A novel strategy for transmural stent removal in necrotizing pancreatitis undergoing endoscopic transmural necrosectomy: a nested, case-control study
Abstract BackgroundAlthough metal stents have been widely used in the endoscopic step-up approach for necrotizing pancreatitis (NP), the exact timing of transmural stent removal has not been well studied. Here, we report a novel strategy for stent removal and compare it with the conventional strategy.MethodsThis retrospective, nested, case-control study analyzed all adult NP patients who underwent endoscopic transmural necrosectomy (ETN). Clinical outcomes were compared between case group (a novel strategy in which the stents were removed during the last necrosectomy when the ETN endpoint was achieved) and 1:1 necrosis extent matched control group (the conventional strategy in which the stents were removed after necrosectomy when clinical symptoms were relieved and collection was nearly completely resolved, as confirmed by imaging).ResultsBaseline characteristics was comparable between case group (n=37) and control group (n=37). Three (8.1%) patients in case group and one (2.7%) patient in control group needed additional ETN after stent removal (P >0.05). Nearly all patients (case: 97.3%; control: 94.6%) achieved clinical success. There was no difference in disease-related (case: 40.5%; control: 37.8%) or stent-related (case: 27.0%; control: 16.2%) complications. Case group had a trend of shorter length of stent placement (median: 20.0 days vs. 29.5 days, P >0.05).ConclusionsCompared to the convention strategy, the novel strategy of transmural stent removal during last necrosectomy avoids one endoscopy procedure and is feasible, with no need for additional ETN after stent removal, similar improvement in clinical outcomes, and no increase in complications. Prospective multicenter studies regarding the timing of transmural stent removal are needed to further validate our conclusions.