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Multicenter Study
. 2025 Aug;57(8):829-838.
doi: 10.1055/a-2569-7056. Epub 2025 Mar 31.

Effect of proton pump inhibitors on occlusion of lumen-apposing metal stents and rate of endoscopic necrosectomies: a Europe-wide multicenter cohort study

Jacob Hamm  1 , Alzbeta Busana  1 , Ahmad Amanzada  1 , Alexander Arlt  2   3 , Thomas Asendorf  4 , Samantha Carswell  5 , Ulrike Denzer  6 , Louis Elsing  7 , Fabian Frost  8 , Lucia Guilabert  9 , Karim Hamesch  10 , Marcus Hollenbach  6   11 , Péter Hegyi  12   13   14 , Alexander Kleger  15   16 , Jan Krivinka  17 , Lumir Kunovsky  17   18   19 , Christian Meinhardt  2 , Veit Phillip  20 , Sophie Schlosser-Hupf  21 , Simon Sirtl  22 , Lukas Welsch  23 , Julian Cardinal von Widdern  24 , Albrecht Neesse  1 , Christoph Ammer-Herrmenau  1 ; PROTOCOL working group
Collaborators, Affiliations
Multicenter Study

Effect of proton pump inhibitors on occlusion of lumen-apposing metal stents and rate of endoscopic necrosectomies: a Europe-wide multicenter cohort study

Jacob Hamm et al. Endoscopy. 2025 Aug.

Abstract

Background: Lumen-apposing metal stents (LAMS) are widely used to drain walled-off necrosis (WON). LAMS occlusion is a significant clinical problem and identification of risk factors for LAMS occlusion could contribute to novel preventive strategies. A previous study suggested contradictory effects of proton pump inhibitors (PPIs) on occlusion and necrosectomy rates.

Methods: We conducted a Europe-wide multicenter retrospective cohort study assessing WONs drained by LAMS. The primary aims were to assess the strength of association between PPI intake and LAMS occlusion and necrosectomy rates, respectively. The secondary aim was to assess the strength of association between PPI intake and other LAMS-associated complications. Multiple mixed-effects models were used to control for possible confounding covariates.

Results: 893 patients with 967 LAMS from 17 centers were included. After excluding incomplete datasets and patients who took PPIs intermittently, 768 LAMS remained. The overall occlusion rate was 28.0 %. Most occlusions occurred within 10 days. Most patients received PPIs continuously (n = 577 vs. no intake n = 191). In patients who did not use PPIs continuously, lower rates of LAMS occlusion (odds ratio [OR] 0.61, P = 0.04) and necrosectomies (incidence rate ratio 0.8, P = 0.006) were observed. A post hoc analysis exhibited a dose- and compound-dependent effect of PPI intake on necrosectomy rate. No increase in other complications in the non-PPI group, such as bleeding events (OR 1.14) were observed.

Conclusion: PPI intake was associated with higher rates of LAMS occlusion and necrosectomy.

Trial registration: ClinicalTrials.gov NCT05817721.

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Conflict of interest statement

Research funding: U. Denzer (Boston Scientific), C. Ammer-Herrmenau (Sander Foundation), A. Neesse (Wilhelm Sander Foundation), A. Hoffmeister (Repha GmbH), K. Hamesch (Grifols Inc.), A. Arlt (Sander Foundation)Lecture and training fees: C. Ammer-Herrmenau (Falk Foundation, Nordmark Pharma), A. Neesse (Boston Scientific), V. Ellenrieder (Janssen, Merck, Falk Foundation), U. Denzer (Falk Foundation, Olympus, Boston Scientific, Ovesco, Pentax, Norgine), J. Rosendahl (Nordmark Pharma, Falk Foundation), A. Hoffmeister (Falk Foundation), L. Welsch (Falk Foundation, Ambu), K. Hamesch (Chiesi, CSL Behring, AbbVie, Falk Foundation), M. Hollenbach (Fujifilm), S. Sirtl (Falk Foundation), G. Beyer (Falk Foundation, Akcea), J. Mayerle (Falk Foundation), A. Arlt (Boston Scientific, Olympus, Falk Foundation), F. Frost (Nordmark Pharma)Consultant activity: U. Denzer (Fujifilm, Pentax), J. Rosendahl (Microtech, Alexxion, Viatris), K. Hamesch (AbbVie, Janssen, Takeda), M. Hollenbach (Fujifilm), V. Philip (Nordmark Pharma), G. Beyer (Nordmark Pharma, Berlin Chemie), A. Arlt (Boston Scientific)Accommodation and traveling expenses: U. Denzer (Ovesco, Falk Foundation, Fujifilm, Boston Scientific, Pentax, Norgine), C. Ammer-Herrmenau (Falk Foundation, Nordmark Pharma), A. Neesse (Boston Scientific, Falk Foundation), V. Ellenrieder (Janssen), J. Rosendahl (Nordmark Pharma), K. Hamesch (AbbVie, Boston Scientific, Cook Medical, Galapagos, Janssen, Olympus, Takeda, Tillotts, Pfizer), M. Hollenbach (Fujifilm), S. Sirtl (Mylan Germany GmbH), J. Mayerle (Falk Foundation), A. Arlt (AbbVie), F. Frost (Nordmark Pharma), L. Guilabert (Janssen, Viatris, Pfizer, Faes Farma, Ferring, Takeda).The remaining authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Strengthening the reporting of observational studies in epidemiology (STROBE) flow chart for primary aims. eCRF, electronic case record form; LAMS, lumen-apposing metal stent; PPI, proton pump inhibitor. *Information on the extent of occlusion was missing for 10 LAMS.
Fig. 2
Fig. 2
Continuous intake of proton pump inhibitors (PPI) was associated with a higher rate of lumen-apposing metal stent (LAMS) occlusion. a Number of LAMS in patients who were prescribed PPIs continuously (cPPI) or not at all (nPPI). b Example images of LAMS with no occlusion (upper panel) and total occlusion of the LAMS lumen (lower panel). c Overall occlusion rates for cPPI and nPPI groups. d Occlusion rates stratified by partial and total occlusions for cPPI and nPPI intake, respectively. * P  < 0.05 using multivariable logistic mixed-effects model and cumulative link mixed models.
Fig. 3
Fig. 3
Continuous intake of proton pump inhibitors (PPIs) was associated with an increased rate of endoscopic necrosectomies in a dose- and compound-dependent manner. Violin-/boxplots displaying numbers of endoscopic necrosectomies depending on: a PPI intake; b PPI dose; and c PPI compound. * P  < 0.05, ** P  < 0.01, *** P  < 0.001 using a multiple negative binomial mixed-effects model. cPPI, continuous PPI intake; nPPI, no PPI intake.
See this image and copyright information in PMC

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