Drainage of pancreatic fluid collections using a lumen-apposing metal stent with an electrocautery-enhanced delivery system
| Autor: | Jirat Jirathan-Opas, Tiing Leong Ang, Jerry Chin, Andrew J. Metz, Arthur J. Kaffes, Christopher Yh Kia, Rees Cameron, Derrick Tee, Peter Tagkalidis, Goktug Ermerak, Saad A. Khan, Andrew T. St John, Mohamad Nasr, Estella Johns, Leon Fisher, Benedict Devereaux, Andrew Trinh, Shwan Karim, Thomas Mules, Abha Kaul, Milan S. Bassan, Frank Weilert, Rhys Vaughan, Thawee Ratanachu-ek, Alan C. Moss, Christine Welch, Sujievvan Chandran, Gary Lim, Mohammadali Zad, Dileep Mangira, Payal Saxena, Luke F. Hourigan |
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| Rok vydání: | 2021 |
| Předmět: |
Endoscopic ultrasound
medicine.medical_specialty Hepatology Pancreatic pseudocyst medicine.diagnostic_test business.industry medicine.medical_treatment Gastroenterology Lumen (anatomy) Stent Pancreatic Diseases Middle Aged medicine.disease Surgery Therapeutic endoscopy medicine Electrocoagulation Pancreatitis Drainage Humans Stents business Complication Adverse effect Retrospective Studies |
| Zdroj: | Journal of gastroenterology and hepatologyReferences. 36(12) |
| ISSN: | 1440-1746 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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