Su1297 A Comparative Study Evaluating Bi-Flanged Fully Covered Self-Expanding Metal Stents and Lumen-Apposing Metal Stents for the Endoscopic Drainage of Pancreatic Walled-Off Necrosis: Results of the Multicenter, International Collaborative Trial (original) (raw)
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Gastrointestinal Endoscopy, 2017
Background and Aims: Endoscopic transmural drainage/debridement of pancreatic walled-off necrosis (WON) has been conducted using double pigtail plastic (DP), fully covered self-expanding metal (FCSEMS) stents 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 (AE) of EUS-guided drainage/debridement of WON with DP stents, FCSEMS and LAMS. Methods: Consecutive patients in 2 centers with WON managed by EUS-guided debridement were divided into 3 groups: (1) those that underwent debridement using DP stents, (2) debridement using FCSEMS, (3) debridement using LAMS. Technical success (ability to access and drain a WON by placement of transmural stents), early adverse events (AE), number of procedures performed per patient to achieve WON resolution, and long-term success (complete resolution of the WON without need for further re-intervention 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 FCSEMS, and 86 using LAMS. The 3 groups were matched with age, etiology of the pancreatitis, WON size, and location. The etiology 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 (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 AE were noted in 27 of 313 (8.6%) patients (6=perforation, 8=bleeding, 9=suprainfection, 7=other). 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=0.37). Early AE were significantly lower in the FCSEMS group compared with DP and
GE - Portuguese Journal of Gastroenterology
Infected walled-off pancreatic necrosis (WOPN) is a severe complication of acute pancreatitis. Surgery in these critically ill patients can be associated with increased morbidity and mortality. Hence, minimally invasive therapies have emerged as an alternative to surgery. Herein, we report a case of severe acute pancreatitis with WOPN which was treated percutaneously with a flexible endoscope through an esophageal self-expanding metal stent using a total retroperitoneal approach. Percutaneous direct endoscopic necrosectomy (p-DEN) using the retroperitoneal route improved the patient’s parameters dramatically with resolution of sepsis without the need for surgery. p-DEN using a flexible endoscope passed through a large bore metal stent shows promise in selected patients with WOPN and can be used in patients who are not ideal candidates for transmural or surgical drainage.
Factors impacting treatment outcomes in the endoscopic management of walled-off pancreatic necrosis
Journal of Gastroenterology and Hepatology, 2013
Background-Treatment outcomes are suboptimal for patients undergoing endoscopic treatment of walled-off pancreatic necrosis (WOPN). The objective of this study is to identify factors that impact treatment outcomes in this patient subset. Methods-This is a retrospective study of patients with WOPN treated endoscopically over 10 years. Patients underwent placement of stents and nasocystic catheters within the necrotic cavity. In select patients, the multiple transluminal gateway technique (MTGT) was adopted to create several openings in the stomach or duodenum to facilitate drainage of necrosis. In patients with disconnected pancreatic duct syndrome (DPDS), the transmural stents were left in place indefinitely to decrease pancreatic fluid collection (PFC) recurrence. Results-Endoscopic treatment was successful in 53 of 76 (69.7%) patients. Treatment success was higher in patients undergoing MTGT than in those in whom conventional drainage was used (94.4% vs 62.1%, P = 0.009). On multivariate logistic regression analysis, only MTGT (OR 15.8, 95% CI 1.77-140.8; P = 0.01) and fewer endoscopic sessions being needed (OR 4.0, 95% CI 1.16-14.0; P = 0.03) predicted treatment success. PFC recurrence was significantly lower in patients with indwelling transmural stents than in patients in whom the stents were removed (0 vs 20.8%; P = 0.02). Conclusions-Creating multiple gateways for drainage of necrotic debris improves treatment success, and not removing the transmural stents decreases PFC recurrence in patients undergoing endoscopic drainage of WOPN.
Journal of the Pancreas, 2017
Background Pancreatic leak is one the most feared complications after duodenopancreatectomy. Treatment depends on the leak’s severity. Conservative treatment is usually effective for leaks of lesser severity. However, conservative treatment prolongs hospital stay, thus increasing hospital cost and decreasing the patient’s quality of life. Surgical treatment is reserved for persistent, high output fistulae but, it is a high risk procedure, often with poor results. There is a plethora of endoscopic methods and devices used to address pancreatic leaks in general. However, in current literature, there is a lack of papers specifically about endoscopic treatment options for pancreatic leaks after duodenopancreatectomy. Methods We present our small series of 4 patients with pancreatic fistula after duodenopancreatectomy and duct-to-mucosa anastomosis. Our patients were treated by implanting a biflanged, fully covered metal stent. The rationale of the treatment, not yet described in the lit...
International Surgery
We aimed to review our experiences to evaluate the practicality, safety, and effectiveness of endoscopic stent placement for the palliation of malignant obstructions of the upper gastrointestinal system (GIS) and the treatment of postoperative complications such as failure of anastomoses and fistulae. Endoscopic stent placement is increasingly used in the upper GIS for the management of both high grade malignancies causing obstruction and benign pathologies such as anastomosis failures, gastrointestinal fistulae, and strictures. Hospital records, clinical data, and endoscopy reports of 61 patients who had undergone endoscopic stenting between the years 2012 and 2015 were analyzed retrospectively. For all patients, self-expandable metal covered stents were used. Data involving technical and clinical success rates, complication, morbidity, and mortality rates of the endoscopic stenting procedure was collected and simple statistical analyses were made. Endoscopic stenting was successfu...