PT  - JOURNAL ARTICLE
AU  - Lotte Boxhoorn
AU  - Robert C Verdonk
AU  - Marc G Besselink
AU  - Marja Boermeester
AU  - Thomas L Bollen
AU  - Stefan AW Bouwense
AU  - Vincent C Cappendijk
AU  - Wouter L Curvers
AU  - Cornelis H Dejong
AU  - Sven M van Dijk
AU  - Hendrik M van Dullemen
AU  - Casper HJ van Eijck
AU  - Erwin JM van Geenen
AU  - Muhammed Hadithi
AU  - Wouter L Hazen
AU  - Pieter Honkoop
AU  - Jeanin E van Hooft
AU  - Maarten AJM Jacobs
AU  - June EC Kievits
AU  - Marnix PM Kop
AU  - Eva Kouw
AU  - Sjoerd D Kuiken
AU  - Michiel Ledeboer
AU  - Vincent B Nieuwenhuijs
AU  - Lars E Perk
AU  - Jan-Werner Poley
AU  - Rutger Quispel
AU  - Rogier JJ de Ridder
AU  - Hjalmar C van Santvoort
AU  - Christina J Sperna Weiland
AU  - Martijn WJ Stommel
AU  - Hester C Timmerhuis
AU  - Ben J Witteman
AU  - Devica S Umans
AU  - Niels G Venneman
AU  - Frank P Vleggaar
AU  - Roy LJ van Wanrooij
AU  - Marco J Bruno
AU  - Paul Fockens
AU  - Rogier P Voermans
ED  - ,
TI  - Comparison of lumen-apposing metal stents versus double-pigtail plastic stents for infected necrotising pancreatitis
AID  - 10.1136/gutjnl-2021-325632
DP  - 2023 Jan 01
TA  - Gut
PG  - 66--72
VI  - 72
IP  - 1
4099  - http://gut.bmj.com/content/72/1/66.short
4100  - http://gut.bmj.com/content/72/1/66.full
SO  - Gut2023 Jan 01; 72
AB  - Objective Lumen-apposing metal stents (LAMS) are believed to clinically improve endoscopic transluminal drainage of infected necrosis when compared with double-pigtail plastic stents. However, comparative data from prospective studies are very limited.Design Patients with infected necrotising pancreatitis, who underwent an endoscopic step-up approach with LAMS within a multicentre prospective cohort study were compared with the data of 51 patients in the randomised TENSION trial who had been assigned to the endoscopic step-up approach with double-pigtail plastic stents. The clinical study protocol was otherwise identical for both groups. Primary end point was the need for endoscopic transluminal necrosectomy. Secondary end points included mortality, major complications, hospital stay and healthcare costs.Results A total of 53 patients were treated with LAMS in 16 hospitals during 27 months. The need for endoscopic transluminal necrosectomy was 64% (n=34) and was not different from the previous trial using plastic stents (53%, n=27)), also after correction for baseline characteristics (OR 1.21 (95% CI 0.45 to 3.23)). Secondary end points did not differ between groups either, which also included bleeding requiring intervention—5 patients (9%) after LAMS placement vs 11 patients (22%) after placement of plastic stents (relative risk 0.44; 95% CI 0.16 to 1.17). Total healthcare costs were also comparable (mean difference −€6348, bias-corrected and accelerated 95% CI −€26 386 to €10 121).Conclusion Our comparison of two patient groups from two multicentre prospective studies with a similar design suggests that LAMS do not reduce the need for endoscopic transluminal necrosectomy when compared with double-pigtail plastic stents in patients with infected necrotising pancreatitis. Also, the rate of bleeding complications was comparable.Data are available on reasonable request. Request for data can be made to the corresponding author (r.p.voermans@amsterdamumc.nl) and will first be discussed during a meeting of the Dutch Pancreatitis Study Group.