A novel self-expanding biflanged metal stent vs tubular metal stent for EUS-guided transmural drainage of pancreatic pseudocyst

Abstract

Although endoscopic ultrasound (EUS)-guided transmural drainage of pancreatic fluid collections with metal stents is generally preferred over plastic stents, its superiority among different types of metal stents has not yet been well studied. We conducted this study to compare clinical outcomes and complications of a novel self-expanding biflanged metal stent (BFMS) and a traditional-shaped tubular metal stent (TMS) in treating pancreatic pseudocyst (PPC).This was a retrospective analysis on consecutive patients with PPC underwent EUS-guided transmural drainage with either TMS or BFMS in a single tertiary center with expertise in management of complex biliary and pancreatic problems. The technical and functional success rate, reintervention, complications, and recurrence rate were evaluated.From September 2013 to January 2018, 125 patients (66.4% male, median age 47 years) underwent EUS-guided transmural drainage for PPC. Among them, 49 used TMS and 76 used BFMS. All patients met the inclusion criteria that cyst diameter was >6 cm or the distance between cyst and stomach wall was shorter than 1 cm. There was no difference in technical success (98% vs 97.4%, P = 1.0) or functional success rate (87.8% vs 92.1%, P = .54) using 2 types of metal stents. However, more procedure related complications occurred in TMS than in BFMS group. TMS group had a much higher migration rate than BFMS group (14.6% vs 0, P = .001), even though there was no significant difference in bleeding, infection, or death rate between 2 groups. With similar clinical outcomes, TMS group required more additional plastic stent placement than BFMS group for better drainage.TMS and BFMS placement can both be considered as methods of endoscopic transmural PPC drainage with equal efficacy, whereas BFMS could be preferred for fewer complications or less need of additional plastic stent placement.

Pancreatic pseudocyst: Dilemma of its recent management (Review)

“…TMD may be achieved across the duodenal or gastric wall, depending on the pseudocyst location. The requirements for TMD include a <1 cm distance between the pseudocyst and intestinal wall on imaging, a clear compression of the intestinal wall on endoscopy, the absence of varices, the absence of pseudoaneurysms and the exclusion of malignant lesions prior to treatment ( 51 , 56 ). TMD begins with a pseudocyst puncture through the compression site of the gastric or duodenal wall to initiate the spontaneous drainage of the fluid; the cyst-gastrostomy (duodenostomy) fistula is pneumatically dilated with 8-15 mm biliary balloon dilators and 9-10 Fr straight or pigtail plastic stents may be passed into the cyst with the help of a guidewire ( 57 , 58 ).…”

Burden of Liver Diseases: A Review from Iran

“…5 Thus, HBV vaccination has effectively decreased the incidence of new cases in Iran, with a primary failure rate of only 5%. 9 Even though, we are still seeing new cases of HBV, mainly due to perinatal transmission. Infant prophylaxis and early childhood vaccination along with Hepatitis B immunoglobulin (HBIG) can prevent this type of transmission, but the latter is expensive and not always available.…”

Comparative efficacy of stents in endoscopic ultrasonography‐guided peripancreatic fluid collection drainage: A systematic review and network meta‐analysis

“…Two RCTs were assessed as having a low risk of bias for all domains, including random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data, selective reporting, and other bias. Among the 13 retrospective cohort studies, 7 (54%) were rated as being of high quality …”

“…The included studies had been published between 2014 and 2019, with an enrollment period that ranged from 2005 to 2017 (Table ) . Among them, two were designed as a three‐arm study that compared efficacy among LAMS, DPPS, and FCSEMS .…”

“…In addition to studies comparing LAMS versus DPPS and FCSEMS versus DPPS, there are many studies on EUS‐guided PFC drainage comparing LAMS versus FCSEMS . These studies aimed to evaluate comparative efficacy between two types of stents in EUS‐guided PFC drainage; however, they resulted in only fragmented pairwise outcomes and could not provide comprehensive evidence including direct or indirect evidence for comparative efficacy among LAMS, DPPS, and FCSEMS.…”