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. 2021;34(2):273-281.
doi: 10.20524/aog.2021.0570. Epub 2021 Jan 4.

International, multicenter retrospective trial comparing the efficacy and safety of bi-flanged versus lumen-apposing metal stents for endoscopic drainage of walled-off pancreatic necrosis

Ali Siddiqui  1 , Mariam Naveed  2 , Jahangeer Basha  3 , Sundeep Lakhtakia  3 , Jose Nieto  4 , Janak Shah  5 , Kenneth Binmoeller  5 , Megan Murphy  1 , Rupjyoti Talukdar  3 , Mohan K Ramchandani  3 , Zaheer Nabi  3 , Rajesh Gupta  3 , Thomas E Kowalski  6 , David E Loren  1 , Reem Z Sharaiha  6 , Michel Kahaleh  6 , Patrick Ten Eyck  2 , Arish Noor  1 , Tayebah Mumtaz  1 , Rakesh Kalalala  3 , Nageshwar D Reddy  3 , Douglas G Adler  7
Affiliations

International, multicenter retrospective trial comparing the efficacy and safety of bi-flanged versus lumen-apposing metal stents for endoscopic drainage of walled-off pancreatic necrosis

Ali Siddiqui et al. Ann Gastroenterol. 2021.

Abstract

Background: To compare fully covered bi-flanged metal stents (BFMS) and lumen-apposing metal stents (LAMS) for endoscopic ultrasound (EUS)-guided drainage/debridement of pancreatic walled-off necrosis (WON).

Methods: Patients with WON managed by EUS-guided therapy were divided into those who underwent: 1) drainage using BFMS; and 2) drainage using LAMS and scheduled direct endoscopic necrosectomy (DEN). Clinical success (resolution of the WON), technical success (successful stent placement), and adverse events (AEs) were evaluated.

Results: 387 patients underwent WON endoscopic drainage, 205 using BFMS and 182 using LAMS. The clinical success in the BFMS or LAMS groups were similar (197 [96.1%] vs. 174 [95.6%]; P=0.81). Median number of procedures required for WON resolution was significantly lower in BFMS compared to LAMS (2 vs. 3, P<0.001). Technical success for stent placement was similar in BFMS and LAMS groups (203 [99%] vs. 180 [99%], P=0.90). Procedure-related AEs were similar in the BFMS and LAMS groups (19 [9.3%] vs. 20 [10.9%], P=0.61). Stent dysfunction with occluding debris was higher in the BFMS group compared to LAMS group (21 [10.2 %] vs. 11 [5.9%], P=0.04). The migration rate was higher in the BFMS group than in the LAMS group (15 [7.3%] vs. 3 [1.6%]; P<0.001). DEN was required in 23 [11.2%] patients in the BFMS group after lack of WON resolution by conservative means.

Conclusion: BFMS with a "step-up approach" and LAMS with scheduled DEN are both safe and effective for EUS-guided drainage/debridement of WON.

Keywords: Pancreatic walled off necrosis; acute pancreatitis; bi-flanged metal stents; endosonography; lumen-apposing metal stents.

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Conflict of interest statement

Conflict of Interest: None

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