P1779 - The Utility of Lumen-Apposing Metal Stents Combined With Coaxial Double-Pigtail Plastic Stents for Endoscopic Ultrasound-Guided Transluminal Drainage of Pancreatic Fluid Collections

Butros Fakhoury, MD¹, Iyiad Alabdul Razzak, MD¹, Hind El Naamani, MD², Dimo Dimitrov, MD², Leandro Sierra, MD³, Syed Kashif. Mahmood, MD, MPH¹, Sandeep Krishnan, MD, PhD^1
1St. Elizabeth's Medical Center, Boston University School of Medicine, Brighton, MA; ²St. Elizabeth's Medical Center, Boston University School of Medicine, Boston, MA; ³Cleveland Clinic Foundation, Cleveland, OH

Introduction: Lumen-apposing metal stents (LAMS) has been the standard of care for drainage of pancreatic fluid collections (PFC). The simultaneous placement of double pigtail plastic stent (DPS) through LAMS during the initial procedure is a commonly employed approach. However, there has been conflicting data regarding the advantages of this method. The objective of our study is to investigate whether this technique reduces the risk of adverse events and the need for further interventions.

Methods: This single-center retrospective cohort study examined medical records of patients who underwent EUS-guided drainage of pancreatic fluid collections using a cautery-enhanced LAMS, with and without DPS, between January 2016 and July 2023. The primary outcome was the mean number of endoscopic interventions required to achieve treatment success. Secondary outcomes included clinical success and overall adverse events. Endoscopic interventions encompassed LAMS placement, necrosectomy, unplanned reinterventions, and LAMS removal. Treatment success was defined as the resolution of PFC to less than 20 mm on cross-sectional imaging at 3 months. Adverse events included bleeding, stent obstruction, and stent migration. Multivariate logistic regression was used to identify predictors of post-LAMS placement adverse events, employing backward stepwise regression with a retention criterion of P < 0.25 for the final model.

Results: Among the 43 patients who underwent LAMS placement, 20 received DPS while 23 did not. Baseline characteristics, including age, gender, etiology of PFC, and type of PFC, were similar between both groups. The mean difference in the number of endoscopic interventions was not statistically significant (LAMS with DPS: 3.29, LAMS without DPS: 3.04, P = 0.68). However, the LAMS with DPS group experienced lower overall adverse events compared to the group without DPS (LAMS with DPS: 20%, LAMS without DPS: 52%, P = 0.026). Multivariate regression analysis indicated that LAMS with DPS was associated with a reduced risk of overall adverse events (OR: 0.038, 95% CI: 0.003-0.66, P = 0.013).

Discussion: While the mean number of interventions did not differ significantly between groups, the LAMS with DPS approach showed a lower rate of adverse events (20% vs. 52%, p = 0.026). These findings suggest potential advantage of adjunctive DPS placement in reducing complications during PFC drainage. Further prospective studies are warranted to validate these findings.



Disclosures:


Butros Fakhoury, MD¹, Iyiad Alabdul Razzak, MD¹, Hind El Naamani, MD², Dimo Dimitrov, MD², Leandro Sierra, MD³, Syed Kashif. Mahmood, MD, MPH¹, Sandeep Krishnan, MD, PhD¹. P1779 - The Utility of Lumen-Apposing Metal Stents Combined With Coaxial Double-Pigtail Plastic Stents for Endoscopic Ultrasound-Guided Transluminal Drainage of Pancreatic Fluid Collections, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.