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Takahashi K, Ohyama H, Ohno I, Kato N. Outcomes and Post-removal Course of Lumen-Apposing Metal Stent Placement for Peripancreatic Fluid Collections: A Comparative Study of Pancreatic Pseudocysts and Walled-Off Necrosis. Cureus 2024; 16:e71561. [PMID: 39553082 PMCID: PMC11565458 DOI: 10.7759/cureus.71561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2024] [Indexed: 11/19/2024] Open
Abstract
AIM Pancreatic fluid collections (PFCs) are common local complications of pancreatitis that may require interventional therapy. Endoscopic ultrasound (EUS)-guided transluminal drainage from the digestive tract, particularly with lumen-apposing metal stents (LAMS), is the first-line therapy due to its safety and efficacy. However, adverse events and post-removal courses remain uncertain. This study aimed to clarify the characteristics of LAMS placement and its removal, comparing pancreatic pseudocysts (PPC) and walled-off necrosis (WON). METHODS This single-center retrospective study included 23 patients who underwent transgastric LAMS placement for PFCs under EUS guidance. The patients were categorized into the PPC group (n = 14) and the WON group (n = 9). Backgrounds and clinical outcomes were analyzed and compared. RESULTS The mean procedure time was 19 minutes in the PPC group and 25 minutes in the WON group, with no significant difference (p = 0.11). The overall incidence of adverse events during LAMS placement was 14.3% in the PPC group and 33.3% in the WON group, with no significant difference (p = 0.28), but the incidence of infection of noninfected fluid collections was 0% in the PPC group and 55.5% in the WON group, significantly higher in the WON group (p = 0.0016). At the time of LAMS removal, a double-pigtail plastic stent (DPS) was replaced in 53.8% of the PPC group and 57.1% of the WON group. Within one year, 57.1% of the replaced DPS in the PPC group and 25.0% in the WON group became dislocated. There were no adverse events due to the dislocation of the replaced DPS. Adverse events occurred in one patient in each group after LAMS removal: 7.7% in the PPC group and 14.3% in the WON group (p = 0.64), which consisted of peritonitis in the PPC group and recurrent infection of fluid collection in the WON group, and both of these events occurred when the replaced DPS was still in place after LAMS removal. CONCLUSIONS Although there was no significant difference in the overall incidence of adverse events between PPC and WON, the incidence of infection after LAMS placement was significantly higher in WON. Regarding the replaced DPS, there were some cases of dislocation within one year, but there were no related adverse events. Adverse events occurred even after the removal of LAMS and replacement with DPS, so careful follow-up is required.
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Affiliation(s)
| | | | - Izumi Ohno
- Gastroenterology, Chiba University, Chiba, JPN
| | - Naoya Kato
- Gastroenterology, Chiba University, Chiba, JPN
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2
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Zhu H, Du Y, Wang K, Li Z, Jin Z. Consensus guidelines on the diagnosis and treatment of pancreatic pseudocyst and walled-off necrosis from a Chinese multiple disciplinary team expert panel. Endosc Ultrasound 2024; 13:205-217. [PMID: 39318749 PMCID: PMC11419518 DOI: 10.1097/eus.0000000000000080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 06/06/2024] [Indexed: 09/26/2024] Open
Abstract
Objective To prepare a set of practice guidelines to standardize the entire process, from diagnosis to treatment and follow-up, for pancreatic pseudocysts and walled-off necrosis. Methods Thirty-six experts in the fields of digestive endoscopy, pancreatic surgery, interventional radiology, and others presented their opinions via discussions in online conferences by referring to the patient, intervention, comparison, and outcomes principles and then reviewed the evidence and statements using the Delphi method to reach a consensus. The consensus of >80% was finally achieved for the items. Results The experts discussed and reached a consensus on 29 statements including 10 categories: (1) definition and classification, (2) imaging and endoscopic diagnosis, (3) therapeutic implications, (4) surgical therapy, (5) percutaneous catheter drainage, (6) endoscopic retrograde cholangiopancreatography, (7) EUS-guided drainage, (8) stent selection for EUS-guided drainage, (9) complication related to stents for cyst drainage, and (10) drug treatment and follow-up. Conclusion This consensus based on the clinical experience of experts in various fields and international evidence-based medicine further standardizes the multidisciplinary diagnosis and treatment processes for pancreatic pseudocysts and walled-off necrosis.
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Affiliation(s)
| | | | | | - Zhaoshen Li
- Department of Gastroenterology, Changhai Hospital of Second Military Medical University/Naval Medical University, Shanghai, China
| | - Zhendong Jin
- Department of Gastroenterology, Changhai Hospital of Second Military Medical University/Naval Medical University, Shanghai, China
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3
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Li Z, Siddiqui A, Singh G, Redstone E, Weinstein J, Mitchell DG. Pancreatic Walled-Off Necrosis: Cross-Sectional Imaging Depiction of Debris Predicts the Success of Endoscopic Drainage Using Lumen-Apposing Metal Stents. Dig Dis 2024; 42:380-388. [PMID: 38663364 DOI: 10.1159/000538472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/12/2024] [Indexed: 06/05/2024]
Abstract
INTRODUCTION The use of endoscopic ultrasound (EUS)-guided transmural stent placement for pancreatic walled-off necrosis (WON) drainage is widespread. This study retrospectively analyzed imaging parameters predicting the outcomes of WON endoscopic drainage using lumen-apposing metal stents (LAMS). METHODS This study analyzed the data of 115 patients who underwent EUS-guided debridement using LAMS from 2011 to 2015. Pre-intervention CT or MRI was used to analyze the total volume of WON, percentage of debris, multilocularity, and density. Success measures included technical success, the number of endoscopic sessions, the requirement of percutaneous drainage, long-term success, and recurrence. RESULTS The primary cause of pancreatitis was gallstones (50.4%), followed by alcohol (27.8%), hypertriglyceridemia (11.3%), idiopathic (8.7%), and autoimmune (1.7%). The mean WON size was 674 mL. All patients underwent endoscopic necrosectomy, averaging 3.1 sessions. Stent placement was successful in 96.5% of cases. Procedural complications were observed in 13 patients (11.3%) and 6 patients (5.2%) who needed additional percutaneous drainage. No patients reported recurrent WON posttreatment. Univariate analysis indicated a significant correlation between debris percentage and the need for additional drainage and long-term success (p < 0.001). The number of endoscopic sessions correlated significantly with debris percentage (p < 0.001). CONCLUSION Pre-procedural imaging, particularly debris percentage within WON, significantly predicts the number of endoscopic sessions, the need for further percutaneous drainage, and overall long-term success.
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Affiliation(s)
- Zhenteng Li
- Department of Radiology, St. Luke's University Health Network, Bethlehem, Pennsylvania, USA
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ali Siddiqui
- Division of Gastroenterology, Inova Health System, Fairfax, Virginia, USA
| | - Gurshawn Singh
- Department of Gastroenterology, St. Luke's University Health Network, Bethlehem, Pennsylvania, USA
| | - Ellen Redstone
- Department of Radiology, St. Luke's University Health Network, Bethlehem, Pennsylvania, USA
| | - Jonathan Weinstein
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Plainview, New York, USA
| | - Donald G Mitchell
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Agrawal S, Arya A, Gautam AD, Yadav RR, Singh A, Boruah D, Mohindra S, Gupta A, Srivastava A, Gurjar M, Singh RK, Rahul R. Current Utility of Transgastric Percutaneous Drainage for the Management of Pancreatitis-Related Retrogastric Walled-Off Necrotic Collections: A Prospective Observational Study. Cureus 2024; 16:e56443. [PMID: 38638772 PMCID: PMC11024891 DOI: 10.7759/cureus.56443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2024] [Indexed: 04/20/2024] Open
Abstract
Introduction Pancreatic fluid collection (PFC) is one of the most frequent complications associated with acute pancreatitis. The route of drainage is guided by the size and site of collection. The present study aims to assess the clinical and technical success of transgastric percutaneous drainage (PCD) for managing retrogastric walled-off pancreatic necrosis (WOPN). Materials and methods A total of 44 patients with acute pancreatitis diagnosed with WOPN who underwent transgastric PCD with ultrasound or CT guidance as part of standard clinical management were included in the study. Patients were observed for improvement in clinical parameters, and treatment outcomes were noted in terms of technical success, clinical success, adverse events, need for additional procedures, hospital stay, and duration of placement of all drains. Data for the internalization of transgastric PCD was also observed in the study. Results Technical success during the drain placement was observed in 93% (n=41) of patients.Internalization of the transgastric drain was attempted in 12 patients and successful in 11 (91%). The median duration of hospital stay from the time of placement of the first PCD until discharge and the median duration of all PCDs placed were higher in patients where the transgastric drain was not internalized as compared to patients where the transgastric drain was internalized. Conclusion In WOPN, transgastric drain placement and successful internalization in any form help in the early resolution of peripancreatic and abdominal collections. It also reduces the time to percutaneous catheter removal, which in turn reduces the morbidity and decreases the need for additional interventions or surgery.
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Affiliation(s)
- Sarthak Agrawal
- Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Asmita Arya
- Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Avinash D Gautam
- Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Rajanikant R Yadav
- Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Ashish Singh
- Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Deb Boruah
- Radiology, All India Institute of Medical Sciences, Guwahati, IND
| | - Samir Mohindra
- Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Archana Gupta
- Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Anshu Srivastava
- Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Mohan Gurjar
- Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Rajneesh K Singh
- Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Rahul Rahul
- Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
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Zhang HM, Ke HT, Ahmed MR, Li YJ, Nabi G, Li MH, Zhang JY, Liu D, Zhao LX, Liu BR. Endoscopic transgastric fenestration versus percutaneous drainage for management of (peri)pancreatic fluid collections adjacent to gastric wall (with video). World J Gastroenterol 2023; 29:5557-5565. [PMID: 37970477 PMCID: PMC10642437 DOI: 10.3748/wjg.v29.i40.5557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/01/2023] [Accepted: 10/23/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Percutaneous drainage (PCD) and endoscopic approaches have largely replaced surgical drainage as the initial approach for (peri) pancreatic fluid collections (PFC)s, while complications associated with endoscopic stent implantation are common. AIM To introduce a novel endoscopic therapy named endoscopic transgastric fenestration (ETGF), which involves resection of tissue by endoscopic accessory between gastric and PFCs without stent implantation, and to evaluate its efficacy and safety compared with PCD for the management of PFCs adjacent to the gastric wall. METHODS Patients diagnosed with PFCs adjacent to the gastric wall and who subsequently received ETGF or PCD were restrospectively enrolled. Indications for intervention were consistent with related guidelines. We analyzed patients baseline characteristics, technical and clinical success rate, recurrence and reintervention rate, procedure-related complications and adverse events. RESULTS Seventy-two eligible patients were retrospectively identified (ETGF = 34, PCD = 38) from October 2017 to May 2021. Patients in the ETGF group had a significantly higher clinical success rate than those in the PCD group (97.1 vs 76.3%, P = 0.01). There were no statistically significant differences regarding recurrence, reintervention and incidence of complication between the two groups. While long-term catheter drainage was very common in the PCD group. CONCLUSION Compared with PCD, ETGF has a higher clinical success rate in the management of PFCs adjacent to the gastric wall. ETGF is an alternative effective strategy for the treatment of PFCs adjacent to the gastric wall.
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Affiliation(s)
- Hong-Mei Zhang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
| | - Hui-Ting Ke
- Department of Ultrasound, Ezhou Central Hospital, Ezhou 436099, Hubei Province, China
| | - Md Robin Ahmed
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
| | - Ya-Juan Li
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
| | - Ghulam Nabi
- Institute of Nature Conservation, Polish Academy of Sciences, Krakow 31120, Poland
| | - Mu-Han Li
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
| | - Ji-Yu Zhang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
| | - Dan Liu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
| | - Li-Xia Zhao
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
| | - Bing-Rong Liu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
- State Key Laboratory of Esophageal Cancer Prevention and Treatment, Zhengzhou University, Zhengzhou 450052, Henan Province, China
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Electrocautery-enhanced Lumen-apposing Metal Stents in the Management of Symptomatic Pancreatic Fluid Collections: Results From the Multicenter Prospective Pivotal Trial. J Clin Gastroenterol 2023; 57:218-226. [PMID: 33899781 DOI: 10.1097/mcg.0000000000001545] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 03/08/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND AIMS Endoscopic decompression is considered a first-line treatment for symptomatic pancreatic fluid collections (PFCs). A lumen-apposing metal stent (LAMS) with an electrocautery-enhanced delivery system [electrocautery-enhanced lumen-apposing metal stent (ELAMS)] may facilitate this procedure. This study evaluated the safety and efficacy of ELAMS in the management of symptomatic PFCs. PATIENTS AND METHODS A multicenter, nonblinded, prospective, Food and Drug Administration (FDA)-approved, investigational device exemption clinical trial was conducted. Enrollment criteria included symptomatic PFCs ≥6 cm with ≥70% fluid fraction. Subjects were followed prospectively for safety, efficacy, and resolution of the collections. Primary endpoint success was defined as ≥50% reduction in PFC size. Clinical outcomes were compared with our previously published series of LAMS without the cautery-enhanced delivery system. RESULTS The target enrollment of 30 patients was achieved in 7 US tertiary care centers. All patients underwent successful placement of the ELAMS. The mean procedure duration, stent placement time, and fluoroscopy exposures were 28.1±12.5, 5.8±2.6, and 1.8±1.6 minutes, respectively. Eight patients had no fluoroscopy. The primary endpoint was achieved in 83.3% of patients. Two adverse events were attributed to the ELAMS: 1 bleeding upon stent removal and 1 stent migration. Relative to the comparator noncautery LAMS multicenter trial (N=33, 8 tertiary centers), there was a significantly shorter procedure duration [36 min ( P <0.001)] with similar technical and clinical outcomes in the ELAMS cohort. CONCLUSION LAMS placed using an electrocautery delivery system significantly reduce procedure duration and were safe and effective in the management of symptomatic PFCs.
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7
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Ramouz A, Shafiei S, Ali-Hasan-Al-Saegh S, Khajeh E, Rio-Tinto R, Fakour S, Brandl A, Goncalves G, Berchtold C, Büchler MW, Mehrabi A. Systematic review and meta-analysis of endoscopic ultrasound drainage for the management of fluid collections after pancreas surgery. Surg Endosc 2022; 36:3708-3720. [PMID: 35246738 PMCID: PMC9085703 DOI: 10.1007/s00464-022-09137-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/13/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND The outcomes of endoscopic ultrasonography-guided drainage (EUSD) in treatment of pancreas fluid collection (PFC) after pancreas surgeries have not been evaluated systematically. The current systematic review and meta-analysis aim to evaluate the outcomes of EUSD in patients with PFC after pancreas surgery and compare it with percutaneous drainage (PCD). METHODS PubMed and Web of Science databases were searched for studies reporting outcomes EUSD in treatment of PFC after pancreas surgeries, from their inception until January 2022. Two meta-analyses were performed: (A) a systematic review and single-arm meta-analysis of EUSD (meta-analysis A) and (B) two-arm meta-analysis comparing the outcomes of EUSD and PCD (meta-analysis B). Pooled proportion of the outcomes in meta-analysis A as well as odds ratio (OR) and mean difference (MD) in meta-analysis B was calculated to determine the technical and clinical success rates, complications rate, hospital stay, and recurrence rate. ROBINS-I tool was used to assess the risk of bias. RESULTS The literature search retrieved 610 articles, 25 of which were eligible for inclusion. Included clinical studies comprised reports on 695 patients. Twenty-five studies (477 patients) were included in meta-analysis A and eight studies (356 patients) were included in meta-analysis B. In meta-analysis A, the technical and clinical success rates of EUSD were 94% and 87%, respectively, with post-procedural complications of 14% and recurrence rates of 9%. Meta-analysis B showed comparable technical and clinical success rates as well as complications rates between EUSD and PCD. EUSD showed significantly shorter duration of hospital stay compared to that of patients treated with PCD. CONCLUSION EUSD seems to be associated with high technical and clinical success rates, with low rates of procedure-related complications. Although EUSD leads to shorter hospital stay compared to PCD, the certainty of evidence was low in this regard.
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Affiliation(s)
- Ali Ramouz
- Department of General, Visceral, and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| | - Saeed Shafiei
- Department of General, Visceral, and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| | - Sadeq Ali-Hasan-Al-Saegh
- Department of General, Visceral, and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| | - Elias Khajeh
- Department of General, Visceral, and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| | - Ricardo Rio-Tinto
- Department of Gastroenterology, Digestive Oncology Unit, Champalimaud Foundation, Lisbon, Portugal
| | - Sanam Fakour
- Department of General, Visceral, and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| | - Andreas Brandl
- Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery Unit, Champalimaud Foundation, Lisbon, Portugal
| | - Gil Goncalves
- Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery Unit, Champalimaud Foundation, Lisbon, Portugal
| | - Christoph Berchtold
- Department of General, Visceral, and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| | - Markus W. Büchler
- Department of General, Visceral, and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral, and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
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Khan S, Chandran S, Chin J, Karim S, Mangira D, Nasr M, Ermerak G, Trinh A, Kia CYH, Mules T, Zad M, Ang TL, Johns E, Tee D, Kaul A, Ratanachu-Ek T, Jirathan-Opas J, Fisher L, Cameron R, Welch C, Lim G, Metz AJ, Moss A, Bassan M, Saxena P, Kaffes A, St John A, Hourigan LF, Tagkalidis P, Weilert F, Vaughan R, Devereaux B. Drainage of pancreatic fluid collections using a lumen-apposing metal stent with an electrocautery-enhanced delivery system. J Gastroenterol Hepatol 2021; 36:3395-3401. [PMID: 34370869 DOI: 10.1111/jgh.15658] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 06/05/2021] [Accepted: 07/25/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Our aim was to evaluate the efficacy and safety of a lumen-apposing metal stent with an electrocautery-enhanced delivery system (EDS-LAMS) for endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collections (PFCs) in regular clinical practice. METHODS A retrospective and subsequent prospective analysis was undertaken of all patients who underwent EUS-guided drainage of their PFCs using the EDS-LAMS at 17 tertiary therapeutic endoscopy centers. RESULTS Two hundred eight cases of EDS-LAMS deployment were attempted in 202 patients (mean age 52.9 years) at time of evaluation. Ninety-seven patients had pancreatic pseudocysts (PPs), 75 walled-off pancreatic necrosis (WOPN), 10 acute peripancreatic fluid collections (APFCs), 6 acute necrotic collections (ANCs), and 14 postoperative collections (POCs). Procedural technical success was achieved in 202/208 cases (97.1%). Maldeployment occurred in 7/208 cases (3.4%). Clinical success was achieved in 142/160 (88.8%) patients (PP 90%, WOPN 85.2%, APFC 100%, ANC 75%, POC 100%). Delayed adverse events included stent migration in 15/202 (7.4%), stent occlusion and infection in 16/202 (7.9%), major bleeding in 4/202 (2%), and buried EDS-LAMS in 2/202 (1%). PFC recurrence occurred in 13/142 (9.2%) patients; 9/202 (4.5%) required surgical or radiological intervention for PFC management after EDS-LAMS insertion. CONCLUSIONS This large international multicenter study evaluating the EDS-LAMS for drainage of PFCs in routine clinical practice suggests that the EDS-LAMS are safe and effective for drainage of all types of PFCs; however, further endoscopic therapy is often required for WOPN. Major bleeding was a rare complication in our cohort.
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Affiliation(s)
- Saad Khan
- Department of Gastroenterology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Department of Gastroenterology, Austin Health, Melbourne, Victoria, Australia
| | - Sujievvan Chandran
- Department of Gastroenterology, Austin Health, Melbourne, Victoria, Australia
| | - Jerry Chin
- Department of Gastroenterology, Waikato Hospital, Waikato District Health Board, Hamilton, New Zealand
| | - Shwan Karim
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Dileep Mangira
- Department of Gastroenterology, Western Health, Melbourne, Victoria, Australia
| | - Mohamad Nasr
- Department of Gastroenterology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Goktug Ermerak
- Department of Gastroenterology and Hepatology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Andrew Trinh
- Department of Gastroenterology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Christopher Y H Kia
- Department of Gastroenterology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Thomas Mules
- Department of Gastroenterology, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Mohammadali Zad
- Department of Gastroenterology, Townsville Hospital, Townsville, Queensland, Australia
| | - Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Estella Johns
- Department of Gastroenterology, Wellington Hospital, Capital and Coast District Health Board, Wellington, New Zealand
| | - Derrick Tee
- Department of Gastroenterology, Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Abha Kaul
- Department of Gastroenterology, Peninsula Health, Melbourne, Victoria, Australia
| | | | - Jirat Jirathan-Opas
- Department of Gastroenterology, Hatyai Hospital, Hat Yai, Songkhla Province, Thailand
| | - Leon Fisher
- Department of Gastroenterology, Peninsula Health, Melbourne, Victoria, Australia
| | - Rees Cameron
- Department of Gastroenterology, Wellington Hospital, Capital and Coast District Health Board, Wellington, New Zealand
| | - Christine Welch
- Department of Gastroenterology, Townsville Hospital, Townsville, Queensland, Australia
| | - Gary Lim
- Department of Gastroenterology, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Andrew J Metz
- Department of Gastroenterology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Alan Moss
- Department of Gastroenterology, Western Health, Melbourne, Victoria, Australia
| | - Milan Bassan
- Department of Gastroenterology and Hepatology, Liverpool Hospital, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Payal Saxena
- Department of Gastroenterology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Arthur Kaffes
- Department of Gastroenterology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Andrew St John
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Department of Medicine, Toowoomba Hospital, Toowoomba, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Luke F Hourigan
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Gallipoli Medical Research Institute, School of Medicine, University of Queensland, Greenslopes Private Hospital, Brisbane, Queensland, Australia
| | - Peter Tagkalidis
- Department of Gastroenterology, Western Health, Melbourne, Victoria, Australia.,Department of Gastroenterology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Frank Weilert
- Department of Gastroenterology, Waikato Hospital, Waikato District Health Board, Hamilton, New Zealand
| | - Rhys Vaughan
- Department of Gastroenterology, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Austin Health, Melbourne, Victoria, Australia
| | - Benedict Devereaux
- Department of Gastroenterology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
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9
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Oh CH, Lee JK, Song TJ, Park JS, Lee JM, Son JH, Jang DK, Choi M, Byeon JS, Lee IS, Lee ST, Choi HS, Kim HG, Chun HJ, Park CG, Cho JY. Clinical Practice Guidelines for the Endoscopic Management of Peripancreatic Fluid Collections. Gut Liver 2021; 15:677-693. [PMID: 34305047 PMCID: PMC8357592 DOI: 10.5946/ce.2021.185] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/26/2021] [Accepted: 05/12/2021] [Indexed: 12/13/2022] Open
Abstract
Endoscopic ultrasonography-guided intervention has gradually become a standard treatment for peripancreatic fluid collections (PFCs). However, it is difficult to popularize the procedure in Korea because of restrictions on insurance claims regarding the use of endoscopic accessories, as well as the lack of standardized Korean clinical practice guidelines. The Korean Society of Gastrointestinal Endoscopy appointed a Task Force to develop medical guidelines by referring to the manual for clinical practice guidelines development prepared by the National Evidence-Based Healthcare Collaborating Agency. Previous studies on PFCs were searched, and certain studies were selected with the help of experts. Then, a set of key questions was selected, and treatment guidelines were systematically reviewed. Answers to these questions and recommendations were selected via peer review. This guideline discusses endoscopic management of PFCs and makes recommendations on Indications for the procedure, pre-procedural preparations, optimal approach for drainage, procedural considerations (e.g., types of stent, advantages and disadvantages of plastic and metal stents, and accessories), adverse events of endoscopic intervention, and procedural quality issues. This guideline was reviewed by external experts and suggests best practices recommended based on the evidence available at the time of preparation. This will be revised as necessary to address advances and changes in technology and evidence obtained in clinical practice and future studies.
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Affiliation(s)
- Chi Hyuk Oh
- Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Jun Kyu Lee
- Division of Gastroenterology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Tae Jun Song
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, Seoul, Korea
| | - Jin-Seok Park
- Division of Gastroenterology, Department of Internal Medicine, Inha University Hospital, Incheon, Korea
| | - Jae Min Lee
- Division of Gastroenterology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Jun Hyuk Son
- Division of Gastroenterology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Dong Kee Jang
- Division of Gastroenterology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Miyoung Choi
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Jeong-Sik Byeon
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, Seoul, Korea
| | - In Seok Lee
- Division of Gastroenterology, Department of Internal Medicine, The Catholic University of Korea Seoul ST. Mary’s Hospital, Seoul, Korea
| | - Soo Teik Lee
- Division of Gastroenterology, Department of Internal Medicine, Jeonbuk National University Hospital, Jeonju, Korea
| | - Ho Soon Choi
- Division of Gastroenterology, Department of Internal Medicine, Hanyang University Seoul Hospital, Seoul, Korea
| | - Ho Gak Kim
- Division of Gastroenterology, Department of Internal Medicine, Daegu Catholic University Hospital, Daegu, Korea
| | - Hoon Jai Chun
- Division of Gastroenterology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Chan Guk Park
- Division of Gastroenterology, Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea
| | - Joo Young Cho
- Division of Gastroenterology, Department of Internal Medicine, Cha University Bundang Medical Center, Seongnam, Korea
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Oh CH, Song TJ, Lee JK, Park JS, Lee JM, Son JH, Jang DK, Choi M, Byeon JS, Lee IS, Lee ST, Choi HS, Kim HG, Chun HJ, Park CG, Cho JY. Clinical Practice Guidelines for the Endoscopic Management of Peripancreatic Fluid Collections. Gut Liver 2021; 15:677-693. [PMID: 34305047 PMCID: PMC8444102 DOI: 10.5009/gnl210001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/26/2021] [Accepted: 05/12/2021] [Indexed: 11/21/2022] Open
Abstract
Endoscopic ultrasonography-guided intervention has gradually become a standard treatment for peripancreatic fluid collections (PFCs). However, it is difficult to popularize the procedure in Korea because of restrictions on insurance claims regarding the use of endoscopic accessories, as well as the lack of standardized Korean clinical practice guidelines. The Korean Society of Gastrointestinal Endoscopy appointed a Task Force to develop medical guidelines by referring to the manual for clinical practice guidelines development prepared by the National Evidence-Based Healthcare Collaborating Agency. Previous studies on PFCs were searched, and certain studies were selected with the help of experts. Then, a set of key questions was selected, and treatment guidelines were systematically reviewed. Answers to these questions and recommendations were selected via peer review. This guideline discusses endoscopic management of PFCs and makes recommendations on Indications for the procedure, pre-procedural preparations, optimal approach for drainage, procedural considerations (e.g., types of stent, advantages and disadvantages of plastic and metal stents, and accessories), adverse events of endoscopic intervention, and procedural quality issues. This guideline was reviewed by external experts and suggests best practices recommended based on the evidence available at the time of preparation. This will be revised as necessary to address advances and changes in technology and evidence obtained in clinical practice and future studies.
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Affiliation(s)
- Chi Hyuk Oh
- Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Tae Jun Song
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, Seoul, Korea
| | - Jun Kyu Lee
- Division of Gastroenterology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Jin-Seok Park
- Division of Gastroenterology, Department of Internal Medicine, Inha University Hospital, Incheon, Korea
| | - Jae Min Lee
- Division of Gastroenterology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Jun Hyuk Son
- Division of Gastroenterology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Dong Kee Jang
- Division of Gastroenterology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Miyoung Choi
- National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Jeong-Sik Byeon
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, Seoul, Korea
| | - In Seok Lee
- Division of Gastroenterology, Department of Internal Medicine, The Catholic University of Korea Seoul St. Mary’s Hospital, Seoul, Korea
| | - Soo Teik Lee
- Division of Gastroenterology, Department of Internal Medicine, Jeonbuk National University Hospital, Jeonju, Korea
| | - Ho Soon Choi
- Division of Gastroenterology, Department of Internal Medicine, Hanyang University Seoul Hospital, Seoul, Korea
| | - Ho Gak Kim
- Division of Gastroenterology, Department of Internal Medicine, Daegu Catholic University Hospital, Daegu, Korea
| | - Hoon Jai Chun
- Division of Gastroenterology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Chan Guk Park
- Division of Gastroenterology, Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea
| | - Joo Young Cho
- Division of Gastroenterology, Department of Internal Medicine, CHA University Bundang Medical Center, Seongnam, Korea
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Rana SS, Sharma R, Dhalaria L, Gupta R. Endoscopic ultrasound-guided transmural drainage of post-traumatic pancreatic fluid collections. Ann Gastroenterol 2021; 34:751-755. [PMID: 34475748 PMCID: PMC8375657 DOI: 10.20524/aog.2021.0607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/22/2020] [Indexed: 11/11/2022] Open
Abstract
Background Pancreatic injury is an uncommon consequence of abdominal trauma, and surgery has been the conventional treatment. The role and timing of endoscopic ultrasound (EUS)-guided treatment of the consequences of traumatic pancreatic injury is unclear. Our study evaluated the safety and efficacy of EUS-guided transmural drainage of post-traumatic pancreatic fluid collections (PFC). Methods A retrospective analysis of 13 patients (mean age 20.2±4.4 years; 12 males) with post-traumatic PFC treated with EUS-guided transmural drainage over the last 10 years was performed. Patient demographics, imaging findings, size of PFC, details of endoscopic transmural drainage procedure, outcome details, as well complications were retrieved from our database. Results The patients underwent drainage at 26.8±7.4 days after abdominal trauma, and the mean size of PFC was 11.8±3.2 cm with 2 patients having multiple fluid collections. Ten patients had PFC with a well-formed wall and 3 patients had an incompletely formed wall. Endoscopic drainage was technically successful in all 13 patients and 11 patients underwent transmural drainage with multiple plastic stents whereas 2 patients were treated with lumen apposing metal stents. The PFC resolved in all patients over a mean period of 2.7±0.4 weeks. One patient developed gastrointestinal bleeding 6 days after the procedure, successfully treated with angio-embolization. Conclusion EUS-guided transmural drainage of post-traumatic PFC is safe and effective and can be safely performed at an early phase (<4 weeks) after pancreatic trauma.
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Affiliation(s)
- Surinder Singh Rana
- Department of Gastroenterology (Surinder Singh Rana, Ravi Sharma, Lovneet Dhalaria)
| | - Ravi Sharma
- Department of Gastroenterology (Surinder Singh Rana, Ravi Sharma, Lovneet Dhalaria)
| | - Lovneet Dhalaria
- Department of Gastroenterology (Surinder Singh Rana, Ravi Sharma, Lovneet Dhalaria)
| | - Rajesh Gupta
- Department of Surgical Gastroenterology (Rajesh Gupta), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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12
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Rai P, Harish KC, Majeed A, Goel A. EUS-guided drainage of pancreatic fluid collection, using a modified technique of cystotome alone without a FNA needle. Saudi J Gastroenterol 2021; 27:283-288. [PMID: 34677161 PMCID: PMC8555769 DOI: 10.4103/sjg.sjg_132_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 05/29/2021] [Accepted: 06/18/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Endoscopic ultrasound (EUS)-guided drainage for pancreatic fluid collection (PFC) involves puncture with a fine-needle aspiration (FNA) needle, followed by tract dilation involving exchange of multiple accessories, and finally deployment of stent. The procedure is time consuming and carries a risk of loss of wire access and hence technical failure. We used a modified technique with a 10-F cystotome alone instead of a FNA needle and dilators. METHODS We retrospectively analysed records of consecutive patients who had undergone EUS-guided drainage of PFC using a modified technique, with puncture of PFC using a 10-Fcystotome, followed by passage of a guidewire through it into the PFC cavity and deployment of a biflanged, 2-cm-long, fully covered self-expanding metal stent over it. Technical and clinical success rates and procedure time were assessed. RESULTS Forty-five patients underwent PFC drainage, median age was 35 (12-76), and 35 (77.8%) were males. The median (range) duration of symptoms was 125 (38-1080) days, while the median PFC size was 11.8 × 11 × 11 cm, and the follow-up period after stent removal was 111 ± 72 (18-251) weeks. The procedure took 10 (8-12) min and had technical and clinical success rates of 100 and 97.8%, respectively. Minor complications occurred in six (13.3%) patients, while recurrence occurred in one. CONCLUSION EUS-guided drainage of PFC using a cystotome is a quick, effective and safe procedure. It may also be less expensive since it obviates the use of FNA needles and dilators, and is likely to be a useful alternative to the conventional technique.
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Affiliation(s)
- Praveer Rai
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - KC Harish
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Abdul Majeed
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Amit Goel
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Aslam S, Ansari Z, Alani M, Srinivasan I, Chuang KY. Coaxial Double-Pigtail Stent Placement: A Simple Solution to Decrease Bleeding Risk Associated With Lumen-Apposing Metal Stent? Cureus 2021; 13:e15981. [PMID: 34336472 PMCID: PMC8318618 DOI: 10.7759/cureus.15981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2021] [Indexed: 11/05/2022] Open
Abstract
Endoscopic cystogastrostomy using lumen-apposing metal stent (LAMS) is considered the first-line therapy for symptomatic pancreatic fluid collections (PFCs). Routine coaxial placement of a double-pigtail stent (DPS) through LAMS is debated. We report the case of a patient with delayed massive gastrointestinal bleed eight weeks after LAMS placement due to splenic artery pseudoaneurysm leading to a complicated hospitalization. Theoretically, coaxial placement of DPS through LAMS can prevent the relatively sharp LAMS from eroding into the mucosa of the collapsed cavity of PFCs, decreasing the risk of bleeding. Our case adds to the growing need to further explore the utility of this combined intervention.
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Affiliation(s)
- Shehroz Aslam
- Internal Medicine, Creighton University School of Medicine, St. Joseph's Hospital and Medical Center, Phoenix, USA
| | - Zaid Ansari
- Internal Medicine, Creighton University School of Medicine, St. Joseph's Hospital and Medical Center, Phoenix, USA
| | - Mustafa Alani
- Gastroenterology, Creighton University School of Medicine, St. Joseph's Hospital and Medical Center, Phoenix, USA
| | - Indu Srinivasan
- Gastroenterology, Valleywise Health Medical Center, Phoenix, USA.,Gastroenterology, Creighton University School of Medicine, Phoenix, USA
| | - Keng-Yu Chuang
- Gastroenterology, Valleywise Health Medical Center, Phoenix, USA.,Gastroenterology, Creighton University School of Medicine, Phoenix, USA
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14
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Khara HS, Gabrielsen JD, Diehl DL, Horsley RD. Endoscopy-guided percutaneous stapled pancreatic cystgastrostomy and necrosectomy. Endoscopy 2021; 53:E199-E200. [PMID: 32877935 DOI: 10.1055/a-1220-5926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Harshit S Khara
- Division of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, Pennsylvania, United States
| | - Jon D Gabrielsen
- Division of Foregut and Bariatric Surgery, Geisinger Medical Center, Danville, Pennsylvania, United States
| | - David L Diehl
- Division of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, Pennsylvania, United States
| | - Ryan D Horsley
- Division of Foregut and Bariatric Surgery, Geisinger Medical Center, Danville, Pennsylvania, United States
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15
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Parihar V, Basir Y, Nally D, Mellotte G, Manoharan T, Walker C, Ridgway PF, Conlon KC, Breslin N, Harewood GC, Ryan BM. A novel value-based scoring system for endoscopic ultrasound-guided drainage of pancreatic fluid collections: a single-centre comparative study of plastic and lumen-apposing metal stents (NOVA study). Eur J Gastroenterol Hepatol 2021; 32:157-162. [PMID: 32804857 DOI: 10.1097/meg.0000000000001891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE Healthcare resources are finite. Value in healthcare can be defined as patient health outcomes achieved per monetary unit spent. Attempts have been made to quantify the value of luminal endoscopy, but there is little in the medical literature describing the value of the complex therapeutic endoscopic activity. This study aimed to characterise the value of endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collections (PFCs) with either plastic or lumen-apposing metal stents (LAMSs). METHODS This is a single-centre, retrospective-prospective comparative study of 39 patients, who underwent EUS-guided PFC drainage between 2009 and 2018. Procedure value was calculated using the formula Q/(T/C), where Q is the quality of procedure adjusted for complications, T procedure duration and C is the complexity adjustment. Quality and complexity were estimated on a 1-4 Likert scale based on the American Society for Gastrointestinal Endoscopy criteria. Time (in minutes) was recorded from the patient entering and leaving the procedure room. Endoscopy time calculated from procedure time was considered a surrogate marker of cost as individual components of procedure cost were not itemized. RESULTS Of 39 identified patients who underwent EUS-guided PFC drainage, 11 received double pigtail plastic stents (DPPSs) and 28 received LAMSs. The two groups were comparable in age, gender and aetiology. Nearly 40% of the LAMS interventions were considered high value but only 11% of the plastic stent interventions achieved the same. The difference predominantly was due to a higher rate of complications and longer procedure time. CONCLUSION In this single-centre study, EUS-guided PFC drainage using LAMS was found to be a higher value procedure compared to the use of DPPS.
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Affiliation(s)
- Vikrant Parihar
- Department of Gastroenterology, Tallaght University Hospital
| | - Yasir Basir
- Department of Surgery, Tallaght University Hospital and Trinity College
| | - Deirdre Nally
- Department of Surgery, Tallaght University Hospital and Trinity College
| | | | | | - Caroline Walker
- Department of Gastroenterology, Tallaght University Hospital
| | - P F Ridgway
- Department of Surgery, Tallaght University Hospital and Trinity College
| | - K C Conlon
- Department of Surgery, Tallaght University Hospital and Trinity College
| | - Niall Breslin
- Department of Gastroenterology, Tallaght University Hospital
| | - Gavin C Harewood
- Department of Gastroenterology, Beaumont University Hospital, Dublin, Ireland
| | - Barbara M Ryan
- Department of Gastroenterology, Tallaght University Hospital
- Department of Clinical Medicine, Trinity College
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16
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Zhu H, Xie P, Wang Y, Jin Z, Li Z, Du Y. The role of solid debris in endoscopic ultrasound-guided drainage of walled-off necrosis: A large cohort study. J Gastroenterol Hepatol 2020; 35:2103-2108. [PMID: 32365410 DOI: 10.1111/jgh.15086] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 04/09/2020] [Accepted: 04/27/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND AIM The effect of solid debris on walled-off necrosis (WON) drainage remains unknown. Our study evaluated the role of solid debris in endoscopic ultrasound (EUS)-guided drainage of WON compared lumen-apposing metal stent (LAMS) with double-pigtail plastic stent (DPPS). METHODS We retrospectively evaluated consecutive patients with WON who underwent EUS-guided drainage in our endoscopic center over a 9-year period. The amount of solid debris in WON was assessed with computed tomography or magnetic resonance imaging and EUS images. RESULTS From 2011 to 2019, 84 WON patients were included. In WON with < 20% solid debris, the short-term clinical success of LAMSs (96.8%) was significantly higher than DPPSs (66.7%) (P = 0.03), and LAMSs were safer than DPPSs with less early adverse events (P = 0.02) and late adverse events (P = 0.03). On multivariable analysis, DPPS (odds ratio [OR], 0.16; 95% confidence interval [CI], 0.04-0.65; P = 0.01) and solid debris > 40% (OR, 0.11; 95% CI, 0.02-0.62; P = 0.01) were the predictors for failure of resolution of WON after adjusting for age and cyst size. The number of DPPSs used was significantly higher than LAMSs in managing WONs (P < 0.001). CONCLUSION For WON with < 20% solid debris, LAMSs might superior to DPPSs in terms of efficacy and safety.
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Affiliation(s)
- Huiyun Zhu
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University/Naval Medical University, Shanghai, China
| | - Pei Xie
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University/Naval Medical University, Shanghai, China
| | - Yuxin Wang
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University/Naval Medical University, Shanghai, China
| | - Zhendong Jin
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University/Naval Medical University, Shanghai, China
| | - Zhaoshen Li
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University/Naval Medical University, Shanghai, China
| | - Yiqi Du
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University/Naval Medical University, Shanghai, China
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17
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Olaiya B, Mekaroonkamol P, Li BW, Massaad J, Vachaparambil CT, Xu J, Lamm V, Luo H, Shen SS, Chen HM, Keilin S, Willingham FF, Cai Q. Outcomes of a single-step endoscopic ultrasound-guided drainage of pancreatic-fluid collections using an electrocautery-enhanced coaxial lumen-apposing, self-expanding metal stent with and without fluoroscopy. Gastroenterol Rep (Oxf) 2020; 8:425-430. [PMID: 33442474 PMCID: PMC7793111 DOI: 10.1093/gastro/goaa020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 11/04/2019] [Accepted: 12/12/2019] [Indexed: 11/29/2022] Open
Abstract
Background Fluoroscopy is often used during the endoscopic drainage of pancreatic-fluid collections (PFCs). An electrocautery-enhanced coaxial lumen-apposing, self-expanding metal stent (ELAMS) facilitates a single-step procedure and may avoid the need for fluoroscopy. This study compares the treatment outcomes using ELAMS with and without fluoroscopy. Methods Patients with PFCs who had cystogastrostomy from January 2014 to February 2017 were enrolled. Two groups were studied based on fluoroscopy use. Technical success was defined as uneventful insertion of ELAMS at time of procedure. Clinical success was defined as (i) clinical resolution of symptoms after the procedure and (ii) >75% reduction in cyst size on computed tomography 8 weeks after stent placement. Adverse events including bleeding, stent migration, and infection were recorded. Results A total of 21 patients (13 males) had PFCs drainage with ELAMS in the study period. The mean age was 51.6 ± 14.2 years. Thirteen patients had walled-off necrosis while eight had a pancreatic pseudocyst. The mean size of the PFCs was 11.3 ± 3.3 cm. Fluoroscopy was used in seven cases (33%) and was associated with a longer procedure time compared to non-fluoroscopy (43.1 ± 10.4 vs 33.3 ± 10.5 min, P = 0.025). This association was independent of the size, location, or type of PFCs. Fluoroscopy had no effect on the technical success rates. In fluoroless procedures, the clinical resolution was 91% as compared to 71% in fluoroscopy procedures (P = 0.52) and the radiologic resolution was 57% as compared to 71% in fluoroscopy procedures (P = 0. 65). Three cases of stent migration/displacement occurred in the fluoroless procedures. Conclusions ELAMS may avoid the need for fluoroscopy during cystogastrostomy. Procedures without fluoroscopy were significantly shorter and fluoroscopy use had no impact on the technical or clinical success rates.
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Affiliation(s)
- Babatunde Olaiya
- Department of Internal Medicine, Marshfield Clinic, Marshfield, WI, USA
| | - Parit Mekaroonkamol
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA, USA
- Division of Gastroenterology, King Chulalongkorn Memorial Hospital, Chulalongkorn University and Thai Red Cross, Bangkok, Thailand
| | - Bai-Wen Li
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA, USA
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, P. R. China
| | - Julia Massaad
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Jennifer Xu
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Vladamir Lamm
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Hui Luo
- Department of Gastroenterology, Xijing Hospital, Xi’an, Shaanxi, P. R. China
| | - Shan-Shan Shen
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Nanjing, Jiangshu, P. R. China
| | - Hui-Min Chen
- Department of Gastroenterology, Renji Hospital, Shanghai Jiaotong University, Shanghai, P. R. China
| | - Steve Keilin
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Field F Willingham
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Qiang Cai
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA, USA
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18
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Jang DK, Lee JK. Recent development of endoscopic ultrasonography-guided drainage of pancreatic fluid collections. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2020. [DOI: 10.18528/ijgii200038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Dong Kee Jang
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Jun Kyu Lee
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
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19
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Kayal A, Taghizadeh N, Ishikawa T, Gonzalez-Moreno E, Bass S, Cole MJ, Heitman SJ, Mohamed R, Turbide C, Chen YI, Forbes N. Endosonography-guided transmural drainage of pancreatic fluid collections: comparative outcomes by stent type. Surg Endosc 2020; 35:2698-2708. [DOI: 10.1007/s00464-020-07699-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 06/09/2020] [Indexed: 12/12/2022]
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20
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Li J, Yu Y, Li P, Zhang ST. Advancements in the endoscopic treatment of pancreatic fluid collections. Chronic Dis Transl Med 2020; 6:158-164. [PMID: 32885152 PMCID: PMC7451715 DOI: 10.1016/j.cdtm.2020.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Indexed: 12/12/2022] Open
Abstract
Endoscopic drainage of pancreatic fluid collections (PFCs) with fewer complications and less trauma has gradually replaced surgery or percutaneous drainage to become the first-line treatment for PFCs. In recent years, the differential efficacy of various stent techniques to drain different types of PFCs has been controversial. This review summarizes the clinical applications of endoscopic ultrasound-guided stent placement for PFCs drainage.
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Affiliation(s)
- Jing Li
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing 100050, China
| | - Yang Yu
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing 100050, China
| | - Peng Li
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing 100050, China
| | - Shu-Tian Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing 100050, China
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Tan S, Zhong C, Ren Y, Luo X, Xu J, Peng Y, Fu X, Tang X. Are Lumen-Apposing Metal Stents More Effective Than Plastic Stents for the Management of Pancreatic Fluid Collections: An Updated Systematic Review and Meta-analysis. Gastroenterol Res Pract 2020; 2020:4952721. [PMID: 32382266 PMCID: PMC7189322 DOI: 10.1155/2020/4952721] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 02/21/2020] [Accepted: 03/06/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND AIMS Recently, a new type of metal stent, named lumen-apposing metal stents (LAMS), has been designed to manage pancreatic fluid collections (PFC), and a few studies have reported its efficacy and safety. Therefore, we conducted this meta-analysis to investigate the role of LAMS for PFC. METHODS We searched the studies from PubMed, MEDLINE, Embase, and Cochrane databases from inception to May 2019. We extracted the data and analyzed the technical success, clinical success, and adverse events of LAMS to evaluate its efficacy and safety. RESULTS Twenty studies with 1534 patients were included. The pooled technical success, clinical success, and adverse event rates of LAMS for PFC were 96.2% (95% confidence interval (CI): 94.6%-97.4%), 86.8% (95% CI: 83.1%-89.8%), and 20.7% (95% CI: 16.1%-26.1%), respectively. Eight studies including 875 patients compared the clinical outcomes of LAMS with plastic stents. The pooled risk ratio (RR) of technical success and clinical success for LAMS and plastic stent was 1.01 (95% CI: 0.98-1.04, P = 0.62) and 1.06 (95% CI: 1.01-1.12, P = 0.03), respectively. As for the overall adverse events, the pooled RR was 1.51 (95% CI: 0.67-3.44, P = 0.32). CONCLUSIONS Our current study revealed that LAMS has advantages over plastic stents for PFC, with higher clinical success rate and lower complication rate of infection and occlusion.
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Affiliation(s)
- Shali Tan
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Chunyu Zhong
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yutang Ren
- Department of Gastroenterology, The People's Hospital of Lianshui, Huaian, China
| | - Xujuan Luo
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jin Xu
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yan Peng
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xiangsheng Fu
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xiaowei Tang
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China
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22
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Guo J, Duan B, Sun S, Wang S, Liu X, Ge N, Liu W, Wang S, Hu J. Multivariate analysis of the factors affecting the prognosis of walled-off pancreatic necrosis after endoscopic ultrasound-guided drainage. Surg Endosc 2020; 34:1177-1185. [PMID: 31190223 DOI: 10.1007/s00464-019-06870-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 05/20/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS Endoscopic ultrasound (EUS)-guided drainage has become the treatment of choice for walled-off pancreatic necrosis (WOPN). However, no consensus exists on the most significant patient- and procedure-related factors that affect prognosis. The aim of the study is to investigate the correlation between patient- and procedure-related factors and post-procedure complications after EUS-guided drainage. METHODS A retrospective analysis of the clinical characteristics of patients with WOPN who underwent EUS-guided drainage at our endoscopy center between November 2011 and August 2017 was performed. Chi-square analysis and binary logistic regression statistical methods were used to analyze the correlation between influencing factors and prognosis. RESULTS A total of 85 patients (male/female, 50/35) with WOPN were included in the study. The average age was 44.95 years. The cyst diameter was 10.58 ± 4.78 cm. Multivariate analysis showed that WOPN with higher solid content (> 30%) increased the probability of endoscopic necrosectomy (OR 6.798; 95% CI 1.423, 32.470; p = 0.016). The use of a metal stent increased the probability of endoscopic necrosectomy (OR 3.503; 95% CI 1.251, 9.810; p = 0.017) and the length of hospitalization (OR 3.315; 95% CI 1.192, 9.215; p = 0.022). Female patients had a higher probability of requiring endoscopic necrosectomy (OR 2.683; 95% CI 1.027, 7.007; p = 0.044) and prolonged hospitalization (OR 2.675; 95% CI 1.065, 6.721; p = 0.036). CONCLUSION The solid content of WOPN, type of stent, and sex of patients were associated with increased probability of endoscopic necrosectomy.
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Affiliation(s)
- Jintao Guo
- Endoscopy Center, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, 110004, Liaoning, China
| | - Bowen Duan
- Endoscopy Center, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, 110004, Liaoning, China
| | - Siyu Sun
- Endoscopy Center, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, 110004, Liaoning, China.
| | - Sheng Wang
- Endoscopy Center, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, 110004, Liaoning, China
| | - Xiang Liu
- Endoscopy Center, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, 110004, Liaoning, China
| | - Nan Ge
- Endoscopy Center, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, 110004, Liaoning, China
| | - Wen Liu
- Endoscopy Center, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, 110004, Liaoning, China
| | - Shupeng Wang
- Endoscopy Center, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, 110004, Liaoning, China
| | - Jinlong Hu
- Endoscopy Center, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, 110004, Liaoning, China
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Ali SE, Benrajab K, Mardini H, Su L, Gabr M, Frandah WM. Anchoring lumen-apposing metal stent with coaxial plastic stent for endoscopic ultrasound-guided drainage of pancreatic fluid collections: any benefit? Ann Gastroenterol 2019; 32:620-625. [PMID: 31700240 PMCID: PMC6826067 DOI: 10.20524/aog.2019.0414] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 07/21/2019] [Indexed: 12/25/2022] Open
Abstract
Background: Anchoring double-pigtail plastic stents (DPSs) within lumen-apposing metal stents (LAMSs) has been proposed to prevent adverse events during endoscopic drainage of pancreatic fluid collections (PFCs). We sought to compare the outcomes of patients who received LAMSs alone and those who received both LAMSs and anchoring DPSs for drainage of PFCs. Methods: A retrospective study was conducted at the University of Kentucky. Patients with PFCs who underwent endoscopic ultrasound-guided drainage using LAMSs, with or without DPSs, between January 2016 and March 2018 were included. Categorical data were analyzed using chi-square tests, and continuous variables using 2-sample t-tests. Adverse events were defined according to the American Society for Gastrointestinal Endoscopy’s Lexicon. The primary outcome was to evaluate the efficacy (PFC resolution), and safety (adverse events) of LAMSs with or without DPSs used to drain PFCs. Results: Fifty-seven patients with PFCs were treated by 2 experienced endoscopists over 26 months. Twenty-one (37%) patients received LAMSs alone, and 36 (63%) received LAMSs plus DPSs. Forty-three patients had walled-off pancreatic necrosis, and 14 patients had pancreatic pseudocyst. Clinical success (resolution of PFCs) was achieved in 15 patients (71.4%) in the LAMSs alone group, and 21 patients (58.3%) with LAMSs plus DPSs (P=0.32). In patients with LAMSs alone, 6 patients (28.6%) had adverse events, while in those with LAMSs plus DPSs, 14 (38.9%) patients had adverse events (P=0.43). Conclusion: No significant difference was identified in fluid resolution or adverse events between patients with LAMSs alone and those with LAMSs plus DPSs.
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Affiliation(s)
- Saad Emhmed Ali
- Department of aInternal Medicine, Division of Hospital Medicine (Saad Emhmed Ali)
| | - Karim Benrajab
- Internal Medicine, Gastroenterology and Hepatology (Karim Benrajab, Houssam Mardini, Moamen Gabr, Wesam M. Frandah)
| | - Houssam Mardini
- Internal Medicine, Gastroenterology and Hepatology (Karim Benrajab, Houssam Mardini, Moamen Gabr, Wesam M. Frandah)
| | - Leon Su
- Statistics, College of Arts and Sciences, College of Public Health (Leon Su), University of Kentucky, USA
| | - Moamen Gabr
- Internal Medicine, Gastroenterology and Hepatology (Karim Benrajab, Houssam Mardini, Moamen Gabr, Wesam M. Frandah)
| | - Wesam M Frandah
- Internal Medicine, Gastroenterology and Hepatology (Karim Benrajab, Houssam Mardini, Moamen Gabr, Wesam M. Frandah)
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24
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Smith S, Ramirez P, Hinds A, Duggan R, Ramirez J. Stent migration following treatment of pancreatic pseudocyst by cyst gastrostomy. Proc AMIA Symp 2019; 32:411-412. [PMID: 31384204 DOI: 10.1080/08998280.2019.1593796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 02/28/2019] [Accepted: 03/07/2019] [Indexed: 12/12/2022] Open
Abstract
Pancreatic pseudocysts are collections of fluid that form as a complication of pancreatitis. Multiple treatment modalities are available; however, stent placement guided by endoscopic ultrasound has become the therapy of choice due to lower complication rates. We present an uncommon case of self-expandable stent migration following endoscopic drainage of a pancreatic pseudocyst.
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Affiliation(s)
- Steven Smith
- Department of Internal Medicine, Scott & White Medical CenterTempleTexas
| | - Patrick Ramirez
- Department of Internal Medicine, Scott & White Medical CenterTempleTexas
| | - Alisha Hinds
- Department of Gastroenterology, Scott & White Medical CenterTempleTexas
| | - Raymond Duggan
- Department of Gastroenterology, Scott & White Medical CenterTempleTexas
| | - Jonathan Ramirez
- Department of Gastroenterology, Scott & White Medical CenterTempleTexas
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25
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Abstract
OBJECTIVE. The purposes of this article are to familiarize radiologists with endoscopic techniques currently in use and to improve identification of clinically relevant imaging findings and procedural complications related to common endoscopic interventions. CONCLUSION. The frequency of performance of therapeutic endoscopic ultrasound-guided procedures has risen precipitously in the last decade. These procedures are replacing surgical and percutaneous approaches to a variety of disease entities. Recent advances include endoscopic bariatric procedures, endoscopic myotomies, and endoscopic ultrasound-guided drainage procedures.
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26
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Spontaneous Closure of a Large Transmural Gastric Defect After Removal of a Migrated AXIOS Stent. ACG Case Rep J 2019; 6:1-3. [PMID: 31620499 PMCID: PMC6658026 DOI: 10.14309/crj.0000000000000033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 12/21/2018] [Indexed: 01/10/2023] Open
Abstract
Pancreatic fluid collections occur in 5%-15% of acute complicated pancreatitis cases. Endoscopic drainage using lumen-apposing metal stents has become the treatment of choice with less incidence of complications, shorter hospital stays, and less cost. The AXIOS stent has proven to be safe and effective in several studies. Despite a low complication rate, bleeding, perforation, and stent migration were still reported. In this case, a patient presented for delayed AXIOS stent removal and was found to have stent migration with embedment in the gastric wall. The transmural defect that resulted after endoscopic stent removal was observed to close spontaneously without further need for intervention.
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27
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Yao Y, Zhang D, Guo J, Qi K, Li F, Zhu J, Wang D, Chen J, Xu C, Wang L, Wang K, Jin Z, Li Z. A novel self-expanding biflanged metal stent vs tubular metal stent for EUS-guided transmural drainage of pancreatic pseudocyst: A retrospective, cohort study. Medicine (Baltimore) 2019; 98:e14179. [PMID: 30653165 PMCID: PMC6370115 DOI: 10.1097/md.0000000000014179] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 12/10/2018] [Accepted: 12/27/2018] [Indexed: 01/06/2023] Open
Abstract
Although endoscopic ultrasound (EUS)-guided transmural drainage of pancreatic fluid collections with metal stents is generally preferred over plastic stents, its superiority among different types of metal stents has not yet been well studied. We conducted this study to compare clinical outcomes and complications of a novel self-expanding biflanged metal stent (BFMS) and a traditional-shaped tubular metal stent (TMS) in treating pancreatic pseudocyst (PPC).This was a retrospective analysis on consecutive patients with PPC underwent EUS-guided transmural drainage with either TMS or BFMS in a single tertiary center with expertise in management of complex biliary and pancreatic problems. The technical and functional success rate, reintervention, complications, and recurrence rate were evaluated.From September 2013 to January 2018, 125 patients (66.4% male, median age 47 years) underwent EUS-guided transmural drainage for PPC. Among them, 49 used TMS and 76 used BFMS. All patients met the inclusion criteria that cyst diameter was >6 cm or the distance between cyst and stomach wall was shorter than 1 cm. There was no difference in technical success (98% vs 97.4%, P = 1.0) or functional success rate (87.8% vs 92.1%, P = .54) using 2 types of metal stents. However, more procedure related complications occurred in TMS than in BFMS group. TMS group had a much higher migration rate than BFMS group (14.6% vs 0, P = .001), even though there was no significant difference in bleeding, infection, or death rate between 2 groups. With similar clinical outcomes, TMS group required more additional plastic stent placement than BFMS group for better drainage.TMS and BFMS placement can both be considered as methods of endoscopic transmural PPC drainage with equal efficacy, whereas BFMS could be preferred for fewer complications or less need of additional plastic stent placement.
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Affiliation(s)
- Yao Yao
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University
| | - Dingguo Zhang
- Department of Gastroenterology, Shenzhen People's Hospital, Second Clinical Medical College of Jinan University, Shenzhen, China
| | - Jiefang Guo
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University
| | - Ke Qi
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University
| | - Feng Li
- Department of Gastroenterology and Hepatology, CHRISTUS Mother Frances Hospital, Tyler, TX
| | - Jianwei Zhu
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University
| | - Dong Wang
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University
| | - Jie Chen
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University
| | - Can Xu
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University
| | - Luowei Wang
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University
| | - Kaixuan Wang
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University
| | - Zhendong Jin
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University
| | - Zhaoshen Li
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University
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Aghdassi A, Simon P, Pickartz T, Budde C, Skube ME, Lerch MM. Endoscopic management of complications of acute pancreatitis: an update on the field. Expert Rev Gastroenterol Hepatol 2018; 12:1207-1218. [PMID: 30791791 PMCID: PMC11851565 DOI: 10.1080/17474124.2018.1537781] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Acute pancreatitis is a frequent, nonmalignant gastrointestinal disorder leading to hospital admission. For its severe form and subsequent complications, minimally invasive and endoscopic procedures are being used increasingly, and are subject to rapid technical advances. Areas covered: Based on a systematic literature search in PubMed, medline, and Web-of-Science, we discuss the currently available treatment strategies for endoscopic therapy of pancreatic pseudocysts, walled-off pancreatic necrosis (WON), and disconnected pancreatic duct syndrome (DPDS), and compare the efficacy and safety of plastic and metal stents. A special focus is placed on studies directly comparing different stent types, including lumen-apposing metal stents (LAMS) and clinical outcomes when draining pseudocysts or WONs. The clinical significance and endoscopic treatment options for DPDS are also discussed. Expert commentary: Endoscopic therapy has become the treatment of choice for different types of pancreatic and peripancreatic collections, the majority of which, however, require no intervention. The use of LAMS has facilitated drainage and necrosectomy in patients with WON or pseudocysts. Serious complications remain a problem in spite of high technical and clinical success rates. DPDS is an increasingly recognized problem in the presence of pseudocysts or WONs but evidence for endoscopic stent placement in this situation remains insufficient.
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Affiliation(s)
- Ali Aghdassi
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Peter Simon
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Tilman Pickartz
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Christoph Budde
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Mariya E. Skube
- Department of Surgery, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Markus. M. Lerch
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
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29
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Petrone MC, Archibugi L, Forti E, Conigliaro R, Di Mitri R, Tarantino I, Fabbri C, Larghi A, Testoni SGG, Mutignani M, Arcidiacono PG. Novel lumen-apposing metal stent for the drainage of pancreatic fluid collections: An Italian multicentre experience. United European Gastroenterol J 2018; 6:1363-1371. [PMID: 30386609 PMCID: PMC6206530 DOI: 10.1177/2050640618785078] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 06/04/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Endoscopic ultrasound (EUS)-guided drainage is the procedure of choice for pancreatic fluid collection (PFC) management. Recently developed lumen-apposing fully covered self-expandable metal stents (LAMSs) may facilitate drainage, especially of necrotic and complex PFCs. OBJECTIVE To evaluate the feasibility and efficacy of a newly developed LAMS (Nagi, Taiwong Medical Co. Ltd, South Korea) in the drainage of PFCs. METHODS Retrospective analysis of LAMS drainage of PFCs from seven centres. Patient demographic, EUS and radiological findings, PFCs aetiology, procedural technical and clinical success, and adverse events were evaluated. RESULTS Sixty-seven patients with mean age 58.8 ± 14 years (68.7% males) were included in the analysis. Of these, 44 patients had pseudocyst (PP) and 23 patients had walled-off pancreatic necrosis (WOPN). Technical success was achieved in 98.5% of cases and clinical success in 94%. The adverse event rate was 24.2%, higher and mostly due to stent migration and occlusion in the WOPN group as compared to the PP group, despite the time to stent removal being significantly lower in the WOPN group. CONCLUSIONS PFC drainage using the Nagi stent is highly feasible and effective, with a relatively safe profile. Future studies enrolling more patients with complex PFCs are needed to clearly establish the role of this stent in PFC management.
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Affiliation(s)
- Maria Chiara Petrone
- Pancreato-Biliary Endoscopy and
Endosonography Division, Pancreas Translational and Clinical Research Center, San
Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan,
Italy
| | - Livia Archibugi
- Digestive and Liver Disease Unit,
Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Edoardo Forti
- Diagnostic and Interventional Digestive
Endoscopy, Niguarda Ca-Granda Hospital, Milan, Italy
| | - Rita Conigliaro
- Gastroenterology and Digestive Endoscopy
Unit, Ospedale S. Agostino-Estense Hospital, Modena, Italy
| | - Roberto Di Mitri
- Gastroenterology and Endoscopy Unit,
ARNAS Civico-Di Cristina-Benfratelli Hospital, Palermo, Italy
| | - Ilaria Tarantino
- Digestive Endoscopy Service, Department
of Diagnostic and Therapeutic Services, IRCCS-ISMETT, Palermo, Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy
Unit, AUSL Bologna, Bologna, Italy
| | - Alberto Larghi
- Digestive Endoscopy Unit, Catholic
University, Rome, Italy
| | - Sabrina Gloria Giulia Testoni
- Pancreato-Biliary Endoscopy and
Endosonography Division, Pancreas Translational and Clinical Research Center, San
Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan,
Italy
| | - Massimiliano Mutignani
- Diagnostic and Interventional Digestive
Endoscopy, Niguarda Ca-Granda Hospital, Milan, Italy
| | - Paolo Giorgio Arcidiacono
- Pancreato-Biliary Endoscopy and
Endosonography Division, Pancreas Translational and Clinical Research Center, San
Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan,
Italy
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30
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Jiang TA, Xie LT. Algorithm for the multidisciplinary management of hemorrhage in EUS-guided drainage for pancreatic fluid collections. World J Clin Cases 2018; 6:308-321. [PMID: 30283794 PMCID: PMC6163138 DOI: 10.12998/wjcc.v6.i10.308] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/05/2018] [Accepted: 07/16/2018] [Indexed: 02/05/2023] Open
Abstract
Pancreatic fluid collections (PFCs), common sequelae of acute or chronic pancreatitis, are broadly classified as pancreatic pseudocysts or walled-off necrosis according to the revised Atlanta classification. Endoscopic ultrasound (EUS)-guided drainage is often considered a standard first-line therapy preferable to surgical or interventional radiology approaches for patients with symptomatic PFC. EUS-guided drainage is effective and successful; it has a technical success rate of 90%-100% and a clinical success rate of 85%-98%. Recent studies have shown a 5%-30% adverse events (AEs) rate for the procedure. The most common AEs include infection, hemorrhage, perforation and stent migration. Hemorrhage, a severe and sometimes deadly outcome, requires a well-organized and appropriate treatment strategy. However, few studies have reported the integrated management of hemorrhage during EUS-guided drainage of PFC. Establishing a practical therapeutic strategy is an essential and significant step in standardized management. The aim of this review is to describe the current situation of EUS-guided drainage of PFCs, including the etiology and treatment of procedure-related bleeding as well as current problems and future perspectives. We propose a novel and meaningful algorithm for systematically managing hemorrhage events. To our limited knowledge, a multidisciplinary algorithm for managing EUS-guided drainage for PFC-related bleeding has not been previously reported.
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Affiliation(s)
- Tian-An Jiang
- Department of Ultrasound, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Li-Ting Xie
- Department of Ultrasound, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
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31
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Yoon SB, Chang JH, Lee IS. [Treatment of Pancreatic Fluid Collections]. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2018; 72:97-103. [PMID: 30270591 DOI: 10.4166/kjg.2018.72.3.97] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Pancreatic Fluid Collection (PFC) develops as a result of acute pancreatitis, chronic pancreatitis, trauma, and postoperation. Although percutaneous drainage, surgery and Endoscopic Retrograde Panceatogram are used as conventional treatments in complicated PFC, the clinical course of PFC is unsatisfactory due to its clinical success rate and the risk of procedure-related complications. Endoscopic ultrasonography-guided transmural drainage of PFC is a safe and effective modality for the management of PFC, particularly in patients with pancreas necrosis. A range of techniques and stents have been introduced and a newly designed metal stent is now available.
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Affiliation(s)
- Seung Bae Yoon
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Hyuck Chang
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In Seok Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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32
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Aburajab M, Smith Z, Khan A, Dua K. Safety and efficacy of lumen-apposing metal stents with and without simultaneous double-pigtail plastic stents for draining pancreatic pseudocyst. Gastrointest Endosc 2018; 87:1248-1255. [PMID: 29233670 DOI: 10.1016/j.gie.2017.11.033] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 11/20/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Lumen-apposing metal stents (LAMSs) are used to perform necrosectomy in walled-off necrosis (WON). Although necrosectomy is not required for pancreatic pseudocyst (PP), an increasing number of PPs are also being drained with LAMSs in view of their ease of deployment. The aim of the present study was to evaluate the safety and efficacy of using LAMSs to drain PPs. METHODS At 1 tertiary center from January 2014 to May 2016, all consecutive patients with PPs were drained by LAMSs, and the data were retrospectively reviewed. After observing cyst-cavity infection in patients enrolled initially (group I), 10F double-pigtail stents (DPSs) were placed across LAMSs in the subsequent patients (group II). Data on technical success, PP resolution, adverse events, and reintervention rates were collected. RESULTS Forty-seven patients with PPs (mean size, 9.5 ± 4.0 cm) were enrolled (group I, 24; group II, 23). There was 1 perforation at deployment (technical success, 98%). In the remaining 46 patients, resolution of the PP was observed in 44 patients (96%). Four patients (17%) in group I presented with PP infection requiring reinterventions. Food material was observed in the cyst cavity. None of the patients in group II had PP infection (relative risk, .84; 95% confidence interval, .71-1.0; P = .054). CONCLUSIONS Similar to WON, LAMSs are also effective in endoscopic drainage of PPs. However, there was a trend toward higher PP infection with LAMSs, and placing a DPS across the LAMS minimized this risk.
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Affiliation(s)
- Murad Aburajab
- Department of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, USA
| | - Zachary Smith
- Department of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, USA
| | - Abdul Khan
- Department of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, USA
| | - Kulwinder Dua
- Department of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, USA
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Siddiqui UD, Levy MJ. EUS-Guided Transluminal Interventions. Gastroenterology 2018; 154:1911-1924. [PMID: 29458153 DOI: 10.1053/j.gastro.2017.12.046] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 11/24/2017] [Accepted: 12/08/2017] [Indexed: 12/13/2022]
Abstract
The role of endoscopic ultrasound (EUS) has transitioned from a diagnostic to a therapeutic one over the past 40 years. With the advent of curvilinear array echoendoscopes in the 1990s with an accessory channel, multiple tools and devices have been developed and used for a variety of transluminal interventions. EUS provides a viable option and is becoming the procedure of choice for many interventions, including bile and pancreatic duct drainage, guiding angiotherapy, pancreatic fluid collection management, gallbladder drainage, and creating a gastrojejunostomy. Although reports demonstrate the technical success of these interventions, there is tremendous study heterogeneity and a relative lack of controlled randomized trials, which may limit our understanding of their role and utility. Furthermore, adverse events are relatively common and occasionally severe. Despite the limitations, available data strongly indicate the efficacy of EUS interventions when performed by well-trained endosonographers in carefully selected patients and managed in a multidisciplinary setting.
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Affiliation(s)
- Uzma D Siddiqui
- Center for Endoscopic Research and Therapeutics (CERT), The University of Chicago Medicine, Chicago, Illinois.
| | - Michael J Levy
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
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Abstract
Open surgical intervention for treatment of simple pancreatic pseuodocyst (PP) has a high success rate and has been the historical gold standard. Open surgical intervention, however, confers significant morbidity and mortality, which has spurred the development of less invasive techniques. Laparoscopic approaches are feasible with the potential for lower complication rates and length of stay. The endoscopic approach has the appeal of potentially shorter hospitalization length of stays and does not require general anesthesia. Complicated PPs or those that arise in the setting of chronic pancreatitis warrant additional workup and special consideration.
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Affiliation(s)
- Lea Matsuoka
- Department of Surgery, Vanderbilt University, 801 Oxford House, 1313 21st Avenue South, Nashville, TN 37232, USA.
| | - Sophoclis P Alexopoulos
- Department of Surgery, Vanderbilt University, 801 Oxford House, 1313 21st Avenue South, Nashville, TN 37232, USA
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Venkatachalapathy SV, Bekkali N, Pereira S, Johnson G, Oppong K, Nayar M, Leeds J, Paranandi B, Penman I, Carroll N, Godfrey E, James M, Aithal G, McKay C, Devlin J, Wong T, Makin A, Ryan B, Huggett M. Multicenter experience from the UK and Ireland of use of lumen-apposing metal stent for transluminal drainage of pancreatic fluid collections. Endosc Int Open 2018; 6:E259-E265. [PMID: 29497684 PMCID: PMC5829997 DOI: 10.1055/s-0043-125362] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 11/22/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND STUDY AIMS Pancreatic fluid collection (PFC) is a common complication of pancreatitis for which endoscopic ultrasound-guided drainage is first-line treatment. A new single-device, lumen-apposing, covered self-expanding metal stent (LAMS) has been licensed for PFC drainage. We therefore present our multicenter experience with the LAMS for PFC drainage in a multicenter prospective case series to assess success and complication rates. PATIENTS AND METHODS All adult patients from 11 tertiary centers who had LAMS placement for PFC from July 2015 to July 2016 were included. Data including indications, technical success, clinical success, collection resolution, stent removal, early and late adverse events (AEs), mortality and recurrence at 6 months were collected. RESULTS 116 patients, median age 52.5 years (range 16 - 80) and 67 % male, were treated with a single LAMS in each case. The indication was walled off necrosis (WON) in 70 and pseudocyst in 46. Median size of the PFC was 11 cm (5 - 21 cm) and the estimated median necrotic volume in WON was 30 % (5 % - 90 %). Stent insertion was technically successful in 115 (99.1 %) and clinically successful in 109 (94 %). Early serious AEs (SAEs): n = 7 sepsis, n = 1 stent blockage with food, n = 1 stent migration requiring laparotomy, n = 1 stent dislodgement and n = 1 bleeding requiring emboliZation. Late AEs: n = 1 buried stent and n = 1 esophageal fistula. Non-procedure-related deaths: n = 3 (2.5 %). CONCLUSION This multicenter case series demonstrates that use of the new LAMS is feasible, effective and relatively safe in draining PFC with a technical success rate of 99 % and cumulative SAE rate of 11.2 %.
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Affiliation(s)
- Suresh Vasan Venkatachalapathy
- Nottingham University Hospitals NHS Trust And University Of Nottingham – Nottingham Biomedical Research Centre and NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom of Great Britain and Northern Ireland,Corresponding author Suresh Vasan Venkatachalapathy Nottingham Biomedical Research Centre and NIHR Nottingham Biomedical Research Centre – HPB medicineQueen's medical centre Derby road Nottingham NG7 2UHUnited Kingdom of Great Britain and Northern Ireland+011-59-70-9012
| | - Noor Bekkali
- Freeman Hospital – HPB Unit, Newcastle upon Tyne, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland
| | - Stephen Pereira
- University College London – UCL Institute of Hepatology, London, London, United Kingdom of Great Britain and Northern Ireland,University College Hospitals NHS Foundation Trust – Department of Gastroenterology, London, London, United Kingdom of Great Britain and Northern Ireland
| | - Gavin Johnson
- University College Hospitals NHS Foundation Trust – Department of Gastroenterology, London, London, United Kingdom of Great Britain and Northern Ireland
| | - Kofi Oppong
- Freeman Hospital – HPB Unit, Newcastle upon Tyne, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland
| | - Manu Nayar
- Freeman Hospital – HPB Unit, Newcastle upon Tyne, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland
| | - John Leeds
- Freeman Hospital – HPB Unit, Newcastle upon Tyne, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland
| | - Bharat Paranandi
- Leeds Teaching Hospitals NHS Trust – Gastroenterology, Leeds, Leeds, United Kingdom of Great Britain and Northern Ireland
| | - Ian Penman
- Royal Infirmary of Edinburgh- Gastroenterology, Edinburgh, Edinburgh, United Kingdom of Great Britain and Northern Ireland
| | - Nicholas Carroll
- Cambridge University Hospitals NHS Foundation Trust – Radiology, Cambridge, Cambridgeshire, United Kingdom of Great Britain and Northern Ireland
| | - Edmund Godfrey
- Cambridge University Hospitals NHS Foundation Trust – Radiology, Cambridge, Cambridgeshire, United Kingdom of Great Britain and Northern Ireland
| | - Martin James
- Nottingham University Hospitals NHS Trust And University Of Nottingham – Nottingham Biomedical Research Centre and NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom of Great Britain and Northern Ireland
| | - Guruprasad Aithal
- Nottingham University Hospitals NHS Trust And University Of Nottingham – Nottingham Biomedical Research Centre and NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom of Great Britain and Northern Ireland
| | - Colin McKay
- Glasgow Royal Infirmary – Pancreatic Surgery, Glasgow, Glasgow, United Kingdom of Great Britain and Northern Ireland
| | - John Devlin
- King's College Hospital NHS Foundation Trust – Hepatology, London, London, United Kingdom of Great Britain and Northern Ireland
| | - Terry Wong
- Guys and St Thomas' NHS Foundation Trust – Gastroenterology, London, United Kingdom of Great Britain and Northern Ireland
| | - Alistair Makin
- Central Manchester University Hospitals NHS Foundation Trust – Gastroenterology, Manchester, Greater Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Barbara Ryan
- Tallaght Hospital/Trinity College Dublin – Gastroenterology, Dublin, Ireland
| | - Matthew Huggett
- Leeds Teaching Hospitals NHS Trust – Gastroenterology, Leeds, Leeds, United Kingdom of Great Britain and Northern Ireland
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Hammad T, Khan MA, Alastal Y, Lee W, Nawras A, Ismail MK, Kahaleh M. Efficacy and Safety of Lumen-Apposing Metal Stents in Management of Pancreatic Fluid Collections: Are They Better Than Plastic Stents? A Systematic Review and Meta-Analysis. Dig Dis Sci 2018; 63:289-301. [PMID: 29282638 DOI: 10.1007/s10620-017-4851-0] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 11/14/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS Endoscopic ultrasound (EUS)-guided transmural drainage has been increasingly utilized as a first-line therapeutic modality for drainage of pancreatic fluid collections (PFC). Recently, lumen-apposing metal stents (LAMS) have been utilized for management of PFCs. We conducted a systematic review and meta-analysis to evaluate the cumulative efficacy and safety of LAMS in the management of PFC (primary outcome). We also compared the efficacy and safety of LAMS with multiple plastic stents (MPS) in the management of PFC (secondary outcome). METHODS We searched Medline, Embase and Cochrane databases from inception to November 5, 2016, to identify studies (with ≥ 10 patients) reporting technical success, clinical success, and adverse events (AE) of EUS-guided transmural drainage of PFC using LAMS. Weighted pooled rates (WPR) were calculated for technical success, clinical success and AE. Risk ratios (RR) were calculated and pooled to compare LAMS with MPS in terms of technical success, clinical success, and AE. Pooled mean difference (MD) was calculated to compare the number of endoscopic sessions required by each type of stent to achieve clinical success. All analyses were done using random effects model. RESULTS Eleven studies with 688 patients were included in this meta-analysis. WPR for technical success of LAMS in PFC management was 98% (96, 99%), (I 2 = 15%). WPR for clinical success was 93% (89, 96%) with moderate heterogeneity (I 2 = 50%). There was no difference in clinical success for pseudocysts (PP) versus walled-off pancreatic necrosis (WON) (P = 0.51). WPR for AE was 13% (9, 20%), (I 2 = 64%). AE were 10% more in WON as compared to PP (P = 0.009). Most common AE requiring intervention was stent migration (4.2%), followed by infection (3.8%), bleeding (2.4%), and stent occlusion (1.9%). Six studies with 504 patients compared the performance of LAMS with MPS. Pooled RR for technical success was 1.71 (0.38, 7.37). Pooled RR for clinical success was 0.37 (0.20, 0.67) in favor of LAMS. Pooled RR for AE was 0.39 (0.18, 0.84), (I 2 = 50%). Pooled MD for number of endoscopic sessions was - 0.84 (- 1.69, 0.01). CONCLUSIONS LAMS seem to have excellent efficacy and safety in the management of PFCs. They may be preferred over plastic stents as they are associated with better clinical success and lesser adverse events.
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Affiliation(s)
- Tariq Hammad
- Division of Gastroenterology and Hepatology, University of Toledo, Toledo, OH, USA.,Division of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA
| | - Muhammad Ali Khan
- Division of Gastroenterology and Hepatology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Yaseen Alastal
- Division of Gastroenterology and Hepatology, University of Toledo, Toledo, OH, USA
| | - Wade Lee
- Carlson and Mulford Libraries, University of Toledo, Toledo, OH, USA
| | - Ali Nawras
- Division of Gastroenterology and Hepatology, University of Toledo, Toledo, OH, USA
| | - Mohammad Kashif Ismail
- Division of Gastroenterology and Hepatology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Michel Kahaleh
- Department of Gastroenterology and Hepatology, Weill Cornell Medical College, 1305 York Avenue, 4th Floor, New York, NY, 10021, USA.
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EUS-guided drainage of peripancreatic fluid collections with lumen-apposing metal stents and plastic double-pigtail stents: comparison of efficacy and adverse event rates. Gastrointest Endosc 2018; 87:150-157. [PMID: 28713067 DOI: 10.1016/j.gie.2017.06.029] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 06/20/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Transmural drainage with double-pigtail plastic stents (DPPSs) was the mainstay of endoscopic therapy for symptomatic peripancreatic fluid collections (PPFCs) until the introduction of lumen-apposing covered self-expanding metal stents (LAMSs). Currently, there are limited data regarding the efficacy and adverse event rate of LAMSs compared with DPPSs. METHODS A retrospective analysis of EUS-guided PPFC drainage at a single tertiary care center between 2008 and 2015 was performed. Patients were classified based on drainage method: DPPSs and LAMSs. Adverse event rates, unplanned endoscopic procedures/necrosectomies, and PPFC resolution within 6 months were recorded. Significant bleeding was defined as necessitating transfusion or requiring endoscopic treatment/radiographic embolization. Subsequent endoscopic procedures were defined as unplanned procedures; stent removals were excluded. RESULTS A total of 103 patients met inclusion criteria (84 DPPSs, 19 LAMSs). PPFCs were classified as walled-off necrosis (WON) in 23 (14 DPPSs, 9 LAMSs). There were significantly more bleeding episodes in the LAMS group (4 [19%]: 2 splenic artery pseudo-aneurysms, 1 collateral vessel bleed, 1 intracavitary variceal bleed; P = .0003) than in the DPPS group (1 (1%]: stent erosion into the gastric wall). One perforation occurred in the DPPS group. Unplanned repeat endoscopy was more frequent in the LAMS group (10% vs 26%, P = .07). Among retreated LAMS patients in with WON, 5 (56%) had obstruction by necrotic debris. In patients for whom follow-up was available, 67 of 70 (96%) with DPPSs and 16 of 17 (94%) with LAMSs had resolution of PPFCs within 6 months (P = .78). CONCLUSIONS DPPSs and LAMSs are effective methods for treatment of PPFCs. In our cohort, use of LAMSs was associated with significantly higher rates of procedure-related bleeding and greater need for repeat endoscopic intervention.
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38
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Ge N, Hu J, Sun S, Linghu E, Jin Z, Li Z. Endoscopic Ultrasound-guided Pancreatic Pseudocyst Drainage with Lumen-apposing Metal Stents or Plastic Double-pigtail Stents: A Multifactorial Analysis. J Transl Int Med 2017. [PMID: 29340278 DOI: 10.1515/jtim-2017-0036.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To compare the efficiency of plastic and metal stents for symptomatic pancreatic pseudocyst (PP) drainage and analyze other main associated factors that affect the outcome of drainage therapy. Method Rates of technical and clinical success, procedure-related side effects (hemorrhage, stent migration, and cyst rupture), reinterventions, and duration of hospital stay. Results There were 52 patients, 40 patients underwent plastic stent placement and 12 patients underwent lumen-apposing metal stent (LAMS) placement. The total rate of technical success was 100%. The total rate of clinical success was 100%. The total rate of adverse events was 7.7% (4/52). On multiple logistic regression analysis, the use of plastic stents (P < 0.05, Exp B = 12.168) and the presence of a large cyst (P < 0.05, Exp B = 1.036) were shown to significantly increase the risk of reintervention. On multivariate linear regression analysis, etiology of pseudocyst (P < 0.05, B = -8.427, -9.785, -5.514) was associated with prolonged hospital stent, while stent type was not shown be a factor (P > 0.05). Conclusion Both plastic and LAMSs are proven to be highly efficient in PP drainage. The LAMS is superior in preventing complications such as migration and cyst leakage and reducing the rate of reintervention.
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Affiliation(s)
- Nan Ge
- Endoscopy center, Shengjing Hospital of China Medical University, Shenyang110004, Liaoning Province, China
| | - Jinlong Hu
- Endoscopy center, Shengjing Hospital of China Medical University, Shenyang110004, Liaoning Province, China
| | - Siyu Sun
- Endoscopy center, Shengjing Hospital of China Medical University, Shenyang110004, Liaoning Province, China
| | - Enqiang Linghu
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
| | - Zhendong Jin
- Department of Gastroenterology, Changhai Hospital, the Second Military Medical University, Shanghai, China
| | - Zhaoshen Li
- Department of Gastroenterology, Changhai Hospital, the Second Military Medical University, Shanghai, China
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Ge N, Hu J, Sun S, Linghu E, Jin Z, Li Z. Endoscopic Ultrasound-guided Pancreatic Pseudocyst Drainage with Lumen-apposing Metal Stents or Plastic Double-pigtail Stents: A Multifactorial Analysis. J Transl Int Med 2017; 5:213-219. [PMID: 29340278 PMCID: PMC5767711 DOI: 10.1515/jtim-2017-0036] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To compare the efficiency of plastic and metal stents for symptomatic pancreatic pseudocyst (PP) drainage and analyze other main associated factors that affect the outcome of drainage therapy. METHOD Rates of technical and clinical success, procedure-related side effects (hemorrhage, stent migration, and cyst rupture), reinterventions, and duration of hospital stay. RESULTS There were 52 patients, 40 patients underwent plastic stent placement and 12 patients underwent lumen-apposing metal stent (LAMS) placement. The total rate of technical success was 100%. The total rate of clinical success was 100%. The total rate of adverse events was 7.7% (4/52). On multiple logistic regression analysis, the use of plastic stents (P < 0.05, Exp B = 12.168) and the presence of a large cyst (P < 0.05, Exp B = 1.036) were shown to significantly increase the risk of reintervention. On multivariate linear regression analysis, etiology of pseudocyst (P < 0.05, B = -8.427, -9.785, -5.514) was associated with prolonged hospital stent, while stent type was not shown be a factor (P > 0.05). CONCLUSION Both plastic and LAMSs are proven to be highly efficient in PP drainage. The LAMS is superior in preventing complications such as migration and cyst leakage and reducing the rate of reintervention.
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Affiliation(s)
- Nan Ge
- Endoscopy center, Shengjing Hospital of China Medical University, Shenyang110004, Liaoning Province, China
| | - Jinlong Hu
- Endoscopy center, Shengjing Hospital of China Medical University, Shenyang110004, Liaoning Province, China
| | - Siyu Sun
- Endoscopy center, Shengjing Hospital of China Medical University, Shenyang110004, Liaoning Province, China
| | - Enqiang Linghu
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
| | - Zhendong Jin
- Department of Gastroenterology, Changhai Hospital, the Second Military Medical University, Shanghai, China
| | - Zhaoshen Li
- Department of Gastroenterology, Changhai Hospital, the Second Military Medical University, Shanghai, China
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Sahar N, Kozarek R, Kanji ZS, Ross AS, Gluck M, Gan SI, Larsen M, Irani S. Do lumen-apposing metal stents (LAMS) improve treatment outcomes of walled-off pancreatic necrosis over plastic stents using dual-modality drainage? Endosc Int Open 2017; 5:E1052-E1059. [PMID: 29090245 PMCID: PMC5658217 DOI: 10.1055/s-0043-111794] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 05/15/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Endoscopic ultrasound-guided drainage of symptomatic walled-off pancreatic necrosis (WON) usually has been performed with double pigtail plastic stents (DPS) and more recently, with lumen-apposing metal stents (LAMS). However, LAMS are significantly more expensive and there are no comparative studies with DPS. Accordingly, we compared our experience with combined endoscopic and percutaneous drainage (dual-modality drainage [DMD]) for symptomatic WON using LAMS versus DPS. PATIENTS AND METHODS Patients who underwent DMD of WON between July 2011 and June 2016 using LAMS were compared with a matched group treated with DPS. Technical success, clinical success, need for reintervention and adverse events (AE) were recorded. RESULTS A total of 50 patients (31 males, 25 patients treated with LAMS and 25 patients treated with DPS) were matched for age, sex, computed tomography severity index, and disconnected pancreatic ducts. Technical success was achieved in all patients. Mean days hospitalized post-intervention (14.5 vs. 13.1, P = 0.72), time to resolution of WON (77 days vs. 63 days, P = 0.57) and mean follow-up (207 days vs. 258 days, P = 0.34) were comparable in both groups. AEs were similar in both groups (6 vs. 8, P = 0.53). Patients treated with LAMS had significantly more reinterventions per patient (1.5 vs. 0.72, P = 0.01). CONCLUSIONS In treatment of symptomatic WON using DMD, LAMS did not shorten time to percutaneous drain removal and was not associated with fewer AEs.
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Affiliation(s)
- Nadav Sahar
- Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, United States
| | - Richard Kozarek
- Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, United States
| | - Zaheer S. Kanji
- Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, United States
| | - Andrew S. Ross
- Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, United States
| | - Michael Gluck
- Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, United States
| | - S. Ian Gan
- Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, United States
| | - Michael Larsen
- Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, United States
| | - Shayan Irani
- Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, United States,Corresponding author Shayan Irani Division of Gastroenterology and HepatologyVirginia Mason Medical Center1100 Ninth Avenue, C3-GASSeattle, WA 98101+1-206-625-7195
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Moutinho-Ribeiro P, Peixoto A, Macedo G. Endoscopic Retrograde Cholangiopancreatography and Endoscopic Ultrasound: To Be One Traveler in Converging Roads. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2017; 25:138-145. [PMID: 29761150 DOI: 10.1159/000481537] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 09/14/2017] [Indexed: 12/28/2022]
Abstract
Background Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) were initially introduced into the world of gastroenterology as purely diagnostic procedures. With progressive evolution of intervention, both these techniques conquered fields in the treatment of many conditions that had once been exclusively surgical domains. Nowadays, more and more clinical situations have an indication to perform both EUS and ERCP, and these two techniques are frequently required at the same time for the same patient. More than competitors, ERCP and EUS are truly complementary, with great ability for mutual aid. They share their main indications, equipment, accessories, and main technical gestures. Objectives and Methods We review the major indications to perform both techniques, sequentially or complementarily, describe the common things that these two techniques essentially share, and discuss the ERCP-EUS single session. Also, the issues of learning curves and education of upcoming biliopancreatic endoscopists are highlighted. Conclusion In recent years the complementation between ECRP and EUS has been growing both from a diagnostic and a therapeutic point of view, allowing optimization of the use of these techniques and the creation of a more systematized approach of patients with biliopancreatic pathology. Endoscopists with experience in both techniques will be increasingly important, suggesting a parallel formation in the training plans of future endoscopists with interest in the area.
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Affiliation(s)
- Pedro Moutinho-Ribeiro
- Gastroenterology Department, Centro Hospitalar São João, and Porto World Gastroenterology Organization Training Center, University of Porto Medical School, Porto, Portugal
| | - Armando Peixoto
- Gastroenterology Department, Centro Hospitalar São João, and Porto World Gastroenterology Organization Training Center, University of Porto Medical School, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar São João, and Porto World Gastroenterology Organization Training Center, University of Porto Medical School, Porto, Portugal
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Guo J, Saftoiu A, Vilmann P, Fusaroli P, Giovannini M, Mishra G, Rana SS, Ho S, Poley JW, Ang TL, Kalaitzakis E, Siddiqui AA, De La Mora-Levy JG, Lakhtakia S, Bhutani MS, Sharma M, Mukai S, Garg PK, Lee LS, Vila JJ, Artifon E, Adler DG, Sun S. A multi-institutional consensus on how to perform endoscopic ultrasound-guided peri-pancreatic fluid collection drainage and endoscopic necrosectomy. Endosc Ultrasound 2017; 6:285-291. [PMID: 29063871 PMCID: PMC5664848 DOI: 10.4103/eus.eus_85_17] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 09/12/2017] [Indexed: 12/13/2022] Open
Abstract
There is a lack of consensus on how endoscopic ultrasound (EUS)-guided pseudocyst drainage and endoscopic necrosectomy should be performed. This survey was carried out amongst members of the EUS Journal Editorial Board to describe their practices in performing this procedure. This was a worldwide multi-institutional survey amongst members of the EUS Journal Editorial Board in May 2017. The responses to a 22-question survey with respect to the practice of EUS-guided pseudocyst drainage and endoscopic necrosectomy were obtained. Twenty-two endoscopists responded to the questionnaire as follows: 72.7% (16/22) were of the opinion that lumen-apposing metal stents (LAMS) should be the standard of care for the creation of an endoscopic cystenterostomy in patients with pancreatic walled-off necrosis (WON); 95.5% (21/22) recommended large diameter (d=15 mm) LAMS for drainage in patients with WON; 54.5% (12/22) would not dilate LAMS after placement into the WOPN; 86.4% (19/22) would not perform endoscopic necrosectomy during the same procedure as the creation of the cystenterostomy; 45.5% (10/22) recommend that agents, such as diluted hydrogen peroxide, should be used to lavage the peri-pancreatic fluid collection (PFC) cavity in patients with WON; and 45.5% (10/22) considered a naso-cystic or other tube to be necessary for lavage of WON after initial drainage. The mean optimal interval recommended for endoscopic necrosectomy procedures after EUS-guided drainage was 6.23 days. The mean optimal interval recommended for repeat imaging in patients undergoing endoscopic necrosectomy was 12.32 days. The mean time recommended for LAMS removal was 4.59 weeks. This is the first worldwide survey on the practice of EUS-guided pseudocyst drainage and endoscopic necrosectomy. There were wide variations in practice and randomized studies are urgently needed to establish the best approach for management of this condition. There is also a pressing need to establish a best practice consensus.
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Affiliation(s)
- Jintao Guo
- Endoscopy Center, Sheng Jing Hospital of China Medical University, Shenyang, China
| | - Adrian Saftoiu
- Department of Endoscopy, University of Medicine and Pharmacy, Craiova, Romania
| | - Peter Vilmann
- Endoscopy Department, GastroUnit, Copenhagen University Hospital, Copenhagen, Denmark
| | - Pietro Fusaroli
- Gastroenterology Unit, University of Bologna, Bologna, Italy
| | - Marc Giovannini
- Pathology Unit (Flora Poizat), Institute Paoli-Calmettes, Marseille, France
| | | | - Surinder S. Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sammy Ho
- Montefiore Medical Center, New York, USA
| | - Jan-Werner Poley
- Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tiing Leong Ang
- Gastroenterology Department, Changi General Hospital, Singapore, Singapore
| | - Evangelos Kalaitzakis
- Endoscopy Unit, Digestive Disease Center, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ali A. Siddiqui
- Division of Digestive and Liver Diseases, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | | | - Sundeep Lakhtakia
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, USA
| | | | - Malay Sharma
- Department of Gastroenterology, Jaswant Rai Specialty Hospital, Meerut, Uttar Pradesh
| | - Shuntaro Mukai
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Pramod Kumar Garg
- Department of Gastroenterology, All Institute of Medical Sciences, New Delhi, India
| | - Linda S. Lee
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA, USA
| | - Juan J. Vila
- Endoscopy Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Everson Artifon
- Department of Surgery, Ana Costa Hospital, Sao Paulo, Brazil
| | - Douglas G. Adler
- Division of Gastroenterology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Siyu Sun
- Endoscopy Center, Sheng Jing Hospital of China Medical University, Shenyang, China
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Mukai S, Tsuchiya T, Itoi T, Tsuji S, Tanaka R, Tonozuka R, Nagakawa Y, Kasuya K, Shimatani M, Sofuni A. Prospective evaluation of a new biflanged metal stent for the treatment of pancreatic fluid collections (with videos). Gastrointest Endosc 2017; 86:203-207. [PMID: 27908599 DOI: 10.1016/j.gie.2016.11.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 11/14/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS EUS-guided transluminal drainage (EUS-TD) and sequential direct endoscopic necrosectomy (DEN) for pancreatic fluid collections (PFCs) by using a dedicated biflanged metal stent (BFMS) has been reported as a useful alternative to using plastic stents or a conventional metal stent. However, current dedicated BFMSs have limitations. Recently, a new BFMS with solidly constructed biflanges and various stent lengths matched to the PFC condition has been developed. Herein, we prospectively evaluated this new BFMS for the treatment of PFCs. METHODS From July 2015 to July 2016, EUS-TD by using the new BFMS was performed in 12 patients for PFCs (4 patients with pancreatic pseudocysts, 8 patients with walled-off necrosis). When clinical resolution could not be achieved, DEN was performed the following day. RESULTS The stent was deployed successfully with a median procedure time of 16 minutes (range 11-24 minutes) and with no procedure-related adverse events in any patients (12/12, 100%). DEN via the stent was achieved in all patients in whom they were attempted (4/4,100%). Spontaneous stent migration or stent dislocation during DEN was not observed in any patients. Two WON patients died from spontaneous pseudoaneurysm rupture and multiple organ failure. The PFCs in the other 10 patients completely resolved, and later the stent was removed with no difficulty in 9 patients after a median time of 48 days (range 30-180 days). CONCLUSIONS The new BFMS is technically feasible and safe for the treatment of PFCs. (Clinical trial registration number: UMIN000021347.).
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Affiliation(s)
- Shuntaro Mukai
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Takayoshi Tsuchiya
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Shujiro Tsuji
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Reina Tanaka
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Ryosuke Tonozuka
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Yuichi Nagakawa
- Third Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kazuhiko Kasuya
- Third Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Masaaki Shimatani
- Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Atsushi Sofuni
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
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Rare Esophageal Migration of AXIOS Stent Used for Walled-off Pancreatic Necrosis Drainage. ACG Case Rep J 2017; 4:e73. [PMID: 28584846 PMCID: PMC5449571 DOI: 10.14309/crj.2017.73] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 04/12/2017] [Indexed: 12/26/2022] Open
Abstract
The AXIOS stent (Boston Scientific, Marlborough, MA) is a novel lumen-apposing self-expandable metallic stent designed for enteric drainage of nonadherent lumens. Efficacy and safety of using the AXIOS stent for pancreatic fluid drainage have been consistently shown in several studies. Although it is less common with this novel stent, stent migration still may happen. We present a case of AXIOS stent migration into the esophagus.
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Sica M, Mutignani M, Alberto T, Manta R. Endoscopic ultrasound-guided drainage of pancreatic pseudocyst after gastrogastric anastomosis in patient with Roux-en-Y gastric bypass: The dream becomes reality! Endosc Ultrasound 2017. [PMID: 28621303 PMCID: PMC5488529 DOI: 10.4103/2303-9027.208176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Mariano Sica
- Surgical Department, Endoscopy Unit, Niguarda Ca-Granda Hospital, Piazza dell'Ospedale Maggiore 3, 20162, Milan, Italy
| | - Massimiliano Mutignani
- Surgical Department, Endoscopy Unit, Niguarda Ca-Granda Hospital, Piazza dell'Ospedale Maggiore 3, 20162, Milan, Italy
| | - Tringali Alberto
- Surgical Department, Endoscopy Unit, Niguarda Ca-Granda Hospital, Piazza dell'Ospedale Maggiore 3, 20162, Milan, Italy
| | - Raffaele Manta
- Surgical Department, Endoscopy Unit, Niguarda Ca-Granda Hospital, Piazza dell'Ospedale Maggiore 3, 20162, Milan, Italy
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Fully covered self-expanding metal stents versus lumen-apposing fully covered self-expanding metal stent versus plastic stents for endoscopic drainage of pancreatic walled-off necrosis: clinical outcomes and success. Gastrointest Endosc 2017; 85:758-765. [PMID: 27566053 DOI: 10.1016/j.gie.2016.08.014] [Citation(s) in RCA: 217] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 08/11/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Endoscopic transmural drainage/debridement of pancreatic walled-off necrosis (WON) has been performed using double-pigtail plastic (DP), fully covered self-expanding metal stents (FCSEMSs), or the novel lumen-apposing fully covered self-expanding metal stent (LAMS). Our aim was to perform a retrospective cohort study to compare the clinical outcomes and adverse events of EUS-guided drainage/debridement of WON with DP stents, FCSEMSs, and LAMSs. METHODS Consecutive patients in 2 centers with WON managed by EUS-guided debridement were divided into 3 groups: (1) those who underwent debridement using DP stents, (2) debridement using FCSEMSs, (3) debridement using LAMSs. Technical success (ability to access and drain a WON by placement of transmural stents), early adverse events, number of procedures performed per patient to achieve WON resolution, and long-term success (complete resolution of the WON without need for further reintervention at 6 months after treatment) were evaluated. RESULTS From 2010 to 2015, 313 patients (23.3% female; mean age, 53 years) underwent WON debridement, including 106 who were drained using DP stents, 121 using FCSEMSs, and 86 using LAMSs. The 3 groups were matched for age, cause of the pancreatitis, WON size, and location. The cause of the patients' pancreatitis was gallstones (40.6%), alcohol (30.7%), idiopathic (13.1%), and other causes (15.6%). The mean cyst size was 102 mm (range, 20-510 mm). The mean number of endoscopy sessions was 2.5 (range, 1-13). The technical success rate of stent placement was 99%. Early adverse events were noted in 27 of 313 (8.6%) patients (perforation in 6, bleeding in 8, suprainfection in 9, other in 7). Successful endoscopic therapy was noted in 277 of 313 (89.6%) patients. When comparing the 3 groups, there was no difference in the technical success (P = .37). Early adverse events were significantly lower in the FCSEMS group compared with the DP and LAMS groups (1.6%, 7.5%, and 9.3%; P < .01). At 6-month follow-up, the rate of complete resolution of WON was lower with DP stents compared with FCSEMSs and LAMSs (81% vs 95% vs 90%; P = .001). The mean number of procedures required for WON resolution was significantly lower in the LAMS group compared with the FCSEMS and DP groups (2.2 vs 3 vs 3.6, respectively; P = .04). On multivariable analysis, DP stents remain the sole negative predictor for successful resolution of WON (odds ratio [OR], 0.18; 95% confidence interval, 0.06-0.53; P = .002) after adjusting for age, sex, and WON size. Although there was no significant difference between FCSEMSs and LAMSs for WON resolution, the LAMS was more likely to have early adverse events (OR, 6.6; P = .02). CONCLUSIONS EUS-guided drainage/debridement of WON using FCSEMSs and LAMSs is superior to DP stents in terms of overall treatment efficacy. The number of procedures required for WON resolution was significantly lower with LAMSs compared with FCSEMSs and DP stents.
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Yoo J, Yan L, Hasan R, Somalya S, Nieto J, Siddiqui AA. Feasibility, safety, and outcomes of a single-step endoscopic ultrasonography-guided drainage of pancreatic fluid collections without fluoroscopy using a novel electrocautery-enhanced lumen-apposing, self-expanding metal stent. Endosc Ultrasound 2017; 6:131-135. [PMID: 28440239 PMCID: PMC5418966 DOI: 10.4103/2303-9027.204814] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVES There are currently limited data available regarding the safety of endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collections (PFCs) using the lumen-apposing metal stent without fluoroscopic guidance. This study aims to evaluate clinical outcomes and safety of EUS-guided drainage of PFC using the electrocautery-enhanced lumen-apposing metal stents (EC-LAMSs) without fluoroscopic guidance. METHODS We conducted a retrospective study on patients with symptomatic PFC who underwent EUS-guided drainage using EC-LAMS without fluoroscopy. All patients were followed clinically until resolution of their PFC. Technical success (successful placement of EC-LAMS), number of patients who achieved complete resolution of PFC without additional intervention and adverse events were noted. RESULTS We evaluated 25 patients, including three with pancreatic pseudocysts and 22 with walled-off necrosis (WON). The etiology of the patient's pancreatitis was gallstones (42%), alcohol (27%), and other causes (31%). The mean cyst size was 82 mm (range, 60-170 mm). The indications for endoscopic drainage were abdominal pain, infected WON, or gastric outlet obstruction. Technical success with placement of the EC-LAMS was achieved in all 25 patients. There were no procedure-related complications. The mean patient follow-up was 7.8 months. PFCs resolved in 24 (96%) patients; the one failure was in a patient with WON. Stent occlusion was seen in one patient. There was a spontaneous migration of one stent into the enteral lumen after resolution of WONs. The EC-LAMS were successfully removed using a snare in all the remaining patients. The median number of endoscopy sessions to achieve PFCs resolution was 2 (range, 2-6). CONCLUSIONS Single-step EUS-guided drainage of PFCs without fluoroscopic guidance using the novel EC-LAMS is a safe and effective endoscopic technique for drainage of PFCs with excellent technical and clinical success rates and no complications. Due to its ease of use, EC-LAMS may simplify and streamline EUS-guided management of PFC and help in its widespread adoption as an alternative to surgery.
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Affiliation(s)
- Joseph Yoo
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Linda Yan
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Raza Hasan
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Saana Somalya
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jose Nieto
- Division of Gastroenterology, Borland Groover Clinic, Jacksonville, FL, USA
| | - Ali A Siddiqui
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA, USA
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Gornals JB, Esteban JM, Guarner-Argente C, Marra-Lopez C, Repiso A, Sendino O, Loras C. Endoscopic ultrasound and endoscopic retrograde cholangiopancreatography: Can they be successfully combined? GASTROENTEROLOGIA Y HEPATOLOGIA 2016; 39:627-642. [PMID: 26920225 DOI: 10.1016/j.gastrohep.2015.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 12/01/2015] [Accepted: 12/04/2015] [Indexed: 02/07/2023]
Abstract
Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) have much in common, including their main indications (biliopancreatic disorders), powerful therapeutic capacities and a steep learning curve. Over the years they have evolved from novel diagnostic procedures to interventional therapeutic techniques, but along different paths (different scopes or devices and endoscopists specializing exclusively in one or the other technique). However, EUS has gradually developed into a therapeutic technique that requires skills in the use of ERCP devices and stents, leading some ERCP specialists to explore the therapeutic potential of EUS. The corresponding literature, which has grown exponentially, includes recent experiments on combining the two techniques, which have gradually come to be used in routine care in a number of centers, with positive technical, clinical and financial outcomes. We review EUS and ERCP as individual or combined procedures for managing biliopancreatic disorders.
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Affiliation(s)
- Joan B Gornals
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Catalonia, Spain.
| | - José Miguel Esteban
- Endoscopy Unit, Department of Digestive Diseases, Hospital Clinic San Carlos, Madrid, Spain
| | - Carlos Guarner-Argente
- Endoscopy Unit, Department of Digestive Diseases, Hospital Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Carlos Marra-Lopez
- Endoscopy Unit, Department of Digestive Diseases, Hospital Universitario Araba sede Txagorritxu, Alava, Spain
| | - Alejandro Repiso
- Endoscopy Unit, Department of Digestive Diseases, Hospital Virgen de la Salud, Toledo, Spain
| | - Oriol Sendino
- Endoscopy Unit, Department of Digestive Diseases, Hospital Clinic, Barcelona, Catalonia, Spain
| | - Carme Loras
- Endoscopy Unit, Department of Digestive Diseases, Hospital Mútua Terrassa, CIBEREHD, Terrassa, Catalonia, Spain
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Rodrigues-Pinto E, Baron TH. Evaluation of the AXIOS stent for the treatment of pancreatic fluid collections. Expert Rev Med Devices 2016; 13:793-805. [PMID: 27545192 DOI: 10.1080/17434440.2016.1222898] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Endoscopic ultrasound guided translumenal drainage of pancreatic fluid collections (PFCs) has been widely practiced for over a decade, using conventional plastic and self-expandable metal stents. The use of such stents for transmural drainage is off-label and limited by the lack of lumen-to-lumen anchorage, which can lead to leakage, migration and tissue trauma. AREAS COVERED Novel stent designs dedicated to applications of translumenal drainage have recently emerged and promise to make transmural drainage quicker, safer, and more effective. Achieving faster resolution of the fluid collection, decreasing adverse events, decreasing recurrence rates, and lowering costs are critical to advancing the endoscopic management of PFCs. Expert commentary: Our paper suggests that the AXIOS stent is an innovative therapeutic approach for PFC drainage with excellent efficacy, safety, and relatively few adverse outcomes. Preliminary reports appear promising and large multicenter prospective studies are needed in the future to further determine its safety and efficacy.
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Affiliation(s)
| | - Todd H Baron
- b Division of Gastroenterology and Hepatology , University of North Carolina , Chapel Hill , North Carolina , USA
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50
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Guo J, Feng L, Sun S, Ge N, Liu X, Wang S, Wang G, Sun B. Risk factors for infection after endoscopic ultrasonography-guided drainage of specific types of pancreatic and peripancreatic fluid collections (with video). Surg Endosc 2016; 30:3114-3120. [PMID: 26801793 PMCID: PMC4912585 DOI: 10.1007/s00464-015-4557-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 09/03/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Endoscopic ultrasonography (EUS)-guided drainage is widely used for the treatment of specific types of peripancreatic fluid collections (PFCs). Infectious complications have been reported. It is recommended that the infection rate should be assessed by measuring risk factors. The objectives of this study were to measure whether the risk of infection after EUS-guided drainage was associated with patient- and procedure-related factors. METHODS Eighty-three patients were eligible for inclusion from September 2008 to November 2012. EUS-guided drainage was performed in all patients. Infectious complications were observed, and data on patient- and procedure-related factors were collected. Patient-related factors mainly included age, sex, etiology of PFC, and cyst location and diameter. Procedure-related factors mainly included approach of EUS-guided drainage and stent diameter. Separate multivariate logistic regression models for all EUS-guided drainage were carried out. RESULTS Complete EUS-guided drainage was achieved in all patients. A definitive diagnosis of infection after EUS-guided drainage was made in seven patients. All seven patients had a history of acute pancreatitis, and the cyst diameters were all >15 cm. Three patients had diabetes mellitus. CONCLUSIONS The cyst diameter was an independent risk factor for infection. Larger cysts with a diameter >15 cm should perhaps be drained initially with multiple pigtail or a larger diameter self-expandable metal stents to try to avoid infection.
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Affiliation(s)
- Jintao Guo
- Endoscopy Center, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, 110004 Liaoning Province China
| | - Linlin Feng
- Endoscopy Center, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, 110004 Liaoning Province China
| | - Siyu Sun
- Endoscopy Center, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, 110004 Liaoning Province China
| | - Nan Ge
- Endoscopy Center, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, 110004 Liaoning Province China
| | - Xiang Liu
- Endoscopy Center, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, 110004 Liaoning Province China
| | - Sheng Wang
- Endoscopy Center, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, 110004 Liaoning Province China
| | - Guoxin Wang
- Endoscopy Center, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, 110004 Liaoning Province China
| | - Beibei Sun
- Endoscopy Center, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Shenyang, 110004 Liaoning Province China
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