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Safety and efficacy of lumen-apposing metal stents with and without simultaneous double-pigtail plastic stents for draining pancreatic pseudocyst

Published:December 09, 2017DOI:https://doi.org/10.1016/j.gie.2017.11.033

      Background and Aims

      Lumen-apposing metal stents (LAMSs) are used to perform necrosectomy in walled-off necrosis (WON). Although necrosectomy is not required for pancreatic pseudocyst (PP), an increasing number of PPs are also being drained with LAMSs in view of their ease of deployment. The aim of the present study was to evaluate the safety and efficacy of using LAMSs to drain PPs.

      Methods

      At 1 tertiary center from January 2014 to May 2016, all consecutive patients with PPs were drained by LAMSs, and the data were retrospectively reviewed. After observing cyst-cavity infection in patients enrolled initially (group I), 10F double-pigtail stents (DPSs) were placed across LAMSs in the subsequent patients (group II). Data on technical success, PP resolution, adverse events, and reintervention rates were collected.

      Results

      Forty-seven patients with PPs (mean size, 9.5 ± 4.0 cm) were enrolled (group I, 24; group II, 23). There was 1 perforation at deployment (technical success, 98%). In the remaining 46 patients, resolution of the PP was observed in 44 patients (96%). Four patients (17%) in group I presented with PP infection requiring reinterventions. Food material was observed in the cyst cavity. None of the patients in group II had PP infection (relative risk, .84; 95% confidence interval, .71-1.0; P = .054).

      Conclusions

      Similar to WON, LAMSs are also effective in endoscopic drainage of PPs. However, there was a trend toward higher PP infection with LAMSs, and placing a DPS across the LAMS minimized this risk.

      Abbreviations:

      DPS (double-pigtail stent (plastic 10F)), LAMS (lumen-apposing metal stents), PFC (postpancreatitis fluid collection), PP (pancreatic pseudocyst), WON (walled-off necrosis)
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      Linked Article

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          Aburajab et al1 reported their recent experience with lumen-apposing metal stents (LAMSs) in the treatment of pancreatic pseudocysts (PPs). They described a decreasing tendency in cyst cavity infection after placing double-pigtail stents (DPSs) across LAMSs compared with those without DPSs. Moreover, several centers reported their experience in DPS placement through LAMSs while draining walled-off necrosis (WON), and DPS was supposed to prevent occlusion by impacting necrotic tissue.2-4 Because PPs have no necrotic component, the authors postulate that DPSs might play a role in holding back the large pieces of solid food material from entering the cavity, which may subsequently lead to infection.
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          We read with interest the single-center, retrospective study by Aburajab et al1 on EUS-guided lumen-apposing metal stents (LAMSs) for symptomatic pancreatic pseudocyst (PP) drainage. Technical success was achieved in 98% (46/47) of patients. An interim analysis of their initial 23 cases revealed high rates of cyst infection (4/23; 17.4%), which prompted them to routinely place a 10F double-pigtail (DP) stent across the LAMS in the remaining 23 cases. Overall, there was a trend toward a lower rate of infection in patients with DP through the LAMS versus LAMS alone (relative risk 0.8; 95% confidence interval, 0.7-1.0; P = .054).
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