OR-THER-05: Lumen-apposing large diameter fully covered self-expandable metallic stents facilitate but do not obviate the need for endoscopic debridement in infected collections

BACKGROUND AND OBJECTIVES: Lumen-apposing large diameter fully covered self-expandable metallic stents (LAFCSEMS) customized for the drainage of pancreatic fluid collections are now available. LAFCSEMS allow more effective drainage as compared to plastic stents (PSs), and an endoscope can be easily inserted for direct endoscopic debridement and direct endoscopic necrosectomy (DEN). The large diameter may allow solid debris to pass out spontaneously. This study examined whether LAFCSEMS can reduce the need for DEN. METHODS: Data of patients who underwent endoscopic ultrasound-guided drainage of symptomatic walled-off collections from November 2006 to January 2017 were reviewed. Primary outcome measures were the need for and frequency of DEN. RESULTS: Forty-two patients underwent 44 procedures. The indications were infected pseudocysts (4), pseudocysts with mass effect (18), infected walled-off necrosis (19), and intra-abdominal abscess (93). PS was used in 32 and LAFCSEMS in 14 (two had PS changed to LAFCSEMS to improve drainage). Technical and clinical success rates were 100% and 95.5%, respectively. When LAFCSEMS were compared with PS, there was no difference in the need for DEN (41.7% vs. 37.5%, P = 0.8) and the median number of DEN sessions (P = 0.554). CONCLUSIONS: LAFCSEMS facilitate but do not obviate the need for endoscopic debridement in infected collections.