Lumen apposing metal stents for the treatment of pancreatic and peri-pancreatic fluid collection and bleeding risk: a propensity matched study

Aims Endoscopic ultrasound (EUS)-guided drainage with luminal apposing metal stent (LAMS) has become the treatment of choice of symptomatic pancreatic fluid collections (PFCs). Recent studies reported a not negligible bleeding risk after Axios stent placement. Spaxus stent has blunt extremity and a softer design. Our aim was to compare the risk of bleeding between the two stents. (▶[Table 1] [2] [3] [4] [5] [6] [7] [8] [8]).

Table 1 Characteristics of the Axios/Hot-Axios (a) and Spaxus/Hot-Spaxus (b) utilized for drainage of pancreatic fluid collection.

Table 2 Baseline characteristics of the 363 patients who were treated with Hot-Axios and both Cold and Hot-Spaxus who were retrospectively retrieved from database of 18 centers.

Table 3 Overall patient's and procedures features.

Table 4 Baseline characteristics of 324 patients who were selected after 1-to-1 propensity score matching,

Table 5 Outcomes of EUS-guided Pancreatic fluid collection drainage with divided based on the stent utilized.

Table 6 Outcomes of the enrolled patients regarding relating to LAMS type and diameter.

Fig. 7Logistic regression analysis for severe bleeding rate.

Fig. 8

Fig. 8

Methods This is a retrospective study in patients with PFC and treated by Axios and Spaxus (both cold and hot), in eighteen endoscopic referral centers [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17] [18] [19] [20] [21] [22] [23] [24] [25] [26] [27].

Results 363 patients were included in the study. The most common type of collection was WON (60% Spaxus group vs 70% Axios; p=0.12). Median size of the collection was 9.65 cm (7-12.57) in the Spaxus and 10 cm (7-13.8) in the Axios group (p=0.50). After 1-to-1 propensity score match, 324 patients were selected (162 per group). Technical success was 100% with Spaxus and 98% with Axios (p=0.10). Adverse events (AEs) were observed in 4 patients treated with Spaxus (2.4%): 2 patients experienced severe bleeding (1.2%); 18 patients experienced AEs with Axios (11.1%): 10 cases of severe bleeding (6.1%) and 1 moderate (0.6%). The difference between the two groups in terms of both AE rate and severe bleeding rate was significant (p=0.001 and p=0.01, respectively).

Conclusions Bleeding is a not negligible AE after PFC drainage by LAMS and is more than five times with Axios, as compared to Spaxus stent. Spaxus stent results the stent of choice over Axios for the EUS-guided PFC drainage with LAMS.

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