included (66.7% men, median age 68 years (IQR, 55-81), 37 and 18 were treated with LAMS and DPPS, respectively. Technical success was similar with 97.3% in the LAMS group and 94.4% in the DPPS group (p=1.00). No difference in clinical success was observed (78.4% for LAMS and 66.7% for DPPS (p=0.542)). Adverse events within 30 days (AGREE classification 1–5) were also similar, with a rate of 31.4% for LAMS and 38.9% for DPPS (p=0.610). There was no statistically significant difference in the occurrence of post-procedural peritonitis (16.7% LAMS vs. 8.3% DPPS, p=0.388) or in 30-day mortality (20% LAMS vs. 27.8% DPPS, p=0.378). However, the incidence of post-procedural septicemia was significantly higher in the DPPS group (38.9% for DPPS vs. 8.3% for LAMS), without any impact on the post-intervention length of hospital stay (6 vs 7 days, p=0.478). In terms of delayed complications (beyond 30 days), there was no difference in recurrent acute cholecystitis (9.4% for LAMS vs 11.1% for DPPS; p=1.00), stent migration (3.7% for LAMS vs 11.8% for DPPS; p=0.549), patency rates (88.9% for LAMS vs 82.4% for DPPS; p=0.662), with similar reintervention rates (29.4% for LAMS vs 38.9% for DPPS; p=0.54).

Conclusions This bicentric retrospective study is the first and largest to evaluate LAMS vs DPPS in EUS-GBD. The results are similar in terms of technical and clinical success, adverse events, and reintervention rates. We only observed a higher risk of post-procedural septicemia in the DDPS group, without any impact on the post-procedure length of hospital stay. Given the cost difference between the two stent types, our findings challenge current recommendations for systematically favoring LAMS in this context.

Publication History

Article published online:
27 March 2025

• References

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