Multicenter Study of the Efficacy and Safety of Electrocautery-Enhanced Lumen-Apposing Metal Stents for the Internal Drainage of Pancreatic Fluid Collections

Abstract

Abstract Pancreatic fluid collections (PFCs) including pancreatic pseudocyst (PP) and walled-off necrosis (WON) are complications after pancreatitis. We aimed to evaluate the efficacy and safety of endoscopic ultrasound (EUS)-guided lumen-apposing metal stent (LAMS) placement to manage PFCs. Between June 2019 and May 2023, patients with symptomatic PFCs who underwent EUS-guided electrocautery-enhanced LAMS drainage were enrolled retrospectively from eight tertiary centers in Taiwan. In total, 33 [14 (42.42%) PP and 19 (57.58%) WON] patients were enrolled. Gallstones (27.27%) and abdominal pain (72.73%) were the most common etiology and indication for drainage. The technical and clinical success rates were 100% and 96.97%, respectively. The mean procedure time of 30.55 (±16.17) minutes. Complications included one (3.03%) case of self-limited bleeding without mortality. There were seven (21.21%) patients with recurrence. Patients with disconnected pancreatic duct syndrome (DPDS) had a higher recurrence rate than those without (71.43% vs. 38.46%, p=0.05). After replacing LAMSs with transmural double-pigtail plastic stents (DPSs) in the DPDS patients, the DPS migration rate was higher in the patients with recurrence (100% vs. 33.33%, p=0.04). In conclusion, drainage of symptomatic PFCs with EUS-guided electrocautery-enhanced LAMS is efficient and safe. Replacing LAMS with DPS in DPDS patients was associated with a lower recurrence rate.