Effect of proton pump inhibitors on occlusion of lumen-apposing metal stents and rate of endoscopic necrosectomies: a Europe-wide multicenter cohort study

Abstract

Background Lumen-apposing metal stents (LAMS) are widely used to drain walled-off necrosis (WON). LAMS occlusion is a significant clinical problem and identification of risk factors for LAMS occlusion could contribute to novel preventive strategies. A previous study suggested contradictory effects of proton pump inhibitors (PPIs) on occlusion and necrosectomy rates.

Methods We conducted a Europe-wide multicenter retrospective cohort study assessing WONs drained by LAMS. The primary aims were to assess the strength of association between PPI intake and LAMS occlusion and necrosectomy rates, respectively. The secondary aim was to assess the strength of association between PPI intake and other LAMS-associated complications. Multiple mixed-effects models were used to control for possible confounding covariates.

Results 893 patients with 967 LAMS from 17 centers were included. After excluding incomplete datasets and patients who took PPIs intermittently, 768 LAMS remained. The overall occlusion rate was 28.0 %. Most occlusions occurred within 10 days. Most patients received PPIs continuously (n = 577 vs. no intake n = 191). In patients who did not use PPIs continuously, lower rates of LAMS occlusion (odds ratio [OR] 0.61, P = 0.04) and necrosectomies (incidence rate ratio 0.8, P = 0.006) were observed. A post hoc analysis exhibited a dose- and compound-dependent effect of PPI intake on necrosectomy rate. No increase in other complications in the non-PPI group, such as bleeding events (OR 1.14) were observed.

Conclusion PPI intake was associated with higher rates of LAMS occlusion and necrosectomy.

Publikationsverlauf

Eingereicht: 07. Juli 2024

Angenommen nach Revision: 25. Februar 2025

Accepted Manuscript online:
31. März 2025

Artikel online veröffentlicht:
08. Mai 2025

• References

• 1 Banks PA, Bollen TL, Dervenis C. et al. Classification of acute pancreatitis – 2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013; 62: 102-111
• 2 Werge M, Novovic S, Schmidt PN. et al. Infection increases mortality in necrotizing pancreatitis: a systematic review and meta-analysis. Pancreatology 2016; 16: 698-707
• 3 Binmoeller KF, Shah JN. Endoscopic ultrasound-guided gastroenterostomy using novel tools designed for transluminal therapy: a porcine study. Endoscopy 2012; 44: 499-503
• 4 Sharaiha RZ, Tyberg A, Khashab MA. et al. Endoscopic therapy with lumen-apposing metal stents is safe and effective for patients with pancreatic walled-off necrosis. Clin Gastroenterol Hepatol 2016; 14: 1797-1803
• 5 Pawa R, Dorrell R, Nguyen M. et al. Analysis of adverse events with lumen apposing metal stents for drainage of pancreatic fluid collections. Endosc Int Open 2023; 11: E1153-E1160
• 6 Gopakumar H, Revanur V, Kandula R. et al. Endoscopic ultrasound-guided lumen-apposing metal stent with or without coaxial plastic stent for pancreatic fluid collections: a systematic review and meta-analysis comparing safety and efficacy. Ann Gastroenterol 2024; 37: 242-250
• 7 DeSimone ML, Asombang AW, Berzin TM. Lumen apposing metal stents for pancreatic fluid collections: recognition and management of complications. World J Gastrointest Endosc 2017; 9: 456
• 8 Chandrasekhara V, Barthet M, Devière J. et al. Safety and efficacy of lumen-apposing metal stents versus plastic stents to treat walled-off pancreatic necrosis: systematic review and meta-analysis. Endosc Int Open 2020; 8: E1639-E1653
• 9 Giri S, Harindranath S, Afzalpurkar S. et al. Does a coaxial double pigtail stent reduce adverse events after lumen apposing metal stent placement for pancreatic fluid collections? A systematic review and meta-analysis.. Ther Adv Gastrointest Endosc 2023; 16: 26317745231199364
• 10 Beran A, Mohamed MFH, Abdelfattah T. et al. Lumen-apposing metal stent with and without concurrent double-pigtail plastic stent for pancreatic fluid collections: a comparative systematic review and meta-analysis. Gastroenterology Res 2023; 16: 59-67
• 11 Holmes I, Shinn B, Mitsuhashi S. et al. Prediction and management of bleeding during endoscopic necrosectomy for pancreatic walled-off necrosis: results of a large retrospective cohort at a tertiary referral center. Gastrointest Endosc 2022; 95: 482-488
• 12 Powers PC, Siddiqui A, Sharaiha RZ. et al. Discontinuation of proton pump inhibitor use reduces the number of endoscopic procedures required for resolution of walled-off pancreatic necrosis. Endosc Ultrasound 2019; 8: 194-198
• 13 Hollemans RA, Timmerhuis HC, Besselink MG. et al. Long-term follow-up study of necrotising pancreatitis: interventions, complications and quality of life. Gut 2024; 73: 787-796
• 14 Gray RJ. A class of K-sample tests for comparing the cumulative incidence of a competing risk. Ann Stat 1988; 16: 1141-1154
• 15 Graham DY, Tansel A. Interchangeable use of proton pump inhibitors based on relative potency. Clin Gastroenterol Hepatol 2018; 16: 800-808.e7
• 16 Knoop RF, Petzold G, Amanzada A. et al. Testing of Helicobacter pylori by endoscopic biopsy: the clinical dilemma of suppressive conditions. Digestion 2020; 101: 552-556
• 17 Kirchheiner J, Glatt S, Fuhr U. et al. Relative potency of proton-pump inhibitors – comparison of effects on intragastric pH. Jan. Eur J Clin Pharmacol 2009; 65: 19-31
• 18 Nayar M, Leeds JS, Oppong K. Lumen-apposing metal stents for drainage of pancreatic fluid collections: does timing of removal matter?. Gut 2022; 71: 850-853
• 19 Kanno T, Yuan Y, Tse F. et al. Proton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding. Cochrane Database Syst Rev 2022; 1: CD005415