Metal stents affixed to the lumen do not decrease the need for endoscopic necrosectomy

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March 27, 2021

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Source / Disclosures

Source:

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

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

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Metal stents affixed to the lumen for endoscopic drainage were not superior to double pigtail plastic stents in reducing the need for endoscopic necrosectomy, according to a presenter at ESGE Days.

“Metal stents affixed to the lumen did not reduce the need for endoscopic necrosectomy compared to plastic double pigtail stents in patients with necrotizing pancreatitis.” Monkfish Boxhoorn, MARYLAND, PhD student of gastroenterology and hepatology Amsterdam University Medical Center, the Netherlands, said during the presentation. “Besides, [there was] no increased risk of complications, especially bleeding.

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

The investigators reported that the LAMS group and the DPS group did not differ for the primary endpoint (64% vs. 57%; RR = 1.13; 95% CI: 0.83-1.54 ). After correcting for age, gender, systemic inflammatory response syndrome, C reactive protein, and antibiotic use, the odds of endoscopic necrosectomy were 1.14 (95% CI, 0.44-2 , 9).

The results of the study showed no difference in terms of mortality (11% vs. 18%; RR = 0.64; 95% CI: 0.25-1.67) or major complications. The 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).

The length of ICU stay was equal (median 0 days versus 0 days) and there was no significant difference in hospital stay (median 34 days versus median 35). The median number of drainage procedures in the LAMS and DPS groups was 1. The median number of necrosectomies was also 1 in both groups.


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