Lumen-apposing metal stents do not decrease need for endoscopic necrosectomy

ByMonica Stonehill

Lumen-apposing metal stents for endoscopic drainage were not superior to double-pigtail plastic stents in reducing the need for endoscopic necrosectomy, according to a presenter at the ESGE Days.

“The lumen-apposing metal stents did not reduce the need for endoscopic necrosectomy when compared with double-pigtail plastic stents in patients with necrotizing pancreatitis,” Lotte Boxhoorn, MD, PhD candidate from gastroenterology and hepatology Amsterdam University Medical Center, in the Netherlands, said during the presentation. “In addition, [there was] no increased risk of complications, in particular bleed.”

In the TENSION trial, Boxhoorn and colleagues identified 53 patients infected with necrotizing pancreatitis eligible for endoscopic drainage with lumen-apposing metal stents (LAMS) and prospectively enrolled and compared them against 51 patients assigned to the endoscopic step-up approach with double-pigtail plastic stents (DPS). The need for endoscopic necrosectomy served as the primary endpoint. Other endpoints included mortality, major complications, total number of interventions, length of intensive care and hospital stay during 6 months of follow-up.

Investigators reported the LAMS group and DPS group did not differ regarding the primary endpoint (64% vs. 57%; RR = 1.13; 95% CI, 0.83-1.54). After they corrected for age, sex, systemic inflammatory response syndrome, C-reactive protein and antibiotic use, the odds of endoscopic necrosectomy were 1.14 (95%CI, 0.44-2.9).

Study results showed no differences in mortality (11% vs. 18%; RR = 0.64; 95%CI, 0.25-1.67) or major complications. Investigators reported bleeding in 9% of patients in the LAMS group and 22% in the DPS-group (RR = 0.44; 95%CI, 0.16-1.17).

Length of extensive care stay was equal (median 0 days vs. 0 days)and there was no significant difference in hospital stay (median 34 days vs. median 35). The median number of drainage procedures in both the LAMS and DPS-group was 1. Median number of necrosectomy was also 1 in both groups.

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Source:

Boxhoorn L, et al. Abstract OP2. Presented at: ESGE Days (virtual), Mar. 25-17, 2020.

Disclosures: The study received financial support from Boston Scientific International BV, and the Amsterdam University Medical Center.

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Lumen-apposing metal stents do not decrease need for endoscopic necrosectomy

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