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

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.

Endoscopic ultrasound-guided gastroenterostomy using large-diameter (20 mm) lumen apposing metal stent (LLAMS)

“…We assume the larger diameter of the LLAMS allows for tolerance of regular consistency solid diet, and is less likely to become obstructed by residual food particles and tissue ingrowth within the stent 18 . The larger luminal diameter of the 20-mm LAMS provides approximately 300 % and 78 % greater cross-sectional area compared with the 10-mm and 15-mm LAMSs, respectively, which has been found to be beneficial for drainage of large walled-off necrosis 19 20 and EUS-directed transgastric ERCP (EDGE) 19 23 .…”

Endoscopic Management of Pancreatic Fluid Collections

“…Parsa et al compared the effectiveness of 20 mm vs. 15 mm LAMSs for WOPN. They demonstrated that 20 mm LAMSs had similar clinical success and adverse event rates as compared to 15 mm LAMSs; however, fewer endoscopic necrosectomies were needed for WOPN resolution [36]. In conclusion, both diameter stents are safe and effective for WOPN; however, collections with extensive necrosis may benefit from the placement of larger diameter stents.…”

The role of endoscopic therapy in the minimally invasive management of pancreatic necrosis

“…These devices have undergone further refinements including greater saddle length (15 mm) to access collections at a distance of > 10 mm from the gastrointestinal lumen and a wider saddle lumen diameter (15 to 20 mm) to permit both passage of larger endoscopes for debridement and egress of WON contents during and in between endoscopic treatment sessions. These refinements show promise in diminishing the number of endoscopic sessions required for endoscopic therapy of WON [31]. Perhaps the most important refinement to this platform The Korean Journal of Internal Medicine Vol.…”