Combotherapy – LAMS and plastic stents for pancreatic pseudocyst drainage

Lumen-apposing metal stents (LAMSs) have undoubtedly revolutionized the endoscopic management of pancreatic fluid collections.

To provide better anchoring and provide migration, double pigtail plastic stents are sometimes placed through the LAMS.

A study published in Gastrointestinal Endoscopy compared LAMS alone vs LAMS+plastic stents regarding safety and efficacy for draining pancreatic pseudocysts (PP). 

The authors found that 17% of patients drained by LAMS alone returned with fever and chills secondary to pseudocyst infection and, in some, food residues (onion and tomato skins) were noticed in the cyst cavity. 50% of these patients required additional endoscopic interventions, and the other 50% required surgical intervention. None of the patients with LAMS+plastic stents developed cyst cavity infection, and the cyst resolution rate in this group was 100%. The possible explanation is that the large communication between the GI lumen and the cyst cavity created by LAMS allows for bi-directional flow of solid food material resulting in contamination/infection of the PP.  Placing double-pigtail stents across LAMSs minimized this risk. 

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