Endoscopy 2020; 52(03): 211-219
DOI: 10.1055/a-1096-3299
Original article

Endoscopic ultrasound-guided drainage of pancreatic walled-off necrosis using 20-mm versus 15-mm lumen-apposing metal stents: an international, multicenter, case-matched study

Nasim Parsa
 1   University of Missouri Health System, Columbia, Missouri, United States
,
Jose M. Nieto
 2   Borland Groover Clinic, Jacksonville, Florida, United States
,
Patrick Powers
 3   University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, Utah, United States
,
Shuji Mitsuhashi
 4   Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
,
Abdelhai Abdelqader
 5   West Virginia University Hospital, Morgantown, West Virginia, United States
,
George Hadzinakos
 6   St James’s University Hospital, Leeds, United Kingdom
,
Andrea A. Anderloni
 7   Digestive Endoscopy Unit, Humanitas Research Hospital, Rozzano, Italy
,
Alessandro Fugazza
 7   Digestive Endoscopy Unit, Humanitas Research Hospital, Rozzano, Italy
,
Theodore W. James
 8   University of North Carolina, Chapel Hill, North Carolina, United States
,
Alexander Arlt
 9   University of Kiel, Kiel, Germany
,
Mark Ellrichmann
 9   University of Kiel, Kiel, Germany
,
Jose Ramon Aparicio
10   Hospital General Universitario de Alicante, Alicante, Spain
,
Arvind J. Trindade
11   Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, New York, New York, United States
,
Tyler K. Stevens
12   Cleveland Clinic Foundation, Cleveland, Ohio, United States
,
Prabhleen Chahal
12   Cleveland Clinic Foundation, Cleveland, Ohio, United States
,
Shawn L. Shah
13   New York-Presbyterian/Weill Cornell Medical Center, New York, New York, United States
,
Ahmed A. Messallam
14   Emory University School of Medicine, Atlanta, Georgia, United States
,
Gabriel Lang
15   Washington University School of Medicine, St Louis, Missouri, United States
,
M. Phillip Fejleh
16   UCLA Medical Center, Los Angeles, California, United States
,
Petros C. Benias
11   Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, New York, New York, United States
,
Divyesh V. Sejpal
11   Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, New York, New York, United States
,
Jason Jones
17   Wake Forest Baptist Medical Center, Winston Salem, North Carolina, United States
,
Fahad Faisal Mir
18   Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
,
Mohamad Aghaie Meybodi
19   Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Yervant Ichkhanian
19   Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Kia Vosoughi
19   Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Aleksey A. Novikov
 4   Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
,
Shayan S. Irani
20   Virginia Mason Medical Center, Seattle, Washington, United States
,
Rishi Pawa
17   Wake Forest Baptist Medical Center, Winston Salem, North Carolina, United States
,
Ali M. Ahmed
21   University of Alabama, Birmingham, Alabama, United States
,
Alireza Sedarat
16   UCLA Medical Center, Los Angeles, California, United States
,
William Hsueh
 5   West Virginia University Hospital, Morgantown, West Virginia, United States
,
Jochen Hampe
22   University Hospital Carl Gustav Carus Dresden, Dresden, Germany
,
Reem Z. Sharaiha
13   New York-Presbyterian/Weill Cornell Medical Center, New York, New York, United States
,
Tyler M. Berzin
18   Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
,
Field F. Willingham
14   Emory University School of Medicine, Atlanta, Georgia, United States
,
Vladimir M. Kushnir
15   Washington University School of Medicine, St Louis, Missouri, United States
,
Olaya I. Brewer Gutierrez
19   Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Saowanee Ngamruengphong
19   Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Matthew T. Huggett
 6   St James’s University Hospital, Leeds, United Kingdom
,
Todd H. Baron
 8   University of North Carolina, Chapel Hill, North Carolina, United States
,
Alessandro Repici
 7   Digestive Endoscopy Unit, Humanitas Research Hospital, Rozzano, Italy
,
Douglas G. Adler
 3   University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, Utah, United States
,
John T. Nasr
 5   West Virginia University Hospital, Morgantown, West Virginia, United States
,
Thomas E. Kowalski
 4   Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
,
Vivek Kumbhari
19   Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Vikesh K. Singh
19   Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Mouen A. Khashab
19   Johns Hopkins Hospital, Baltimore, Maryland, United States
› Author Affiliations
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Abstract

Backgrounds Endoscopic ultrasound (EUS)-guided placement of lumen-apposing metal stents (LAMSs) has gained popularity for the treatment of pancreatic walled-off necrosis (WON). We compared the 20-mm and 15-mm LAMSs for the treatment of symptomatic WON in terms of clinical success and adverse events.

Methods We conducted a retrospective, case-matched study of 306 adults at 22 tertiary centers from 04/2014 to 10/2018. A total of 102 patients with symptomatic WON who underwent drainage with 20-mm LAMS (cases) and 204 patients who underwent drainage with 15-mm LAMS (controls) were matched by age, sex, and drainage approach. Conditional logistic regression analysis was performed to compare clinical success (resolution of WON on follow-up imaging without reintervention) and adverse events (according to American Society for Gastrointestinal Endoscopy criteria).

Results Clinical success was achieved in 92.2 % of patients with 20-mm LAMS and 91.7 % of patients with 15-mm LAMS (odds ratio 0.92; P = 0.91). Patients with 20-mm LAMS underwent fewer direct endoscopic necrosectomy (DEN) sessions (mean 1.3 vs. 2.1; P < 0.001), despite having larger WON collections (transverse axis 118.2 vs. 101.9 mm, P = 0.003; anteroposterior axis 95.9 vs. 80.1 mm, P = 0.01). There was no difference in overall adverse events (21.6 % vs. 15.2 %; P = 0.72) and bleeding events (4.9 % vs. 3.4 %; P = 0.54) between the 20-mm and 15-mm LAMS groups, respectively.

Conclusions The 20-mm LAMS showed comparable clinical success and safety profile to the 15-mm LAMS, with the need for fewer DEN sessions for WON resolution.

Table 1s – 3s



Publication History

Received: 31 March 2019

Accepted: 02 December 2019

Article published online:
30 January 2020

© Georg Thieme Verlag KG
Stuttgart · New York