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

N. Parsa
J. M. Nieto
P. Powers
S. Mitsuhashi
A. Abdelqader
G. Hadzinakos
A. A. Anderloni
A. Fugazza
T. W. James
A. Arlt
M. Ellrichmann
J. R. Aparicio
A. J. Trindade, Zucker School of Medicine at Hofstra/Northwell
T. K. Stevens
P. Chahal
S. L. Shah
A. A. Messallam
P. C. Benias, Zucker School of Medicine at Hofstra/Northwell
D. V. Sejpal, Zucker School of Medicine at Hofstra/Northwell
M. A. Khashab

Abstract

© 2020 Royal Society of Chemistry. All rights reserved. Backgrounds â 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 â 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 â Clinical success was achieved in 92.2âŠ% of patients with 20-mm LAMS and 91.7âŠ% of patients with 15-mm LAMS (odds ratio 0.92; P âŠ=âŠ0.91). Patients with 20-mm LAMS underwent fewer direct endoscopic necrosectomy (DEN) sessions (mean 1.3 vs. 2.1; P âŠ<âŠ0.001), despite having larger WON collections (transverse axis 118.2 vs. 101.9âŠmm, P âŠ=âŠ0.003; anteroposterior axis 95.9 vs. 80.1âŠmm, P âŠ=âŠ0.01). There was no difference in overall adverse events (21.6âŠ% vs. 15.2âŠ%; P âŠ=âŠ0.72) and bleeding events (4.9âŠ% vs. 3.4âŠ%; P âŠ=âŠ0.54) between the 20-mm and 15-mm LAMS groups, respectively. Conclusions â 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.