Does the timing of removal of a lumen-apposing metal stent influence the outcome after drainage of a pancreatic collection?

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Aims Drainage of infected or symptomatic pancreatic collections after acute necrotizing pancreatitis or post-operative fistula is indicated, with a lumen-apposing metal stent (LAMS) or double pigtail plastic stent. It is usually suggested to not exceed 4 weeks for LAMS removal to avoid adverse events. Our primary aim is to evaluate if timing of LAMS removal influences the resolution of the initial symptoms. Methods We conducted a retrospective single-center study in a tertiary center from January 2019 to May 2024. All patients who had a pancreatic collection that required a LAMS drainage whose follow-up after the procedure was accessible were included. The primary endpoint was resolution of symptoms 6 to 8 weeks after removal of the stent. The clinical and biological parameters at drainage time and follow-up after the procedure and at 6 months were collected, as well as the morphological evolution at 6 months from the initial drainage. Results Twenty-six patients were included, including 9 women (35%). Etiology of the collection was acute pancreatitis of alcoholic cause in 5 cases (n=19%), biliary in 10 cases (n=39%), pancreatitis of another cause in 8 cases (30%), and a post-operative collection in 3 cases (12%). The median time for removal of the LAMS was 11 days (IQR 6-23). Drainage was performed using a 20 mm-diameter stent for 11 patients, 15 mm for 14 patients and 10 mm for one patient. Initial symptoms (sepsis or digestive compression related symptoms) resolved at 6-8 weeks after removal of the LAMS for 62% of patients (n=16). The time between removal of the LAMS and the date of resolution of symptoms was 44.3 days (min 3-max 150). Eleven patients had a stent removed within 7 days after installation with a symptom resolution rate at 8 weeks of 54%, while 15 patients had a stent removal more than 7 days after initial procedure with a symptom resolution rate of 66% (OR=0.61 95% CI [0.0918; 3.93], p=0.69). Conclusions Overall, the results of our study suggest that a longer time between drainage of the pancreatic collection and removal of the LAMS could have a positive outcome on the resolution of symptoms, without significant statistical difference. However, a study with a larger sample size and prospective data collection is required to confirm these results. 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

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