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Minerva Gastroenterology 2022 Feb 03

DOI: 10.23736/S2724-5985.22.03055-8

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Lumen apposing metal stents vs double pigtail plastic stents for the drainage of pancreatic walled-off necrosis

Roberto VALENTE 1, 2, 3 , Laura ZARANTONELLO 4, Marco DEL CHIARO 2, Miroslav VUJASINOVIC 5, Francisco BALDAQUE SILVA 5, Chiara M. SCANDAVINI 3, Elena RANGELOVA 6, Francesca VESPASIANO 7, Giuseppe ANZILLOTTI 7, Johannes M. LÖHR 1, 5, Urban ARNELO 1, 3

1 Department of Surgery, Karolinska Institutet, Stockholm, Sweden; 2 Department of Surgical Oncology, Anschutz Medical Campus, University of Colorado, Denver, CO, USA; 3 Department of Surgery, Umeå University Hospital, Umeå, Sweden; 4 Department of Surgery, Uppsala University Hospital, Uppsala, Sweden; 5 Department of Upper Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden; 6 Department of Surgery, Sahlgrenska Hospital, Gothenburg, Sweden; 7 Department of Upper Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden within the European Project “Erasmus”


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BACKGROUND: Few studies compared lumen-apposing metal stents (LAMS) and standard double pigtail plastic stents (PS) for the endoscopic drainage of pancreatic walled-off necrosis (WON). Albeit sometimes large, previously described cohorts display considerable heterogeneity and often pooled together data from several centers, involving multiple operators and techniques. Moreover, they often lack a control group for the comparison of outcomes.
AIM: to compare clinical efficacy and safety of PS versus LAMS for the endoscopic drainage of infected WON.
METHODS: Single-centre, 1:1 case-control study. We compared patients undergoing endoscopic drainages of infected WON through LAMS (cases) or PS (controls). The primary endpoint was the clinical efficacy (resolution of the WON/sepsis), the secondary endpoint was safety (procedure-related complications).
RESULTS: Thirty patients were enrolled between 2011 and 2017. Cases and controls were homogeneous in terms of etiology and clinical characteristics. 93% of cases and 86.7% of controls were clinically successfully treated, with no significant differences in rates of post-operative infections, bleedings and stent migrations (respectively 13.3% vs 21.4%; p=0.65; 13.3% vs 0%; p=0.48; 13.3% vs 7.1%; p=1.00). No difference was shown regarding the need for additional percutaneous or surgical treatments (33.3% vs 13.3%; p=0.39). Cases, however, displayed a significantly prolonged mean hospital stay (90.2 days vs 18.5 days; p<0.01) and a higher mean number of endoscopic procedures per patient (4.8 vs 1.5; p<0.01).
CONCLUSIONS: PS might be not inferior to LAMS for the treatment WONs. Further prospective RCT is needed to compare clinical efficacy and safety in the two groups.


KEY WORDS: Acute pancreatitis; Double pigtails plastic stents; LAMS; WON

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