Safety and Efficacy of Early versus Late Removal of LAMS for Pancreatic Fluid Collections

Author:

Willems Philippe12,Esmail Eslam23ORCID,Paquin Sarto42,Sahai Anand42

Affiliation:

1. Gastroenterology, University of Montreal Hospital Centre, Montréal, Canada

2. Gastroenterology, CRCHUM, Montreal, Canada

3. Tropical medicine, Tanta University Faculty of Medicine, Tanta, Egypt

4. Gastroenterology, University of Montreal Hospital Centre, Montreal, Canada

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 is 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 ASGE lexicon. Multiple logistic regression analysis was performed to determine variables associated with clinical success and AE. Results: 108 consecutive PFC were included. LAMS deployment was technically successful in 103/108 (95.4%) of cases. Failure was associated with collection diameter ≤4 cm (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). AE 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 AE but did lead to increased clinical failure.

Publisher

Georg Thieme Verlag KG

Subject

Obstetrics and Gynecology

Cited by 3 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. When to remove a lumen-apposing metal stent for pancreatic fluid collections?;Endoscopy International Open;2024-08

2. The i-EUS consensus on the management of pancreatic fluid collections – Part 1;Digestive and Liver Disease;2024-07

3. Reply to Saito et al;Endoscopy International Open;2024-05

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