Large-caliber metal stents versus plastic stents for the management of pancreatic walled-off necrosis

Barham K. Abu Dayyeh, Saurabh Mukewar, Shounak Majumder, Raja Zaghlol, Eric J. Vargas Valls, Fateh Bazerbachi, Michael J. Levy, Todd H. Baron, Christopher J. Gostout, Bret Thomas Petersen, John Martin, Ferga C. Gleeson, Randall K. Pearson, Suresh T Chari, Santhi Swaroop Vege, Mark Topazian

Research output: Contribution to journalArticle

16 Scopus citations

Abstract

Background and Aims: Symptomatic pancreatic walled-off necrosis (WON) may be managed by endoscopic transmural drainage and endoscopic transmural necrosectomy, with stent placement at endoscopic drainage sites. The optimal stent choice is yet to be determined. We compared outcomes after endoscopic management of WON using either large-caliber fully covered self-expandable metal stents (LC-SEMSs) or double-pigtail plastic stents (DPPSs). Methods: We performed a retrospective comparison of outcomes among patients who received LC-SEMSs or DPPSs before endoscopic transmural necrosectomy for WON. Results: Among 94 patients included, WON resolution rates did not differ between the DPPS (36 patients) and LC-SEMS (58 patients) groups, whether concomitant percutaneous drainage was considered a failure (75% vs 82.8%; P = .36) or not (91.7% vs 94.8%; P = .55). Of 75 patients (80%) successfully treated without percutaneous drainage, 37 (49%) underwent endoscopic transmural drainage without subsequent endoscopic transmural necrosectomy. WON was more likely to resolve without subsequent endoscopic transmural necrosectomy in the LC-SEMS group than the DPPS group (60.4% vs 30.8%; P = .01). WON resolution without subsequent endoscopic transmural necrosectomy remained more likely with LC-SEMSs (odds ratio, 4.5 [95% confidence interval, 1.5-15.5]) after adjusting for patient age and size and location of WON. Rates of adverse events were similar except for clinically significant bleeding requiring endoscopic intervention, which was higher with DPPSs than LC-SEMSs (14% vs 2%; P = .02). Conclusion: Management of pancreatic WON with LC-SEMSs appears to decrease both the need for repeated necrosectomy procedures and the risk of intervention-related hemorrhage.

Original languageEnglish (US)
JournalGastrointestinal Endoscopy
DOIs
StateAccepted/In press - Dec 15 2016

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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    Abu Dayyeh, B. K., Mukewar, S., Majumder, S., Zaghlol, R., Vargas Valls, E. J., Bazerbachi, F., Levy, M. J., Baron, T. H., Gostout, C. J., Petersen, B. T., Martin, J., Gleeson, F. C., Pearson, R. K., Chari, S. T., Vege, S. S., & Topazian, M. (Accepted/In press). Large-caliber metal stents versus plastic stents for the management of pancreatic walled-off necrosis. Gastrointestinal Endoscopy. https://doi.org/10.1016/j.gie.2017.04.032