Endoscopy 2020; 52(04): 322
DOI: 10.1055/a-1114-2740
Letter to the editor

Reply to Rizzatti et al.

Juliana Yang
1   The Vanderbilt University Medical Center, Nashville, Tennessee, USA
,
Mouen A. Khashab
2   The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
› Author Affiliations

We would like to thank Rizzatti et al. for their interest and comments in their letter regarding our publication [1].

In our study, 24 patients underwent placement of one double-pigtail plastic stent (DPPS), 86 had two DPPSs, and 15 had > 2 DPPSs. Clinical failure occurred in two patients with a single DPPS and 14 patients with ≥ 2 DPPSs. There was no difference in the rate of clinical failure between the two groups (P = 0.47). Adverse events (AEs) occurred in 16.7 % of patients (4/24) with one DPPS and 17.8 % (18/101) with ≥ 2 DPPSs (P = 0.89). There were two infections in the single DPPS group and nine in the ≥ 2 DPPSs group. When the single DPPS patients were excluded, there was a significantly higher incidence of AEs in the multiple DPPSs group compared with the LAMS group (DPPSs 17.8 % vs. LAMS 7.5 %; P = 0.04). In addition, clinical success was significantly higher in the LAMS group (LAMS 96.3 % vs. DPPSs 86.1 %; P = 0.01). Finally, there was no correlation between percutaneous drainage and paracolic gutter extension (P = 0.58).

Over the past decade, the treatment of pancreatic fluid collections has rapidly evolved. The development of LAMSs has emerged as an ideal option because of their large caliber and streamlined design; however, there has been concern about a possible increased risk of AEs, especially bleeding, with reported rates between 0 and 21 % [2] [3] [4]. Dr. Rizzatti and colleagues referred to the randomized trial by Bang et al. [5], which reported a rate of AEs of 42 % in their LAMS group as opposed to 20.7 % in their plastic stent group (P = 0.077). The high AE rate in the LAMS group has not been substantiated by other large studies [3] [6] or our extensive experience with LAMSs. Furthermore, our study included only patients with pseudocysts, while the above trial included patients with walled-off necrosis (WON).

We acknowledge that the major limitation of the currently existing literature is the retrospective design of the majority of the studies. We fully agree that more randomized trials are needed to scientifically examine the role of LAMSs in the management of pseudocysts and WON.

Correction

Reply to Rizzatti et al.
Yang J, Khashab MA. Reply to Rizzatti et al.Endoscopy 2020; 52: 322
In the above-mentioned article, the name of Mouen A. Khashab has been corrected. This was corrected in the online version on April 17, 2020.



Publication History

Article published online:
25 March 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 
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