Timing of lumen-apposing metal stents removal in pancreatic fluid collections: Could we go beyond?

IF 2.8 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pancreatology Pub Date : 2024-10-28 DOI:10.1016/j.pan.2024.10.011

S Stigliano, G Marocchi, F Baldaro, B Neri, G Del Vecchio Blanco, E Troncone, F M Di Matteo

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Abstract

Background and aims: Lumen-apposing metal stents (LAMS) are the mainstay treatment for pancreatic fluid collections (PFC). A 4-weeks interval for LAMS removal has been suggested to avoid adverse events (AEs). Primary aim is to evaluate the AEs rate in patients with LAMS removal <4 and >4 weeks from placement and possible associated factors.

Methods: Retrospective study on patients underwent EUS-guided drainage of PFC with LAMS at two Italian centers between January 2017 and November 2023. PFC and LAMS features were collected. AEs were defined as bleeding, obstruction and buried LAMS.

Results: 108 patients were enrolled (62.9 % males; mean age 61 ± 14 years old). In 38 % PFC was in pancreatic head. In 64.8 % of patients LAMS ≥15 mm was used. Mean time of LAMS indwelling was 71 ± 87 days and in 73.1 % of patients the LAMS was removed after 4 weeks. AE occurred in 8.3 % of patients and the most common (77.8 %) was bleeding. There was no association between LAMS indwelling >4 weeks (8/9 vs 65/93 p = 0.44) and the rate of AE. A comparable mean time of LAMS persistence (108 ± 96 vs 67 ± 86 p = 0.18) between patients with and without AE was observed. PFC in the head (7/9 vs 33/93 p = 0.02) and LAMS ≥15 mm (9/9 vs 58/93 p = 0.03) were associated with a higher rate of AE.

Conclusion: When needed, LAMS removal >4 weeks appears to be as safe as LAMS removal within 4 weeks. LAMS ≥15 mm and Head location were associated with higher rate of AE and thus should arouse more caution.

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胰腺积液中腔镜金属支架的取出时机：我们还能超越吗？

背景和目的：腔隙贴合金属支架（LAMS）是治疗胰腺积液（PFC）的主要方法。为避免不良事件（AEs），有人建议间隔 4 周拆除 LAMS。该研究的主要目的是评估在放置 LAMS 4 周后移除 LAMS 的患者的 AEs 发生率以及可能的相关因素：回顾性研究：2017 年 1 月至 2023 年 11 月期间，在两个意大利中心接受 EUS 引导引流 PFC 和 LAMS 的患者。收集了 PFC 和 LAMS 的特征。AEs定义为出血、梗阻和LAMS埋藏：108名患者（62.9%为男性；平均年龄为61±14岁）接受了治疗。38% 的 PFC 位于胰腺头部。64.8%的患者使用了≥15毫米的LAMS。LAMS 的平均留置时间为 71 ± 87 天，73.1% 的患者在 4 周后移除 LAMS。8.3%的患者发生了 AE，其中最常见（77.8%）的是出血。LAMS留置时间超过4周（8/9 vs 65/93 p = 0.44）与AE发生率之间没有关联。观察发现，有 AE 和无 AE 患者的 LAMS 平均持续时间相当（108 ± 96 vs 67 ± 86 p = 0.18）。头部 PFC（7/9 vs 33/93 p = 0.02）和 LAMS ≥15 mm（9/9 vs 58/93 p = 0.03）与较高的 AE 发生率相关：结论：在必要时，LAMS >4周切除与LAMS 4周内切除同样安全。LAMS≥15毫米和头部位置与较高的AE相关，因此应更加谨慎。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pancreatology 医学-胃肠肝病学

CiteScore

7.20

自引率

5.60%

发文量

194

审稿时长

44 days

期刊介绍： Pancreatology is the official journal of the International Association of Pancreatology (IAP), the European Pancreatic Club (EPC) and several national societies and study groups around the world. Dedicated to the understanding and treatment of exocrine as well as endocrine pancreatic disease, this multidisciplinary periodical publishes original basic, translational and clinical pancreatic research from a range of fields including gastroenterology, oncology, surgery, pharmacology, cellular and molecular biology as well as endocrinology, immunology and epidemiology. Readers can expect to gain new insights into pancreatic physiology and into the pathogenesis, diagnosis, therapeutic approaches and prognosis of pancreatic diseases. The journal features original articles, case reports, consensus guidelines and topical, cutting edge reviews, thus representing a source of valuable, novel information for clinical and basic researchers alike.