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CC BY 4.0 · Endoscopy
DOI: 10.1055/a-2569-7056
Original article

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

Jacob Hamm
1   Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Goettingen, Goettingen, Germany
,
Alzbeta Busana
1   Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Goettingen, Goettingen, Germany
,
Ahmad Amanzada
1   Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Goettingen, Goettingen, Germany
,
Alexander Arlt
2   Department of Gastroenterology, University Hospital Oldenburg, Oldenburg, Germany
3   Department of Gastroenterology, Israelitisches Krankenhaus, Hamburg, Germany
,
Thomas Asendorf
4   Department of Medical Statistics, University Medical Center Goettingen, Goettingen, Germany
,
Samantha Carswell
5   HPB and Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom
,
Ulrike Denzer
6   Department of Gastroenterology, University Hospital Marburg, Marburg, Germany
,
Louis Elsing
 7   Department of Oncology, Gastroenterology, Hepatology and Pneumology, University Hospital Leipzig, Leipzig, Germany
,
Fabian Frost
 8   Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
,
Lucia Guilabert 
 9   Department of Gastroenterology, Hospital General Universitario Dr. Balmis, ISABIAL (Instituto de Investigación Sanitaria y Biomédica de Alicante), Alicante, Spain
,
Karim Hamesch 
10   Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
,
Marcus Hollenbach
6   Department of Gastroenterology, University Hospital Marburg, Marburg, Germany
11   Department of Gastroenterology, University Hospital Heidelberg, Heidelberg, Germany
,
Péter Hegyi
12   Translational Pancreatology Research Group, Interdisciplinary Center of Excellence for Research Development and Innovation, University of Szeged, Szeged, Hungary
13   Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
14   Institute of Pancreatic Diseases and Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
,
Alexander Kleger
15   Institute of Molecular Oncology and Stem Cell Biology, University Hospital Ulm, Ulm, Germany
16   Division of Interdisciplinary Pancreatology, Department of Internal Medicine I, Ulm University Hospital, Ulm, Germany
,
Jan Krivinka
17   2nd Department of Internal Medicine – Gastroenterology and Geriatrics, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
,
Lumir Kunovsky 
17   2nd Department of Internal Medicine – Gastroenterology and Geriatrics, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
18   Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
19   Department of Gastroenterology and Digestive Endoscopy, Masaryk Memorial Cancer Institute, Brno, Czech Republic
,
Christian Meinhardt
2   Department of Gastroenterology, University Hospital Oldenburg, Oldenburg, Germany
,
Veit Phillip
20   Department of Clinical Medicine II, Technical University of Munich, TUM School of Medicine and Health, TUM University Hospital, Munich, Germany
,
Sophie Schlosser-Hupf
21   Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital Regensburg, Regensburg, Bavaria, Germany
,
Simon Sirtl 
22   Department of Medicine II, University Hospital LMU Munich, Munich, Germany
,
Lukas Welsch
23   Department of Gastroenterology, Diabetology and Infectiology, Klinikum Hanau, Hanau, Germany
,
Julian Cardinal von Widdern
24   Department of Internal Medicine I, Martin Luther University Halle-Wittenberg, Halle, Germany
,
Albrecht Neesse
1   Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Goettingen, Goettingen, Germany
,
Christoph Ammer-Herrmenau 
1   Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Goettingen, Goettingen, Germany
,
PROTOCOL working group
› Author AffiliationsTrial Registration: ClinicalTrials.gov Registration number (trial ID): NCT05817721 Type of study: Retrospective multicenter cohort study
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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.

Supplementary material



Publication History

Received: 07 July 2024

Accepted after revision: 25 February 2025

Accepted Manuscript online:
31 March 2025

Article published online:
08 May 2025

© 2025. 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/)

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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