Effects of PPI on LAMS occlusion rate following pancreatic necrosectomies

This study explored the impact of proton pump inhibitors (PPIs) on lumen-apposing metal stent (LAMS) occlusion rates in patients undergoing pancreatic necrosectomy for walled-off necrosis (WON). LAMS are used to drain infected or necrotic fluid collections in the pancreas, offering a minimally invasive alternative to surgical approaches. However, complications like stent blockage can occur, requiring additional procedures such as endoscopic necrosectomy to remove debris.

The study analyzed data from 893 patients and 967 LAMS placements across multiple European centers. After excluding intermittent PPI users and incomplete records, 768 stents were evaluated. Among these, 577 patients were on continuous PPIs, while 191 did not use PPIs. Results showed that PPI use significantly increased LAMS occlusion rates (30% in PPI users vs. 23% in non-users) and the need for endoscopic necrosectomies. Statistical models confirmed that continuous PPI use heightened the risk of stent blockage (OR 0.61, P = 0.04 for non-PPI users) and necrosectomy (IRR 0.8, P = 0.006). A dose-dependent and compound-specific effect of PPIs was also observed.

PPIs may contribute to stent occlusion by altering gastric pH, which can affect the composition of pancreatic fluid and promote debris accumulation. Importantly, avoiding PPIs did not increase bleeding risks or other complications, suggesting routine PPI use during LAMS placement should be reconsidered to improve outcomes.