Safety and Efficacy of EUS-Guided Drainage of Pancreatic Fluid Collection Using LAMS

Researchers sought to confirm the good safety and efficacy profile of using LAMS in EUS-guided drainage for pancreatic fluid collection in a real-world setting.

Endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collection (PFC) by positioning luminal-apposing metal stents (LAMS) was safe and effective in a real-world setting, according to study results published in Gut.

For the analysis, researchers conducted a multicenter retrospective review, analyzing patient records included in the Italian nationwide EUS registry. Patients who underwent treatment for PFC at 30 centers between 2016 and 2020 were evaluated for efficacy outcomes and risk factors for adverse events.

Patients (N=516) had a mean age of 61.64±15.16 years, 68% were men, 52.1% had walled-off necrosis, and 47.9% pseudocyst. The indications for drainage were primarily due to infection (40.1%) and abdominal pain (32%). During the procedure, 40.3% underwent necrosectomy and 3.7% needed percutaneous drainage.

Technical success of the procedure was achieved by 96.9% of patients and clinical success by 91.7%. Stratified by walled-off necrosis and pseudocyst status, no significant differences in efficacy were observed.

For adverse events, 14.7% experienced an adverse event, the most common of which was bleeding (5.6%). The events were mild (4.7%), moderate (6.3%), severe (2.6%), and fatal (1.1%). A total of 35 patients had a collection recurrence and 56 died. As with the efficacy endpoints, the patients with walled-off necrosis or pseudocyst had similar safety outcomes.

Risk for experiencing an adverse event was associated with number of stents used (odds ratio [OR], 3; 95% CI, 1.28-5.24; P =.05), pseudoaneurysm (OR, 2.99; 95% CI, 1.75-11.93; P =.002), center experience (OR, 2.95; 95% CI, 1.48-5.90; P =.002), abnormal peri-gastric varices (OR, 2.90; 95% CI, 1.31-6.42; P =.008), need for combined percutaneous drainage (OR, 2.81; 95% CI, 1.03-7.65; P =.04), main pancreatic duct complete disruption (OR, 2.61; 95% CI, 1.53-4.45; P =.01), and main pancreatic duct leak (OR, 2.51; 95% CI, 1.06-5.97; P =.03).

The average time to stent removal was 50.3±64.92 days. In a subgroup analysis among a propensity-matched subset, the patients with early (<4 weeks) or late (>4 weeks) LAMS removal had similar rates of adverse events (5% vs 10%; P =.19) and recurrence (8% vs 3%; P =.17), respectively.

The study may have included heterogeneity, given that endoscopies were performed by different endoscopists at multiple centers.

“…[O]ur study contributes to the definition of an important topic such as the management of PFCs, showing good results in terms of safety and efficacy in a real-life setting, pointing out some predictive factors of [adverse events] and assuming that the removal time of LAMS may not have to be considered as a rigid assumption,” the study authors noted. “Further studies are needed to adequately define the right protocols for the best endoscopic treatment of PFCs drainage.”

Reference

Amato A, Tarantino I, Facciorusso A, et al. Real-life multicentre study of lumen-apposing metal stent for EUS-guided drainage of pancreatic fluid collections. Gut. Published online February 22, 2022. doi:10.1136/gutjnl-2022-326880