EUS-guided drainage of peripancreatic fluid collections using LAMS: association between the duration of stent indwell and the adverse events

Résumé fourni par la source

Aims The application of Lumen-Apposing Metal Stents (LAMS) guided by EUS has gained traction in the drainage of peripancreatic fluid collections (PFCs), ERCP in patients with surgically altered anatomy, and the creation of anastomoses in cases of enteral obstruction. However, the early reports of potentially severe and even fatal complications associated with LAMS utilization prompted the adoption of preventive measures during their use to mitigate adverse events (AEs). A widely endorsed recommendation is the removal of LAMS within 3-4 weeks of placement; this guideline has emerged despite the absence of studies specifically designed to assess whether prolonged retention of LAMS correlates with a higher incidence of AEs. The present study aimed to evaluate the AEs reported in patients undergoing PFC drainage via LAMS, focusing on the timing of these events with the date of stent placement [ 1 ] [ 2 ] [ 3 ] [ 4 ] [ 5 ]. Methods A systematic review (SR) of prospective studies evaluating the use of LAMS in PFC drainage was conducted. Prospective studies that explicitly detailed the timing of AEs relative to the date of stent placement were included. The literature search was executed through databases such as PubMed, Scopus, and EMBASE, employing the following keywords: (peripancreatic OR pancreatic) AND (fluid collection)) OR "pfc") AND (lumen-apposing metal stent*OR "lams"). The review protocol was duly registered in PROSPERO. Results 1,242 references were identified in the literature search, of which 15 prospective studies (Figure 1) encompassing 677 patients were included in this SR (Table 1). Among the included studies, 142 AEs were reported, with the timing ascertainable for 135 cases (95.1%). The most frequently reported AEs were as follows: stent obstruction (n=42, 29.5%), bleeding (n=31, 21.8%), stent migration (n=24, 16.9%), buried stent (n=23, 16.1%), biliary obstruction (n=3, 2.4%), intestinal perforation (n=2, 1.6%), and other AEs (n=17, 11.9%) such as fever and abdominal pain. Notably, 12 AEs occurred during the prosthesis removal, while 41 AEs (6%) were classified as severe. Mortality associated with LAMS was reported in 5 cases. Of the total AEs for which the timing of occurrence was documented (n=135), 67 AEs (49.6%) transpired within the first 4 weeks following stent placement. In contrast, the remaining complications (n=68, 50.4%) occurred in patients who retained the stent for more than 4 weeks (Table 1). Importantly, no significant differences were observed concerning the type of collection (pseudocyst vs. necrosis). Conclusions The observed AEs rate of 20.9% is noteworthy; however, it is pertinent to highlight that most reported AEs (94%) were not classified as severe. Contrary to the current recommendations, this study did not find a correlation between the duration of stent placement and the incidence or severity of complications. Publication History Article published online: 27 March 2025 © 2025. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.