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.
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.
Introduction: Obesity has become one of the greatest global health challenges. New incretin-based therapies—including semaglutide, tirzepatide, resmetirom, and SGLT2 inhibitors such as empagliflozin—have transformed the treatment of obesity, diabetes, and MASLD. However, many patients discontinue...
Introduction: Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is the standard technique for diagnosing solid pancreatic lesions. Traditionally, biopsy specimens are processed for cytology, often requiring on-site cytopathology support. This multicenter prospective study evaluated whether directly placing...
Introduction: Although Roux-en-Y gastric bypass (RYGB) is an effective bariatric procedure, a small proportion of patients develop severe nutritional complications, refractory dumping syndrome, or other debilitating adverse events requiring reversal. This study describes a novel...
Introduction: Simultaneous malignant distal biliary obstruction (MDBO) and gastric outlet obstruction (GOO), commonly caused by advanced pancreatic, biliary, or duodenal cancers, presents a major palliative challenge. Conventional endoscopic approaches often require repeated interventions and may...
Introduction: Long benign esophageal strictures remain one of the most difficult benign conditions to manage. Although endoscopic dilation and incision techniques provide temporary relief, recurrence is common, often requiring repeated interventions. This study introduces a...
Introduction: Peroral endoscopic myotomy (POEM) and endoscopic submucosal dissection (ESD) have revolutionized the management of esophageal motility disorders and early gastrointestinal neoplasia. Despite their proven clinical benefits, widespread adoption has been limited by concerns regarding...
We are pioneers in clinical intelligence, dedicated to helping gastroenterologists harness the power of artificial intelligence to drive precision, efficiency, and patient growth.