Safety and Efficacy of Lumen-Apposing Metal Stents With and Without Coaxial Plastic Stents for Pancreatic Fluid Collections

Background and Aims: Pancreatic fluid collections (PFCs) are common complications of acute pancreatitis and can cause pain, difficulty feeding, and infection. Endoscopic ultrasound-guided drainage has become the standard of care, with lumen-apposing metal stents (LAMSs) replacing double pigtail plastic stents (DPPSs) as the preferred device. Coaxial placement of DPPSs through LAMSs is hypothesized to lower the risks of adverse events related to LAMSs. We conducted a retrospective study to evaluate the safety and efficacy of this strategy. Methods: We conducted a retrospective study of consecutive patients with PFCs undergoing endoscopic cystgastrostomy with LAMSs and DPPSs or LAMSs alone at two U.S. academic tertiary care centers from January 2016 until November 2022. Propensity scoring and an adjusted logistic regression model were used for analysis. Results: We included 68 patients with an average follow-up of 189 days. The most common etiology of pancreatitis was gallstones (35.3%), most PFCs were walled-off necrosis (61.8%), and the mean size was 14.7 cm (SD ± 5.9 cm). Overall clinical success was 88.2%, without significant differences between LAMSs and DPPSs vs LAMSs alone (95.7% vs 84.4%; P = 0.18; aOR = 4.6; 95% CI, 0.5-41.4). We found no statistically significant differences in rates of LAMS occlusion (aOR = 0.47; 95% CI, 0.09-2.5), infection (aOR = 1.03; 95% CI, 0.17-6.2), bleeding (aOR = 0.4; 95% CI, 0.03-5), or stent migration (aOR = 0.42; 95% CI, 0.04-4.1) between the 2 groups. Conclusion: This retrospective cohort study found no statistically significant differences in the safety or efficacy of cystgastrostomy with LAMSs and DPPSs vs LAMSs alone. Larger, prospective trials comparing these strategies are needed.