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The safety and efficacy of a new 20-mm lumen apposing metal stent (lams) for the endoscopic treatment of pancreatic and peripancreatic fluid collections: a large international, multicenter study

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  • Andrea Anderloni, IRCCS Istituto Clinico Humanitas - Rozzano (Milano)
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  • Carlo Fabbri, Forlì-Cesena Hospitals
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  • Jose Nieto, Borland-Groover Clinic
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  • Will Uwe, Municipal Hospital
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  • Markus Dollhopf, Klinikum Bogenhausen
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  • José Ramón Aparicio, University of Alicante
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  • Manuel Perez-Miranda, Hospital Universitario Río Hortega
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  • Ilaria Tarantino, IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT) - Palermo
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  • Alexander Arlt, Kiel University
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  • Frank Vleggaar, Utrecht University
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  • Geoffrey Vanbiervliet, CHU de Nice
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  • Jochen Hampe, Faculty of Medicine and University Hospital Carl Gustav Carus
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  • Michel Kahaleh, Cornell University
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  • Juan J. Vila, Hospital Virgen del Camino
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  • Barham K.Abu Dayyeh, Mayo Clinic Rochester, MN
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  • Andrew C. Storm, Mayo Clinic Rochester, MN
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  • Alessandro Fugazza, IRCCS Istituto Clinico Humanitas - Rozzano (Milano)
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  • Cecilia Binda, Forlì-Cesena Hospitals
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  • Antoine Charachon, CH Princesse Grace
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  • Sergio Sevilla-Ribota, Hospital Universitario Río Hortega
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  • Amy Tyberg, Cornell University
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  • Moran Robert, Johns Hopkins University
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  • Sachin Wani, University of Colorado Anschutz Medical Campus
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  • Alessandro Repici, IRCCS Istituto Clinico Humanitas - Rozzano (Milano), Humanitas University
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  • Amrita Sethi, Columbia University
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  • Mouen A. Khashab, Johns Hopkins University
  • ,
  • Rastislav Kunda, Vrije Universiteit Brussel

Background: Lumen apposing metal stent (LAMS) allows an easy access to peripancreatic fluid collections (PPFCs) and the possibility of performing direct endoscopic necrosectomy (DEN). The aim of our study was to evaluate the safety and efficacy of a new 20-mm LAMS in the management of PPFCs. This novel stent represents the largest diameter LAMS available on the market to date. Methods: This is an international, multicenter retrospective study involving 20 centers. Consecutive patients who underwent EUS-guided PPFC drainage using a 20-mm LAMS were included. Primary outcomes were technical and clinical success. Secondary outcomes were rate and the severity of adverse events. Results: A total 105 patients underwent PPFC drainage using the new 20-mm LAMS and 106 LAMS were placed. Technical success was 100% (106/106). 7/105 patients died due to causes not related to the stent. Clinical success was achieved in 92/98 patients (93.9%). Significant adverse events occurred in 8/98 patients (8.16%): 4 cases (4.08%) of bleeding, 3 cases (3.06%) of suprainfection, 1 case of gastric outlet obstruction. Conclusions: This multicenter study demonstrated acceptable rates of technical and clinical success using a new 20-mm LAMS for PPFC, including walled-off pancreatic necrosis (WOPN). The results of our study suggest that a new 20-mm LAMS is non-inferior in terms of safety, efficacy, and adverse events as compared to smaller diameter LAMS in the management of PPFCs, including pancreatic psuedocysts (PP) and WOPN. Randomized controlled studies will be needed to determine the ideal size of LAMS need to achieve the greatest clinical benefit with the minimized risk exposure for this high-risk patient population.

Original languageEnglish
JournalSurgical Endoscopy
Volume35
Issue4
Pages (from-to)1741-1748
Number of pages8
ISSN0930-2794
DOIs
Publication statusPublished - Apr 2021

Bibliographical note

Publisher Copyright:
© 2020, Springer Science+Business Media, LLC, part of Springer Nature.

Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.

    Research areas

  • EUS-guided drainage, Lumen apposing metal stent, Pancreatic fluid collection, Walled-off pancreatic necrosis

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