Resolution of walled-off pancreatic necrosis by EUS-guided drainage when using a fully covered through-the-scope self-expandable metal stent in a single procedure (with video) (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
Case reports in gastroenterology, 2013
Walled-off pancreatic necrosis (WOPN) is one of the most life-threatening complications of acute severe pancreatitis. Regarding its high mortality and morbidity without appropriate treatment, the drainage procedure is still the mainstay of the treatment for this condition. There are multiple drainage options for this event. To date, endoscopic drainage alone has not been adequate for this condition, while surgical drainage has been reported to have a high morbidity. Endoscopic drainage with pancreatic necrosectomy is the most effective and safe method, while endoscopic drainage with aggressive lavage is another acceptable treatment option. The procedural details have been described elsewhere in many studies. In this report, we describe an alternative technique of drainage by endoscopy alone, without aggressive lavage procedure, that yielded an acceptable outcome with an easier procedure.
Journal of the Pancreas, 2016
Context Acute necrotizing pancreatitis, with an incidence of nearly 20% in patients with acute pancreatitis, can lead to significant morbidity and mortality. Management can be difficult and at times requires a multidisciplinary approach. Endoscopic and minimally invasive techniques can reduce end-organ failure, procedure related complications, and the high mortality associated with acute necrotizing pancreatitis. Case series We present a series of six consecutive patients who underwent successful Endoscopic Ultrasound guided necrosectomy of symptomatic walled-off pancreatic necrosis using a lumen-apposing fully covered self-expanding metal stent and hydrogen peroxide. Technical success was achieved in 100% of patients. Clinical success was achieved in 83% of patients. Cross-sectional imaging confirmed resolution of walled-off pancreatic necrosis in these patients during follow up. The mean number of endoscopic sessions to perform direct endoscopic necrosectomy was 3.0 and the averag...
2019
Background: It seems that the appearance of lumen-apposing metal stents (LAMS), are displacing the role of plastic stents in the therapy of pancreatic fluid collection as walled-off necrosis (WON). To date there is no quality of evidence to recommend LAMS as the standard treatment in management of WON. The theoretical benefit of LAMS over PLASTIC stents, need to be proved.Methods/design: This is a multicenter prospective study, superiority, randomized controlled clinical trial by parallel groups, without masking. One hundred fourteen patients with WON will be Endoscopic ultrasound (EUS)-guided transmural drained in 9 tertiary hospitals in Spain and will be randomized to the LAMS or PLASTIC stent group. The primary endpoint is to assess the short-term (4 weeks) clinical success determined by the reduction of the collection (to <50% or < 5cm in size), along with clinical improvement. Secondary endpoints: the long-term (4 months) clinical success (total resolution or 5cm); the pr...
Trials
Background It seems that lumen-apposing metal stents (LAMS) are displacing plastic stents in the therapy of pancreatic-fluid collection in walled-off necrosis (WON). To date, there is no quality of evidence to recommend LAMS as the standard treatment in the management of WON. The theoretical benefit of LAMS over plastic stents needs to be proven. Methods/design This is a randomized controlled, multicenter, prospective clinical trial with two parallel groups, without masking. One-hundred and fourteen patients with WON will undergo endoscopic ultrasound (EUS)-guided transmural draining in nine tertiary hospitals in Spain and will be randomized to the LAMS or plastic-stent group. The primary endpoint is the short-term (4 weeks) clinical success determined by the reduction of the collection (to
2019
Background: It seems that the appearance of lumen-apposing metal stents (LAMS), are displacing the role of plastic stents in the therapy of pancreatic fluid collection as walled-off necrosis (WON). To date there is no quality of evidence to recommend LAMS as the standard treatment in management of WON. The theoretical benefit of LAMS over PLASTIC stents, need to be proved. Methods/design: This is a multicenter prospective study, superiority, randomized controlled clinical trial by parallel groups, without masking. One hundred fourteen patients with WON will be Endoscopic ultrasound (EUS)-guided transmural drained in 9 tertiary hospitals in Spain and will be randomized to the LAMS or PLASTIC stent group. The primary endpoint is to assess the short-term (4 weeks) clinical success determined by the reduction of the collection (to <50% or < 5cm in size), along with clinical improvement. Secondary endpoints: the long-term (4 months) clinical success (total resolution or 5cm); the p...