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CC BY 4.0 · Endoscopy
DOI: 10.1055/a-2569-7056
Original article

Proton pump inhibitors are associated with occlusion of lumen-apposing metal stents and higher frequency of endoscopic necrosectomies – A European-wide multicenter cohort study

Jacob Hamm
1   Gastroenterology, Gastrointestinal Oncology, Endocrinology, University Medical Center Göttingen, Gottingen, Germany (Ringgold ID: RIN27177)
,
Alzbeta Busana
1   Gastroenterology, Gastrointestinal Oncology, Endocrinology, University Medical Center Göttingen, Gottingen, Germany (Ringgold ID: RIN27177)
,
Ahmad Amanzada
1   Gastroenterology, Gastrointestinal Oncology, Endocrinology, University Medical Center Göttingen, Gottingen, Germany (Ringgold ID: RIN27177)
,
Alexander Arlt
2   Department of Gastroenterology, University Hospital Oldenburg, Oldenburg, Germany
3   Department of Gastroenterology, Israelitisches Krankenhaus Hamburg, Hamburg, Germany (Ringgold ID: RIN139257)
,
Thomas Asendorf
4   Department of Medical Statistics, University Medical Center Göttingen, Gottingen, Germany (Ringgold ID: RIN27177)
,
Samantha Carswell
5   HPB and Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, Newcastle Upon Tyne, United Kingdom of Great Britain and Northern Ireland
,
Ulrike Denzer
6   Department of Gastroenterology, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany (Ringgold ID: RIN61061)
,
Louis Elsing
7   Department of Oncology, Gastroenterology, Hepatology and Pneumology, University Hospital Leipzig, Leipzig, Germany (Ringgold ID: RIN39066)
,
Fabian Frost
8   Department of Medicine A, University Medicine Greifswald, Greifswald, Germany (Ringgold ID: RIN60634)
,
Lucía Guilabert 
9   Department of Gastroenterology, Hospital General Universitario de Alicante, Alicante, Spain (Ringgold ID: RIN16802)
,
Karim Hamesch 
10   Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
,
Marcus Hollenbach
6   Department of Gastroenterology, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany (Ringgold ID: RIN61061)
11   Department of Gastroenterology, University Hospital Heidelberg, Heidelberg, Germany (Ringgold ID: RIN27178)
,
Péter Hegyi
12   Institute for Translational Medicine, University of Pécs, Medical School, Pécs, Hungary
13   Institute of Pancreatic Diseases and Centre for Translational Medicine, Semmelweis University, Budapest, Hungary (Ringgold ID: RIN37637)
,
Alexander Kleger
14   Institute of Molecular Oncology and Stem Cell Biology, Universitatsklinikum Ulm, Ulm, Germany (Ringgold ID: RIN27197)
15   Division of Interdisciplinary Pancreatology, Department of Internal Medicine I, University Hospital Ulm, Ulm, Germany
,
Jan Krivinka
16   Department of Oncology, Palacky University Olomouc, Olomouc, Czech Republic (Ringgold ID: RIN48207)
,
Lumir Kunovsky 
17   Department Surgery, Masaryk University, Brno, Czech Republic (Ringgold ID: RIN37748)
16   Department of Oncology, Palacky University Olomouc, Olomouc, Czech Republic (Ringgold ID: RIN48207)
18   Department of Gastroenterology and Digestive Endoscopy, Masaryk University, Brno, Czech Republic (Ringgold ID: RIN37748)
,
Christian Meinhardt
2   Department of Gastroenterology, University Hospital Oldenburg, Oldenburg, Germany
,
Veit Phillip
19   Clinical Department for Internal Medicine II, Technical University of Munich, TUM School of Medicine and Health, Munchen, Germany
,
Sophie Schlosser-Hupf
20   Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital Regensburg, Regensburg, Germany
,
Simon Sirtl 
21   Department of Medicine II, University Hospital LMU Munich, Munich, Germany
,
Lukas Welsch
22   Department of Gastroenterology, Diabetology and Infectiology, Klinikum Hanau gGmbH, Hanau, Germany (Ringgold ID: RIN39790)
,
Julian Cardinal von Widdern
23   Department of Internal Medicine I, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
,
Albrecht Neesse
1   Gastroenterology, Gastrointestinal Oncology, Endocrinology, University Medical Center Göttingen, Gottingen, Germany (Ringgold ID: RIN27177)
,
Christoph Ammer-Herrmenau 
1   Gastroenterology, Gastrointestinal Oncology, Endocrinology, University Medical Center Göttingen, Gottingen, Germany (Ringgold ID: RIN27177)
› Author Affiliations Clinical Trial: Registration number (trial ID): NCT05817721, Trial registry: ClinicalTrials.gov (http://www.clinicaltrials.gov/), Type of Study: Retrospective multicenter cohort study
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Background: Lumen apposing metal stents (LAMS) are widely used to drain walled-off necrosis (WON). LAMS occlusion is considered a significant clinical problem and identification of risk factors for LAMS occlusion could contribute to novel preventive strategies. A previous study suggested contradictory effects of proton pump inhibitor (PPI) intake on the occlusion and necrosectomy rate. Methods: We conducted a European-wide multicenter retrospective cohort study assessing WONs drained by LAMS. Primary aims were to assess the strength of an association between PPI intake and LAMS occlusion and necrosectomies rates. The secondary aim was to assess the strength of an association between PPI intake and other LAMS-associated complications. Multiple mixed effects models were used to control for possible confounding covariates. Results: 893 patients with 967 LAMS from 17 centers were included retrospectively. After exclusion of 10 incomplete datasets and patients who took PPIs intermittently, 768 LAMS remained. Overall occlusion rate was 27.9%. Most occlusion events occurred within 10 days. Most patients received PPIs continuously (continuous intake (cPPI) n = 577, no intake (nPPI) n = 191). In patients who did not use PPIs continuously, lower LAMS occlusion (OR 0.61, p 0.039*) and necrosectomy rates were observed (IRR 0.8, p 0.006**). A post-hoc analysis exhibited a dose- and compound-dependent effect of PPI-intake on necrosectomy rate. We did not observe any increase in other complications in the nPPI group such as bleeding events (OR 0.88, p 0.9). Conclusion: Intake of PPIs upon LAMS placement is associated with a higher LAMS occlusion and necrosectomy rate.



Publication History

Received: 07 July 2024

Accepted after revision: 25 February 2025

Accepted Manuscript online:
31 March 2025

© . The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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