RT Journal Article
SR Electronic
T1 Comparison of lumen-apposing metal stents versus double-pigtail plastic stents for infected necrotising pancreatitis
JF Gut
JO Gut
FD BMJ Publishing Group Ltd and British Society of Gastroenterology
SP 66
OP 72
DO 10.1136/gutjnl-2021-325632
VO 72
IS 1
A1 Lotte Boxhoorn
A1 Robert C Verdonk
A1 Marc G Besselink
A1 Marja Boermeester
A1 Thomas L Bollen
A1 Stefan AW Bouwense
A1 Vincent C Cappendijk
A1 Wouter L Curvers
A1 Cornelis H Dejong
A1 Sven M van Dijk
A1 Hendrik M van Dullemen
A1 Casper HJ van Eijck
A1 Erwin JM van Geenen
A1 Muhammed Hadithi
A1 Wouter L Hazen
A1 Pieter Honkoop
A1 Jeanin E van Hooft
A1 Maarten AJM Jacobs
A1 June EC Kievits
A1 Marnix PM Kop
A1 Eva Kouw
A1 Sjoerd D Kuiken
A1 Michiel Ledeboer
A1 Vincent B Nieuwenhuijs
A1 Lars E Perk
A1 Jan-Werner Poley
A1 Rutger Quispel
A1 Rogier JJ de Ridder
A1 Hjalmar C van Santvoort
A1 Christina J Sperna Weiland
A1 Martijn WJ Stommel
A1 Hester C Timmerhuis
A1 Ben J Witteman
A1 Devica S Umans
A1 Niels G Venneman
A1 Frank P Vleggaar
A1 Roy LJ van Wanrooij
A1 Marco J Bruno
A1 Paul Fockens
A1 Rogier P Voermans
A1 ,
YR 2023
UL http://gut.bmj.com/content/72/1/66.abstract
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.