Hamm Jacob, Busana Alzbeta, Amanzada Ahmad, Arlt Alexander, Asendorf Thomas, Carswell Samantha, Denzer Ulrike, Elsing Louis, Frost Fabian, Guilabert Lucia, Hamesch Karim, Hollenbach Marcus, Hegyi Péter, Kleger Alexander, Krivinka Jan, Kunovsky Lumir, Meinhardt Christian, Phillip Veit, Schlosser-Hupf Sophie, Sirtl Simon, Welsch Lukas, Cardinal von Widdern Julian, Neesse Albrecht, Ammer-Herrmenau Christoph
Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Goettingen, Goettingen, Germany.
Department of Gastroenterology, University Hospital Oldenburg, Oldenburg, Germany.
Endoscopy. 2025 Aug;57(8):829-838. doi: 10.1055/a-2569-7056. Epub 2025 Mar 31.
Lumen-apposing metal stents (LAMS) are widely used to drain walled-off necrosis (WON). LAMS occlusion is a significant clinical problem and identification of risk factors for LAMS occlusion could contribute to novel preventive strategies. A previous study suggested contradictory effects of proton pump inhibitors (PPIs) on occlusion and necrosectomy rates.
We conducted a Europe-wide multicenter retrospective cohort study assessing WONs drained by LAMS. The primary aims were to assess the strength of association between PPI intake and LAMS occlusion and necrosectomy rates, respectively. The secondary aim was to assess the strength of association between PPI intake and other LAMS-associated complications. Multiple mixed-effects models were used to control for possible confounding covariates.
893 patients with 967 LAMS from 17 centers were included. After excluding incomplete datasets and patients who took PPIs intermittently, 768 LAMS remained. The overall occlusion rate was 28.0 %. Most occlusions occurred within 10 days. Most patients received PPIs continuously (n = 577 vs. no intake n = 191). In patients who did not use PPIs continuously, lower rates of LAMS occlusion (odds ratio [OR] 0.61, = 0.04) and necrosectomies (incidence rate ratio 0.8, = 0.006) were observed. A post hoc analysis exhibited a dose- and compound-dependent effect of PPI intake on necrosectomy rate. No increase in other complications in the non-PPI group, such as bleeding events (OR 1.14) were observed.
PPI intake was associated with higher rates of LAMS occlusion and necrosectomy.
管腔贴壁金属支架（LAMS）广泛用于引流包裹性坏死（WON）。LAMS闭塞是一个重要的临床问题，识别LAMS闭塞的危险因素有助于制定新的预防策略。先前的一项研究表明质子泵抑制剂（PPI）对闭塞率和坏死组织清除率有相互矛盾的影响。
我们进行了一项全欧洲范围的多中心回顾性队列研究，评估LAMS引流的WON。主要目的分别是评估PPI摄入与LAMS闭塞及坏死组织清除率之间的关联强度。次要目的是评估PPI摄入与其他LAMS相关并发症之间的关联强度。使用多个混合效应模型来控制可能的混杂协变量。
纳入了来自17个中心的893例患者的967个LAMS。排除不完整数据集和间歇性服用PPI的患者后，剩余768个LAMS。总体闭塞率为28.0%。大多数闭塞发生在10天内。大多数患者持续服用PPI（n = 577，未服用者n = 191）。在未持续使用PPI的患者中，观察到LAMS闭塞率（优势比[OR] 0.61，P = 0.04）和坏死组织清除率（发病率比0.8，P = 0.006）较低。事后分析显示PPI摄入对坏死组织清除率有剂量和化合物依赖性影响。在非PPI组中未观察到其他并发症增加，如出血事件（OR 1.14）。
PPI摄入与LAMS闭塞率和坏死组织清除率较高有关。
