Impact of long-term transmural plastic stents on recurrence after endoscopic treatment of walled-off pancreatic necrosis

David Michaël de Jong; Pauline Maria Catharine Stassen; Ivo Schoots; Robert C Verdonk; Marco J Bruno; Rogier P Voermans; Pieter J F de Jonge

doi:10.1055/a-2307-7123

Impact of long-term transmural plastic stents on recurrence after endoscopic treatment of walled-off pancreatic necrosis

Endoscopy. 2024 Apr 16. doi: 10.1055/a-2307-7123. Online ahead of print.

Authors

David Michaël de Jong¹, Pauline Maria Catharine Stassen², Ivo Schoots³, Robert C Verdonk⁴, Marco J Bruno², Rogier P Voermans⁵, Pieter J F de Jonge²

Affiliations

¹ Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands.
² Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands.
³ Radiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands.
⁴ Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, Netherlands.
⁵ Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, Netherlands.

PMID: 38626890
DOI: 10.1055/a-2307-7123

Abstract

Background and study aims: Endoscopic transmural drainage (ETD) using double pigtail stents (DPS) is a well-established treatment for walled-off pancreatic necrosis (WON). This study aimed to compare outcomes in patients undergoing ETD with DPS left indwelling versus those where stents were removed or migrated.

Patients and methods: This retrospective, multicenter cohort study included patients with WON who underwent ETD using DPS between July 2001 and December 2019. The primary outcome was recurrence of a pancreatic fluid collection (PFC). Secondary outcomes were long term complications and recurrence-associated factors. Competing risk regression analysis considered DPS removal or migration as time-varying covariate.

Results: Among 320 patients (median age 58, 36% female), DPS were removed in 153 (47.8%), migrated spontaneously in 27 (8.4%), and remained indwelling in 140 (43.8%). PFC recurrence was observed in 57 patients (17.8%): after removal in 39 (25.5%), after migration in 4 (14.8%) and in patients with indwelling DPS in 14 patients (10%). In 25 patients (7.8%) drainage of recurrent PFC was indicated. Risk factors for recurrence were DPS removal or migration (HR: 3.45, 95%CI: 1.37-8.70) and presence of a disconnected pancreatic duct (HR: 3.45, 95%CI: 1.84-14.0).

Conclusions: Among patients who undergo ETD of WON, leaving DPS in situ seems to lower the risk on recurrent fluid collections, without any long term DPS-related complications. These results suggest that DPS should not be routinely removed and can be safely left indwelling indefinitely.

The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).