Rana Surinder Singh, Sharma Ravi, Dhalaria Lovneet, Gupta Rajesh
Departments of Gastroenterology (Surinder Singh Rana, Ravi Sharma, Lovneet Dhalaria).
Departments of Division of Surgical Gastroenterology, Department of Surgery (Rajesh Gupta), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Ann Gastroenterol. 2020 Jul-Aug;33(4):426-432. doi: 10.20524/aog.2020.0499. Epub 2020 May 25.
Lumen-apposing metal stents (LAMS) were considered a breakthrough in the endoscopic management of walled-off necrosis (WON), as their larger drainage diameter was expected to provide effective drainage of necrotic material. However, various studies and meta-analyses that have compared plastic and metal stents for the treatment of WON have shown conflicting results. We retrospectively compared the efficacy and safety of endoscopic transmural drainage between multiple plastic stents and LAMS.
Endoscopic data were retrospectively retrieved for patients who had undergone endoscopic ultrasound (EUS)-guided drainage/debridement of WON. Patients were divided into 2 groups according to whether multiple plastic stents or LAMS were deployed during initial drainage. The resolution and complication rates were compared between the 2 groups.
One hundred sixty-six patients (83% male, mean age 37.5 years) with symptomatic WON were treated with EUS-guided drainage using either multiple plastic stents (n=138) or LAMS (n=28). Patients in the LAMS group had significantly larger WON and a significantly higher proportion of solid content. WON resolution rates did not differ between plastic stents and LAMS (98.5% vs. 96.4% respectively, P=0.42). However, the time taken to resolution was significantly shorter in the LAMS group than in the plastic stents group (26.7 vs. 29.8 days, P=0.03). There was no significant difference between the groups in either mortality or complication rates.
The technical success, rates of WON resolution and complications were similar in patients treated with multiple plastic stents and LAMS. However, LAMS were associated with a significantly shorter time to resolution.
管腔对合金属支架（LAMS）被认为是壁内坏死（WON）内镜治疗的一项突破，因为其较大的引流直径有望有效引流坏死物质。然而，多项比较塑料支架和金属支架治疗WON的研究和荟萃分析结果相互矛盾。我们回顾性比较了多个塑料支架与LAMS内镜透壁引流的疗效和安全性。
回顾性检索接受内镜超声（EUS）引导下WON引流/清创的患者的内镜数据。根据初始引流时使用的是多个塑料支架还是LAMS，将患者分为两组。比较两组的消退率和并发症发生率。
166例有症状的WON患者（83%为男性，平均年龄37.5岁）接受了EUS引导下的引流，其中使用多个塑料支架的患者有138例，使用LAMS的患者有28例。LAMS组患者的WON明显更大，固体成分比例明显更高。塑料支架组和LAMS组的WON消退率无差异（分别为98.5%和96.4%，P = 0.42）。然而，LAMS组的消退时间明显短于塑料支架组（26.7天对29.8天，P = 0.03）。两组在死亡率或并发症发生率方面均无显著差异。
使用多个塑料支架和LAMS治疗的患者在技术成功率、WON消退率和并发症方面相似。然而，LAMS的消退时间明显更短。
