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CC BY-NC-ND 4.0 · Endosc Int Open 2024; 12(02): E317-E323
DOI: 10.1055/a-2226-0840
Original article

Safety and efficacy of early versus late removal of LAMS for pancreatic fluid collections

Philippe Willems
1   Gastroenterology, University of Montreal Hospital Centre, Montréal, Canada (Ringgold ID: RIN25443)
2   Gastroenterology, CRCHUM, Montreal, Canada (Ringgold ID: RIN177460)
,
Eslam Esmail 
2   Gastroenterology, CRCHUM, Montreal, Canada (Ringgold ID: RIN177460)
3   Tropical medicine, Tanta University Faculty of Medicine, Tanta, Egypt (Ringgold ID: RIN68782)
,
Sarto Paquin
1   Gastroenterology, University of Montreal Hospital Centre, Montréal, Canada (Ringgold ID: RIN25443)
2   Gastroenterology, CRCHUM, Montreal, Canada (Ringgold ID: RIN177460)
,
Anand Sahai
1   Gastroenterology, University of Montreal Hospital Centre, Montréal, Canada (Ringgold ID: RIN25443)
2   Gastroenterology, CRCHUM, Montreal, Canada (Ringgold ID: RIN177460)
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Abstract

Background and study aims Optimal timing for removal of lumen-apposing metal stents (LAMS) for effective drainage of pancreatic fluid collections (PFC) while minimizing adverse events (AE) is unknown. Outcomes of early (≤ 4 weeks) or delayed (> 4 weeks) LAMS removal on both clinical efficacy and the incidence of AE were assessed.

Patients and methods This was a retrospective analysis of a prospectively maintained registry of PFC drainage between November 2016 and September 2021. Clinical success was defined as a 75% decrease in fluid collection volume with no need for reintervention at 6 months. AE were defined using the American Society for Gastrointestinal Endoscopy lexicon. Multiple logistic regression analysis was performed to determine variables associated with clinical success and AE.

Results A total of 108 consecutive PFCs were included. LAMS deployment was technically successful in 103 of 108 cases (95.4%). Failure was associated with collection diameter ≤ 4 cm (odds ratio [OR] 24.0, P = 0.005) and presence of more than 50% necrotic material (OR 20.1, P = 0.01). Stents were left in place for a median of 48 days. Patients with early stent removal (< 4 weeks) had clinical success in 70.0% of cases, which was significantly less than in the group with delayed stent removal (96.4%, P = 0.03). On multiple regression analysis, clinical failure was associated with early stent removal (OR 25.5, P = 0.003). AEs occurred in 8.7% of cases (9/103). There were no predictors of AE. Notably, delayed stent removal did not predict the occurrence of AE.

Conclusions Early LAMS removal (< 4 weeks) did not prevent AEs but did lead to increased clinical failure.

Keywords

Pancreas - Endoscopic ultrasonography - Intervention EUS - Quality and logistical aspects - Performance and complications


Publication History

Received: 17 July 2023

Accepted after revision: 07 December 2023

Accepted Manuscript online:
11 December 2023

Article published online:
28 February 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
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Comment to this article:

Endoscopy International Open – recently publishedEndoscopy 2024; 56(05): 394-394
DOI: 10.1055/a-2252-3068

 

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