Effect of proton pump inhibitors on occlusion of lumen-apposing metal stents and rate of endoscopic necrosectomies: a Europe-wide multicenter cohort study

Authors	HAMM Jacob BUSANA Alzbeta AMANZADA Ahmad ARLT Alexander ASENDORF Thomas CARSWELL Samantha DENZER Ulrike ELSING Louis FROST Fabian GUILABERT Lucia HAMESCH Karim HOLLENBACH Marcus HEGYI Péter KLEGER Alexander KRIVINKA Jan KUNOVSKÝ Lumír MEINHARDT Christian PHILLIP Veit SCHLOSSER-HUPF Sophie SIRTL Simon WELSCH Lukas WIDDERN Julian Cardinal von NEESSE Albrecht AMMER-HERRMENAU Christoph
Year of publication	2025
Type	Article in Periodical
Magazine / Source	Endoscopy
MU Faculty or unit	Faculty of Medicine
Citation
web	https://www.thieme-connect.com/products/ejournals/abstract/10.1055/a-2569-7056
Doi	http://dx.doi.org/10.1055/a-2569-705
Description	Background: Lumen-apposing metal stents (LAMS) are widely used to drain walled-off necrosis (WON). LAMS occlusion is a significant clinical problem and identification of risk factors for LAMS occlusion could contribute to novel preventive strategies. A previous study suggested contradictory effects of proton pump inhibitors (PPIs) on occlusion and necrosectomy rates. Methods: We conducted a Europe-wide multicenter retrospective cohort study assessing WONs drained by LAMS. The primary aims were to assess the strength of association between PPI intake and LAMS occlusion and necrosectomy rates, respectively. The secondary aim was to assess the strength of association between PPI intake and other LAMS-associated complications. Multiple mixed-effects models were used to control for possible confounding covariates. Results: 893 patients with 967 LAMS from 17 centers were included. After excluding incomplete datasets and patients who took PPIs intermittently, 768 LAMS remained. The overall occlusion rate was 28.0 %. Most occlusions occurred within 10 days. Most patients received PPIs continuously (n = 577 vs. no intake n = 191). In patients who did not use PPIs continuously, lower rates of LAMS occlusion (odds ratio [OR] 0.61, P = 0.04) and necrosectomies (incidence rate ratio 0.8, P = 0.006) were observed. A post hoc analysis exhibited a dose- and compound-dependent effect of PPI intake on necrosectomy rate. No increase in other complications in the non-PPI group, such as bleeding events (OR 1.14) were observed. Conclusion: PPI intake was associated with higher rates of LAMS occlusion and necrosectomy.