PMID- 37214030
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230523
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 15
IP  - 4
DP  - 2023 Apr
TI  - Self-Expandable Metal Stent (SEMS) Versus Lumen-Apposing Metal Stent (LAMS) for 
      Drainage of Pancreatic Fluid Collections: A Randomized Clinical Trial.
PG  - e37731
LID - 10.7759/cureus.37731 [doi]
LID - e37731
AB  - Background and aim Endoscopic ultrasound (EUS)-guided drainage is the gold 
      standard approach for the treatment of encapsulated pancreatic collections (EPCs) 
      including pseudocyst and walled-off pancreatic necrosis (WON), and is associated 
      with an equivalent clinical efficacy to surgical drainage with fewer 
      complications and less morbidity. Drainage may be achieved via several types of 
      stents including a fully covered self-expandable metallic stent (SEMS) and 
      lumen-apposing metal stent (LAMS). However, to date there have been no randomized 
      trials to compare these devices. This study aimed to compare the efficacy and 
      safety of the SEMS versus LAMS for EUS-guided drainage of EPCs. Methods A phase 
      IIB randomized trial was designed to compare the SEMS versus LAMS for the 
      treatment of EPCs. Technical success, clinical success, adverse events (AEs), and 
      procedure time were evaluated. A sample size of 42 patients was determined. 
      Results There was no difference between the two groups in technical (LAMS 80.95% 
      vs 100% SEMS, p=0.107), clinical (LAMS 85.71% vs 95.24% SEMS, p=0.606) or 
      radiological success (LAMS 92.86% vs 83.33% SEMS, p=0.613). There was no 
      difference in AEs including stent migration rate and mortality. The procedure 
      time was longer in the LAMS group (mean time 43.81 min versus 24.43 min, 
      p=0.001). There was also a difference in the number of intra-procedure 
      complications (5 LAMS vs 0 SEMS, p=0.048). Conclusion SEMS and LAMS have similar 
      technical, clinical, and radiological success as well as AEs. However, SEMS has a 
      shorter procedure time and fewer intra-procedure complications compared to 
      non-electrocautery-enhanced LAMS in this phase IIB randomized controlled trial 
      (RCT). The choice of the type of stent used for EUS drainage of EPCs should 
      consider device availability, costs, and personal and local experience.
CI  - Copyright (c) 2023, Lera dos Santos et al.
FAU - Lera Dos Santos, Marcos Eduardo
AU  - Lera Dos Santos ME
AD  - Servico de Endoscopia Gastrointestinal do Departamento de Gastroenterologia, 
      Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo 
      (HCFMUSP), Sao Paulo, BRA.
FAU - Proenca, Igor Mendonca
AU  - Proenca IM
AD  - Servico de Endoscopia Gastrointestinal do Departamento de Gastroenterologia, 
      Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo 
      (HCFMUSP), Sao Paulo, BRA.
FAU - de Moura, Diogo Turiani Hourneaux
AU  - de Moura DTH
AD  - Servico de Endoscopia Gastrointestinal do Departamento de Gastroenterologia, 
      Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo 
      (HCFMUSP), Sao Paulo, BRA.
FAU - Ribeiro, Igor Braga
AU  - Ribeiro IB
AD  - Servico de Endoscopia Gastrointestinal do Departamento de Gastroenterologia, 
      Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo 
      (HCFMUSP), Sao Paulo, BRA.
FAU - Matuguma, Sergio Eiji
AU  - Matuguma SE
AD  - Servico de Endoscopia Gastrointestinal do Departamento de Gastroenterologia, 
      Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo 
      (HCFMUSP), Sao Paulo, BRA.
FAU - Cheng, Spencer
AU  - Cheng S
AD  - Servico de Endoscopia Gastrointestinal do Departamento de Gastroenterologia, 
      Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo 
      (HCFMUSP), Sao Paulo, BRA.
FAU - de Freitas Junior, Joao Remi
AU  - de Freitas Junior JR
AD  - Servico de Endoscopia Gastrointestinal do Departamento de Gastroenterologia, 
      Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo 
      (HCFMUSP), Sao Paulo, BRA.
FAU - Luz, Gustavo de Oliveira
AU  - Luz GO
AD  - Servico de Endoscopia Gastrointestinal do Departamento de Gastroenterologia, 
      Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo 
      (HCFMUSP), Sao Paulo, BRA.
FAU - McCarty, Thomas R
AU  - McCarty TR
AD  - Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's 
      Hospital, Harvard Medical School, Boston, USA.
FAU - Jukemura, Jose
AU  - Jukemura J
AD  - Division of Gastrointestinal Surgery, Hospital das Clinicas da Faculdade de 
      Medicina da Universidade de Sao Paulo (HCFMUSP), Sao Paulo, BRA.
FAU - de Moura, Eduardo Guimaraes Hourneaux
AU  - de Moura EGH
AD  - Servico de Endoscopia Gastrointestinal do Departamento de Gastroenterologia, 
      Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo 
      (HCFMUSP), Sao Paulo, BRA.
LA  - eng
PT  - Journal Article
DEP - 20230417
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC10191807
OTO - NOTNLM
OT  - encapsulated pancreatic collection
OT  - eus-drainage
OT  - lams
OT  - lumen-apposing metal stent
OT  - pancreatic fluid collection
OT  - pancreatic pseudocyst
OT  - self-expandable metal stent
OT  - sems
COIS- The authors have declared that no competing interests exist.
EDAT- 2023/05/22 13:04
MHDA- 2023/05/22 13:05
PMCR- 2023/04/17
CRDT- 2023/05/22 12:06
PHST- 2023/03/15 00:00 [accepted]
PHST- 2023/05/22 13:05 [medline]
PHST- 2023/05/22 13:04 [pubmed]
PHST- 2023/05/22 12:06 [entrez]
PHST- 2023/04/17 00:00 [pmc-release]
AID - 10.7759/cureus.37731 [doi]
PST - epublish
SO  - Cureus. 2023 Apr 17;15(4):e37731. doi: 10.7759/cureus.37731. eCollection 2023 
      Apr.