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Year : 2017  |  Volume : 6  |  Issue : 7  |  Page : 9

Long-term results of short-term lumen-apposing metal stent placement for walled-off necrosis: Impact of ductal leaks and disconnection

1 Baldota Institute of Digestive Sciences, Mumbai, Maharashtra, India
2 School of Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2303-9027.212268

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Background and Objectives: Lumen-apposing metal stents (LAMSs) have shown promise for management of walled-off necrosis (WON). The impact of ductal leaks and disconnection on long-term results is unclear. We aimed to determine whether ductal leaks and disconnection influence WON recurrence after short-term drainage with LAMS. Methods: Patients with WON underwent LAMS placement. Magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP) were done on day 8. A 5F stent was placed in patients with ductal leak. LAMS was removed when the cavity collapsed completely. Patients were followed up at 3-month intervals Results: Eighty-eight patients with WON underwent LAMS placement. Sixty-four patients (72.72%) underwent necrosectomy (median session 3). Overall, 15 (17%) patients had complications (12 fever, 3 bleed). All LAMSs were removed at a median of 3.5 weeks (2–17 weeks). ERCP showed ductal disconnection and leak in 53 (60.2%) and 61 (69.3%) patients, respectively. A 5F stent was placed in 56/61 (91.8%) patients with ductal leak. There were 8 (9.09%) recurrences at a median follow-up of 22 months. Recurrence in patients with disconnection was higher than in those without (13.2% vs. 2.8%, P = 0.08). There were 4 (7.1%) recurrences in patients who underwent pancreatic duct stenting and 4 (12.1%) in those who did not (P = 0.45). Seven recurrences partially regressed on follow-up and did not require therapy. Conclusions: Short-term LAMS placement is an effective therapy for WON. There is a high prevalence of ductal leaks and disconnection in patients with WON. Recurrences are more common in patients with disconnection and are not impacted by ductal stent, and majority do not require therapy.

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