Pancreas

Gut. 2023;72(1):66–72

Boxhoorn L, Verdonk RC, Besselink MG, Boermeester M, Bollen TL, Bouwense SAW, Cappendijk VC, Curvers WL, Dejong CH, van Dijk SM, van Dullemen HM, van Eijck CHJ, van Geenen EJM, Hadithi M, Hazen WL, Honkoop P, van Hooft JE, Jacobs MAJM, Kievits JEC, Kop MPM, Kouw E, Kuiken SD, Ledeboer M, Nieuwenhuijs VB, Perk LE, Poley JW, Quispel R, de Ridder RJJ, van Santvoort HC, Sperna Weiland CJ, Stommel MWJ, Timmerhuis HC, Witteman BJ, Umans DS, Venneman NG, Vleggaar FP, van Wanrooij RLJ, Bruno MJ, Fockens P, Voermans RP; Dutch Pancreatitis Study Group

Comparison of lumen-apposing metal stents versus double-pigtail plastic stents for infected necrotizing pancreatitis

Objective: Lumen-apposing metal stents (LAMS) are believed to clinically improve endoscopic transluminal drainage of infected necrosis when compared with double-pigtail plastic stents. However, comparative data from prospective studies are very limited.
Design: Patients with infected necrotizing pancreatitis, who underwent an endoscopic step-up approach with LAMS within a multicenter prospective cohort study were compared with the data of 51 patients in the randomized TENSION trial who had been assigned to the endoscopic step-up approach with double-pigtail plastic stents. The clinical study protocol was otherwise identical for both groups. Primary end point was the need for endoscopic transluminal necrosectomy. Secondary end points included mortality, major complications, hospital stay and healthcare costs.
Results: A total of 53 patients were treated with LAMS in 16 hospitals during 27 months. The need for endoscopic transluminal necrosectomy was 64% (n = 34) and was not different from the previous trial using plastic stents (53%, n = 27), also after correction for baseline characteristics (odds ratio = 1.21; 95% confidence interval [CI]: 0.45–3.23). Secondary end points did not differ between groups either, which also included bleeding requiring intervention: 5 patients (9%) after LAMS placement versus 11 patients (22%) after placement of plastic stents (relative risk = 0.44; 95% CI: 0.16–1.17). Total healthcare costs were also comparable (mean difference, -6348 €, bias-corrected and accelerated 95% CI: -26,386–10,121 €).

Conclusion: This comparison of 2 patient groups from 2 multicenter prospective studies with a similar design suggests that lumen-apposing metal stents do not reduce the need for endoscopic transluminal necrosectomy when compared with double-pigtail plastic stents in patients with infected necrotizing pancreatitis. Also, the rate of bleeding complications was comparable.

DOI: DOI: 10.1136/gutjnl-2021-325632