Coaxial plastic stents do not affect outcomes in endoscopic drainage of pancreatic fluid
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Key takeaways:
- Success rates were similar between patients who had coaxial double pigtail plastic stent placement for drainage of pancreatic fluid and those who did not.
- Adverse events also were comparable between groups.
The placement of a coaxial double pigtail plastic stent within a lumen-apposing metal stent for drainage of pancreatic fluid collection did not improve clinical success or safety outcomes, according to results from a single-center study.
“Lumen-apposing metal stents are increasingly being used for endoscopic drainage of pancreatic fluid collections, including pseudocysts and walled-off necrotic collections,” Vinay Chandrasekhara, MD, study author and a gastroenterologist at Mayo Clinic in Rochester, told Healio. “While many endoscopists place coaxial plastic stents, it is unknown if this practice helps with outcomes, including faster resolution of the collection or fewer adverse events, including bleeding and infection.”
In a comparative study published in Gastrointestinal Endoscopy, researchers evaluated the rate and type of adverse events as well as clinical success among 185 individuals who underwent lumen-apposing metal stent (LAMS) drainage for pancreatic fluid collection. Most patients (n = 102) had a coaxial double pigtail plastic stent (DDPS) placed within LAMS for drainage, while the remainder (n = 83) underwent drainage with LAMS alone.
“While a common practice, placement of a double pigtail plastic stent through a lumen-apposing metal stent was not associated with improved rates of clinical success nor with an improved safety profile,” Chandrasekhara noted.
The results showed 75.9% of patients in the LAMS group and 69.9% in the LAMS with DDPS group (P = .34) achieved clinical success. Adverse events occurred among 15.7% of patients in both groups (P = .825).
“These results, along with the growing collective data on this topic, suggest that coaxial double pigtail plastic stent placement through a LAMS does not affect patient outcomes,” Chandrasekhara told Healio. “Thus, they should only be used in select cases. It is our opinion that DPPS should be considered when a patient is suspected to have a disconnected pancreatic duct or has deep collections extending into the paracolic gutters.”
He continued: “Additional prospective studies on this topic are needed.”
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