Outcomes of Endoscopic Single-Gated Compared to Multigated Approach using Lumen Apposing Metal Stents in the...

Background and Study Aims Endoscopic transluminal drainage is the preferred approach for managing pancreatic and pericpancreatic collections associated with necrotizing pancreatitis (NP). We compared outcomes of a single-gated (SG) versus multigated (MG) approach using lumen-apposing metal stents (LAMS) in NP. Patients and Methods A retrospective, multicenter study of NP patients treated with an SG compared with MG approach, between January 2021 and December 2023, was performed. The primary outcome was time from index LAMS placement to clinical success (CS), defined as symptom resolution and a cavity size <5 cm. Results Among the 145 patients (SG: 116, MG: 29) included, CS was achieved in 133 (91.7%) patients (SG: 106 vs. MG: 27, P = 0.731). The time from index LAMS placement to CS, was shorter in the MG group (51.6 ± 93.9 vs. 88.6 ± 72.2 days, P = 0.022). LAMS removal occurred earlier in the MG group (56.5 ± 63.9 vs. 86.5 ± 67.6 days, P = 0.030) however there was no difference in adverse events and mortality rates. Among the SG cohort, multiorgan failure, Charlson Comorbidity Index >3, pancreatic duct leak or disconnection, and periduodenal extension of necrosis were predictive of failure of an SG approach (16%) and need for step-up to an MG approach. Conclusions The overall success rate was similar for the SG and MG cohorts; however, an MG approach was associated with earlier necrosis resolution and LAMS removal. Among those requiring step-up from SG to MG, patient and disease characteristics predicted failure of an SG approach.