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

Lotte Boxhoorn, Robert C. Verdonk, Marc G. Besselink, Marja Boermeester, Thomas L. Bollen, Stefan Aw Bouwense, Vincent C. Cappendijk, Wouter L. Curvers, Cornelis H. Dejong, Sven M. van Dijk, Hendrik M. van Dullemen, Casper Hj van Eijck, Erwin Jm van Geenen, Muhammed Hadithi, Wouter L. Hazen, Pieter Honkoop, Jeanin E. van Hooft, Maarten Ajm Jacobs, June Ec Kievits, Marnix Pm KopEva Kouw, Sjoerd D. Kuiken, Michiel Ledeboer, Vincent B. Nieuwenhuijs, Lars E. Perk, Jan-Werner Poley, Rutger Quispel, Rogier Jj de Ridder, Hjalmar C. van Santvoort, Christina J. Sperna Weiland, Martijn Wj Stommel, Hester C. Timmerhuis, Ben J. Witteman, Devica S. Umans, Niels G. Venneman, Frank P. Vleggaar, Roy Lj van Wanrooij, Marco J. Bruno, Paul Fockens, Rogier P. Voermans

Research output: Contribution to journalArticleAcademicpeer-review

24 Citations (Scopus)

Abstract

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 necrotising pancreatitis, who underwent an endoscopic step-up approach with LAMS within a multicentre prospective cohort study were compared with the data of 51 patients in the randomised 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 (OR 1.21 (95% CI 0.45 to 3.23)). Secondary end points did not differ between groups either, which also included bleeding requiring intervention - 5 patients (9%) after LAMS placement vs 11 patients (22%) after placement of plastic stents (relative risk 0.44; 95% CI 0.16 to 1.17). Total healthcare costs were also comparable (mean difference -€6348, bias-corrected and accelerated 95% CI -€26 386 to €10 121). Conclusion: Our comparison of two patient groups from two multicentre prospective studies with a similar design suggests that LAMS do not reduce the need for endoscopic transluminal necrosectomy when compared with double-pigtail plastic stents in patients with infected necrotising pancreatitis. Also, the rate of bleeding complications was comparable.
Original languageEnglish
Article numbere22325632
Pages (from-to)66-72
Number of pages7
JournalGut
Volume72
Issue number1
Early online date2022
DOIs
Publication statusPublished - 14 Jun 2022

Keywords

  • acute pancreatitis
  • endoscopy

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