Lumen-apposing metal stent for peripancreatic fluid collection contributes to early improvement of nutritional status: A multicenter retrospective study (YCR-P001)

Acute pancreatitis causes malnutrition due to severe systemic inflammatory response and organ failure and is associated with increased susceptibility to severe infections and complications such as peripancreatic fluid collection (PFC). PFC is treated using endoscopic ultrasound-guided transluminal drainage (EUS-TD). Lumen-apposing metal stents (LAMSs) have high drainage efficiency and are useful; however, their impact on improving nutritional status and long-term prognosis is unclear. We aimed to evaluate the clinical outcomes and nutritional status after LAMS versus plastic stent (PS) in patients with PFC. This multicenter retrospective study included 59 patients who underwent EUS-TD (18 LAMS and 41 PS) for PFC between December 2018 and March 2023. Nutritional indices (prognostic nutritional index [PNI] and modified controlling nutritional status [M-CONUT]) were evaluated using blood tests 2, 4, and 8 weeks postoperatively, and compared using analysis of covariance, with pretreatment values as covariates. Endoscopic procedure time (21.0 vs 48.0 min; P <.001) and time to diet initiation (3.0 vs 5.0 days; P = .04) were significantly shorter in the LAMS group. There were no differences in the clinical success rate (88.9 vs 85.4%; P >.99), number of procedures (2.0 vs 2.0; P = .68), time to discharge after the procedure (28.5 vs 36.0 days; P = .19), adverse events (16.7 vs 14.6%; P >.99), or recurrence rate (16.7 vs 17.1%; P >.99). Post-procedure PNI (2 weeks: 4.5 vs -0.1; P = .09, 4 weeks: 7.2 vs 0.7; P = .03, 8 weeks: 11.0 vs 5.1; P = .05) and M-CONUT (2 weeks: -1.7 vs 0.5; P = .03, 4 weeks: -2.2 vs 0.4; P = .03, 8 weeks: -3.5 vs -1.1; P = .03) showed better improvement in the LAMS group. LAMS group show earlier improvement of nutrition status than PS group in this study.