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”

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