Background
While most pancreatic fluid collections (PFCs) resolve spontaneously, endoscopic ultrasound-guided transluminal drainage (EUS-TD) may be necessary. EUS-TD has evolved from multiple double-pigtail plastic stents (DPPS) to fully covered self-expanding metal stents (FCSEMS) and lumen-apposing metal stents (LAMS). This study compares clinical attributes of DPPS, FCSEMS and LAMS.
Methods
This is a single-centre retrospective review of EUS-TD for PFCs. The primary outcome was clinical success. Secondary outcomes were technical success, procedure time, hospital length of stay (HLOS), number of endoscopies, need for necrosectomy, adverse events (AEs) and overall cost.
Results
Fifty-eight patients (37 male, average age 49 years) underwent a total of 60 EUS-TD procedures for PFCs (average size 11.2 cm with 29 pseudocysts and 29 walled-off necrosis). Ten patients (17%) underwent EUS-TD with DPPS and 48 patients (83%) with metal stents (32 FCSEMS, 16 LAMS). Overall technical and clinical success was 100% and 84%, respectively. Lumen-apposing metal stents had shorter procedure times (14.9 versus 63.6 DPPS, 39.1 min FCSEMS, P < 0.001), and no difference in AEs (3 of 16 versus 4 of 10 DPPS, 12 of 34 FCSEMS, ns). Double-pigtail plastic stents required more endoscopies (3.7 versus 2.3 LAMS, 2.3 FCSEMS, P = 0.013) and necrosectomies (4 of 10 [40%]) compared with 5 of 34 [15%] in the FCSEMS group and 3 of 16 [19%] in the LAMS group, respectively, P = 0.001) to achieve clinical resolution. The overall cost and HLOS was not significantly different between groups.
Conclusion
The use of LAMS for PFCs is not associated with any significant increase in cost despite technical (shorter procedure time) and clinical advantages (shorter indwell time, reduced need for necrosectomy and no increase in AEs).
476 cases of Stage I-IV invasive carcinoma of the uterine cervix were treated at the Gynecology Departments in Karlstad and Orebro in 1965-75. 232 (48.7%) were classified Stage I, 198 (85.3%) of them were treated with primary surgery (57 Stage IA and 141 Stage IB). Thirty-four were given primary radiotherapy because of advanced age or co-existing conditions contra-indicating surgery. Of the 141 patients with primary surgery for Stage IB, squamous epithelial carcinoma was established in 88.7% and adenocarcinoma in 11.3%. Surgery revealed lymph node metastases in 13 (9.2%). Postoperative radiotherapy was given to all patients with lymph node metastases, to 3 patients with tumor thrombi in the parametrial vessels, and to 6 in whom surgery had conceivably not been radical. Urinary tract complications requiring reconstructive surgery occurred in 8 (4.0%). The 5-year survival rate with Stage IB was 91.5%, corrected for intercurrent diseases, 5-year survival was 92.8%. Of the 13 with lymph node metastases, 7 were still alive after 5 years. The 5-year survival rate for those without demonstrable lymph node metastases was 94.5%, corrected 96.0%.
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