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. 2023 Dec 12;11(12):E1153-E1160.
doi: 10.1055/a-2197-3731. eCollection 2023 Dec.

Analysis of adverse events with lumen apposing metal stents for drainage of pancreatic fluid collections

Rishi Pawa  1 , Robert Dorrell  1 , Madison Nguyen  2 , Greg Russell  3 , John Gilliam  1
Affiliations

Analysis of adverse events with lumen apposing metal stents for drainage of pancreatic fluid collections

Rishi Pawa et al. Endosc Int Open. .

Abstract

Background and study aims Innovations in endoscopic management of pancreatic fluid collections (PFCs) using lumen apposing metal stents (LAMS) have rendered it a preferred approach for drainage of PFCs. These advances have not come without concern for adverse events (AEs). We present our experience with LAMS for drainage of PFCs and analyze factors that contribute to LAMS-related AEs. Patients and methods From November 2015 to October 2021, a retrospective analysis was performed of patients undergoing endoscopic management of PFCs using LAMS. All AEs were classified as either early (<48 hours) or late (>48 hours). Univariate and multivariate analysis were performed using logistic regression to assess the relationship between independent variables and AEs. Results A total of 119 patients with symptomatic PFCs underwent endoscopic drainage with LAMS. There were 16 AEs (12.4%). These included systemic inflammatory response syndrome (SIRS) (n=2), stent occlusion (n=5), bleeding (n=7), and stent migration (n=2). Univariate analysis of risk of AEs showed that no variables approached statistical significance. Of the seven patients who developed bleeding, five had pseudoaneurysms following LAMS placement and underwent angioembolization by an interventional radiologist. The average time to bleeding was 9.3 days (standard deviation 7.3) with all bleeding events occurring within 3 weeks. In a multivariate model, pseudocysts and presence of paracolic gutter extension were associated with an increased risk of bleeding. Conclusions Endoscopists should be aware of the risk factors for LAMS-related bleeding and tailor their drainage strategy, including utilization of plastic stents for drainage of pseudocysts and adherence to a strict imaging interval and follow-up protocol.

Keywords: Endoscopic ultrasonography; GI radiology; Intervention EUS; Pancreas; Quality and logistical aspects.

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Conflict of interest statement

Conflict of Interest Rishi Pawa is a consultant for Boston Scientific and Cook Medical. The remaining authors have no conflict of interest to declare.

Figures

Fig. 1
Fig. 1
Endoscopic ultrasound-guided drainage of walled-off necrosis with lumen apposing metal stent. a Endoscopic ultrasound image of walled-off necrosis. b Deployment of proximal flange of lumen apposing metal stent under EUS guidance, c Endoscopic image showing fluid draining from the cyst cavity following LAMS placement. d Fluoroscopic image showing balloon dilation of LAMS. e Endoscopic image showing direct endoscopic necrosectomy using a snare.
Fig. 2
Fig. 2
LAMS-associated bleeding secondary to splenic artery pseudoaneurysm managed with angioembolization. a Endoscopic image of bleeding within the cyst cavity following LAMS placement. b CT angiogram showing splenic artery pseudoaneurysm (red arrowhead). c Angiogram showing splenic artery pseudoaneurysm (red arrowhead). d Coils packing the pseudoaneurysm and splenic artery.
Fig. 3
Fig. 3
Cumulative proportion of AEs over time following LAMS placement.
See this image and copyright information in PMC

References

    1. Thompson CC, Kumar N, Slattery J et al. A standardized method for endoscopic necrosectomy improves complication and mortality rates. Pancreatology. 2016;16:66–72. doi: 10.1016/j.pan.2015.12.001. - DOI - PMC - PubMed
    1. Fugazza A, Sethi A, Trindade AJ et al. International multicenter comprehensive analysis of adverse events associated with lumen-apposing metal stent placement for pancreatic fluid collection drainage. Gastrointest Endosc. 2020;91:574–583. - PubMed
    1. Bang JY, Hasan M, Navaneethan U et al. Lumen-apposing metal stents (LAMS) for pancreatic fluid collection (PFC) drainage: may not be business as usual. Gut. 2017;66:2054–2056. doi: 10.1136/gutjnl-2016-312812. - DOI - PMC - PubMed
    1. Nayar M, Leeds JS, Oppong K. Lumen-apposing metal stents for drainage of pancreatic fluid collections: does timing of removal matter? Gut. 2022;71:850–853. doi: 10.1136/gutjnl-2021-325812. - DOI - PMC - PubMed
    1. Amato A, Tarantino I, Facciorusso A et al. Real-life multicentre study of lumen-apposing metal stent for EUS-guided drainage of pancreatic fluid collections. Gut. 2022;71:1050–1052. doi: 10.1136/gutjnl-2022-326880. - DOI - PubMed