LAMS use leads to high technical, clinical success for drainage of pancreatic, gallbladder collections
Use of lumen apposing metal stents (LAMS) in endoscopic ultrasound-guided transmural drainage results in high clinical and technical success rates and acceptable adverse events, making this a widely accepted therapeutic approach for the treatment of pancreatic pseudocysts (PP), walled-off pancreatic necrosis (WOPN) and gallbladder (GB) drainage, a recent study has found.
“Further prospective randomized trials reporting long-term clinical efficacy and cost-effectiveness are needed to validate LAMS as a therapeutic modality for pancreatic and GB collections,” the authors said.
A total of 20 trials involving 993 patients were included in this meta-analysis (WOPN: n=608; PP: n=204; GB drainage: n=181).
For drainage of WOPN, the pooled technical and clinical success rates were 98.9 percent (95 percent CI, 98.2–99.7 percent) and 90 percent (87–93 percent), respectively (τ2=0.001). For PP drainage, the pooled technical success was 97 percent (95–99 percent) and clinical success was 98 percent (96–100 percent; τ2=0.001). For GB drainage, the respective pooled technical and clinical success rates were 95 percent (91–99 percent) and 93 percent (90–97 percent; τ2=0.001).
Eleven percent of patients with higher complication rates had total adverse events in GB drainage. Additionally, no evidence of publication bias was seen in this meta-analysis.
The authors performed a comprehensive search of multiple literature databases through November 2016, which included human studies with at least 10 participants that examined the clinical success, technical success and adverse events of LAMS in treating PP, WOPN and GB drainage.
“Endoscopic ultrasound-guided transmural drainage using LAMS is becoming a popular and promising therapeutic approach for drainage of intra-abdominal fluid collections,” the authors said.