TY - JOUR

T1 - A novel lumen-apposing metal stent for endoscopic ultrasound-guided drainage of pancreatic fluid collections

T2 - a prospective cohort study

AU - Walter, Daisy

AU - Will, Uwe

AU - Sanchez-Yague, Andres

AU - Brenke, Dirk

AU - Hampe, Jochen

AU - Wollny, Helge

AU - López-Jamar, Jose Miguel Esteban

AU - Jechart, Gertrud

AU - Vilmann, Peter

AU - Gornals, Joan B

AU - Ullrich, Sebastian

AU - Fähndrich, Martin

AU - de Tejada, Alberto Herreros

AU - Junquera, Félix

AU - Gonzalez-Huix, Ferran

AU - Siersema, Peter D

AU - Vleggaar, Frank P

N1 - © Georg Thieme Verlag KG Stuttgart · New York.

PY - 2015/1

Y1 - 2015/1

N2 - BACKGROUND AND STUDY AIMS: A novel large-diameter, lumen-apposing, self-expanding metal stent with bilateral flanges was recently developed for endoscopic ultrasound (EUS)-guided transmural drainage of symptomatic pancreatic fluid collections (PFCs). The aim of this study was to evaluate the efficacy and safety of this stent in a large cohort.PATIENTS AND METHODS: Patients with a PFC undergoing EUS-guided drainage with this novel stent were prospectively enrolled in this multicenter cohort study.RESULTS: There were 61 patients: 46 patients (75 %) with walled-off necrosis (WON) and 15 (25 %) with a pancreatic pseudocyst. Stent placement was technically successful in 60 patients (98 %, 95 %CI 95 % - 100 %). Clinical success, defined as resolution of clinical symptoms in combination with a decrease in the PFC size to ≤ 2 cm on imaging, was achieved in 93 % of patients with a pancreatic pseudocyst (95 %CI 77 % - 100 %) and in 81 % of patients with WON (95 %CI 69 % - 94 %). Treatment failure occurred in nine patients (16 %, 95 %CI 6 % - 26 %), including four patients who required surgical intervention. Stent removal was performed in 82 % of patients after a median of 32 days (range 2 - 178) and was rated as easy in all but one patient. In 10 patients, endoscopic stent removal was not performed because of stent migration (n = 3), stent dislodgement during necrosectomy (n = 3), stent removal during surgery (n = 2), or refusal by the patient (n = 2). In total, five major complications were reported (9 %, 95 %CI 2 % - 16 %), including PFC infection (n = 4) and perforation (n = 1).CONCLUSION: EUS-guided drainage using this novel stent is feasible and the clinical results obtained are promising with a low major complication rate.

AB - BACKGROUND AND STUDY AIMS: A novel large-diameter, lumen-apposing, self-expanding metal stent with bilateral flanges was recently developed for endoscopic ultrasound (EUS)-guided transmural drainage of symptomatic pancreatic fluid collections (PFCs). The aim of this study was to evaluate the efficacy and safety of this stent in a large cohort.PATIENTS AND METHODS: Patients with a PFC undergoing EUS-guided drainage with this novel stent were prospectively enrolled in this multicenter cohort study.RESULTS: There were 61 patients: 46 patients (75 %) with walled-off necrosis (WON) and 15 (25 %) with a pancreatic pseudocyst. Stent placement was technically successful in 60 patients (98 %, 95 %CI 95 % - 100 %). Clinical success, defined as resolution of clinical symptoms in combination with a decrease in the PFC size to ≤ 2 cm on imaging, was achieved in 93 % of patients with a pancreatic pseudocyst (95 %CI 77 % - 100 %) and in 81 % of patients with WON (95 %CI 69 % - 94 %). Treatment failure occurred in nine patients (16 %, 95 %CI 6 % - 26 %), including four patients who required surgical intervention. Stent removal was performed in 82 % of patients after a median of 32 days (range 2 - 178) and was rated as easy in all but one patient. In 10 patients, endoscopic stent removal was not performed because of stent migration (n = 3), stent dislodgement during necrosectomy (n = 3), stent removal during surgery (n = 2), or refusal by the patient (n = 2). In total, five major complications were reported (9 %, 95 %CI 2 % - 16 %), including PFC infection (n = 4) and perforation (n = 1).CONCLUSION: EUS-guided drainage using this novel stent is feasible and the clinical results obtained are promising with a low major complication rate.

KW - Adult

KW - Aged

KW - Drainage

KW - Endosonography

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Logistic Models

KW - Male

KW - Middle Aged

KW - Pancreatic Pseudocyst

KW - Pancreatitis, Acute Necrotizing

KW - Prospective Studies

KW - Stents

KW - Treatment Outcome

KW - Ultrasonography, Interventional

U2 - 10.1055/s-0034-1378113

DO - 10.1055/s-0034-1378113

M3 - Letter

C2 - 25268308

VL - 47

SP - 63

EP - 67

JO - Endoscopy

JF - Endoscopy

SN - 0013-726X

IS - 1

ER -