Brimhall B, et al. - Experts undertook a comparative scrutiny of the technical and clinical success and adverse events in patients who received lumen-apposing metal stents (LAMS) vs double pigtail plastic stents (DPS) for pancreatic pseudocysts and walled-off necrosis. LAMS and DPS exhibited comparable rates of technical and clinical success and adverse events. Findings shed light on the connection between drainage of walled-off necrosis or pancreatic pseudocysts using DPS with fewer bleeding events overall, including pseudoaneurysm bleeding. However, weighing of bleeding risk with LAMS was recommended against the trend of higher actionable perforation and infection rates with DPS.

Methods

• The design of this research was a retrospective study of endoscopic ultrasound-mediated drainage in 149 patients (65% male; mean age, 47 years) with pancreatic pseudocysts or walled-off necrosis (97 received LAMS and 152 received DPS), from January 2011 through September 2016 at a single center.
• Data was cumulated with regard to the patient characteristics, outcomes, hospitalizations, and imaging findings.
• Herein, technical success was defined as LAMS insertion or minimum of 2 DPS and clinical success was defined as resolution of pancreatic pseudocysts or walled-off necrosis based on imaging results.
• Resolution of peri-pancreatic fluid collection with reduced abdominal pain or obstructive signs or symptoms served as the primary outcome.
• Secondary outcomes comprised of the identification and management of adverse events, number of additional procedures required to resolve fluid collection, and the recurrence of fluid collection.

Results

• Larger peripancreatic fluid collections were reported among patients who received LAMS when compared to subjects who received DPS prior to intervention (P=.001) and underwent an average 1.7 interventions vs 1.9 interventions for patients who received DPS (P=.93).
• Technical success was achieved for 90 patients with LAMS (92.8%) vs 137 patients with DPS (90.1%) (odds ratio [OR] for success with DPS, 0.82; 95% CI, 0.33-2.0; P=.67).
• Regardless of larger fluid collections in the LAMS group, no notable variation was found in the proportions of patients with clinical success following placement of LAMS (82/84 patients, 97.6%) vs DPS (118/122 enrollees, 96.7%) (OR for clinical success with DPS, 0.73; 95% CI, 0.13-4.0; P=.71).
• The development of adverse events was illustrated in 24 candidates who received LAMS 24 (24.7%) vs 27 participants who received DPS (17.8%) (OR for an adverse event in a patient receiving a DPS, 0.82; 95% CI, 0.33-2.0; P=0.67).
• Nonetheless, a higher risk of pseudoaneurysm bleeding was disclosed in individuals with LAMS than patients with DPS (OR, 10.0; 95% CI, 1.19-84.6; P=.009).