Drainage of pancreatic fluid collections using a lumen‐apposing metal stent with an electrocautery‐enhanced delivery system

Chandran, Sujievvan; Chin, Jerry Yung-Lun; Karim, Shakir; Mangira, Dileep; Nasr, Mohamad; Ermerak, Goktug; Trinh, Andrew; Kia, Christopher Y.; Mules, Thomas; Zad, Mohammadali; Johns, Estella; Tee, Derrick; Kaul, Abha; Ratanachu‐ek, Thawee; Jirathan-Opas, Jirat; Fisher, Leon; Cameron, Rees; Welch, C E; Lim, Gary; Metz, Andrew J.; Moss, Alan; Bassan, Milan S.; Saxena, Payal; Kaffes, Arthur J.; John, Andrew St; Hourigan, Luke F.; Tagkalidis, Peter; Weilert, Frank; Vaughan, Rhys; Devereaux, Benedict M.

doi:10.1111/jgh.15658

Cited by 18 publications

(24 citation statements)

References 25 publications

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“…Based on quantitative measurement using Egger's test as well as visual inspection of the funnel plot, there was no significant evidence of publication bias in reporting adverse events (Figure 3). The rates of bleeding 25,[27][28][29][32][33][34][35] showed TA B L E 2 Summary of studies included in the meta-analysis a similar tendency, with a pooled OR of 1.35 (95% CI 0.72-2.53; p = 0.36) and potential heterogeneity between the studies (p heterogeneity = 0.05 and I 2 = 49%). The results were consistent when three studies including the initial surgical approach were excluded from the analysis (Table 4).…”

Section: Resultsmentioning

confidence: 70%

“…28,29,[32][33][34] The summary of pooled ORs according to the treatment approach is shown in Table 4. Based on eight studies, 25,[27][28][29][32][33][34][35] the rate of adverse events was comparable, with a pooled OR of 1.41 (95% CI 0.66-3.01; p = 0.38; Figure 2) for early interventions compared to delayed interventions, though the data were heterogeneous between the studies (p heterogeneity < 0.01 and I 2 = 82%). Based on quantitative measurement using Egger's test as well as visual inspection of the funnel plot, there was no significant evidence of publication bias in reporting adverse events (Figure 3).…”

Section: Resultsmentioning

confidence: 99%

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Early versus delayed interventions for necrotizing pancreatitis: A systematic review and meta‐analysis

et al. 2022

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Objectives Interventions for necrotizing pancreatitis are generally postponed until 4 weeks after the onset of acute pancreatitis, but there remains controversy about whether we should always wait >4 weeks or can intervene early when necessary. This meta‐analysis was conducted to evaluate treatment outcomes of necrotizing pancreatitis according to the cut‐off defined in the revised Atlanta classification (≤4 vs. >4 weeks). Methods Using PubMed, Web of Science, and the Cochrane database, we identified clinical studies published until March 2022 with data comparing outcomes of early and delayed interventions of necrotizing pancreatitis. We pooled data on adverse events, mortality, technical and clinical success rates, and needs for necrosectomy and open surgery, using the random‐effects model. Results We identified 11 retrospective studies, including 775 patients with early interventions and 725 patients with delayed interventions. Patients with early interventions tended to be complicated by organ failure. The rate of adverse events was comparable (OR 1.41, 95% CI 0.66–3.01; p = 0.38) but the rate of mortality was significantly higher (OR 1.70, 95% CI 1.21–2.40; p < 0.01) in early interventions. Technical success rates were similarly high but clinical success rates tended to be low (OR 0.39, 95% CI 0.15–1.00; p = 0.05) in early interventions, though not statistically significant. Pooled ORs for necrosectomy and open surgery were 2.14 and 1.23, respectively. Conclusions Early interventions for necrotizing pancreatitis were associated with higher mortality rates and did not reduce adverse events or improve clinical success. However, our results should be confirmed in prospective studies.

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Section: Resultsmentioning

confidence: 70%

Section: Resultsmentioning

confidence: 99%

Early versus delayed interventions for necrotizing pancreatitis: A systematic review and meta‐analysis

et al. 2022

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“…A survey found that 16 of 22 advanced endoscopists believed that LAMS should be the standard of care for WON [ 44 ]. Khan et al noted that EUS-guided PFC drainage with LAMS was effective in all 4 classifications of PFC, with a technical success rate of 202/208 (97.1%) [ 45 ]. Anderloni et al evaluated the safety of the largest available diameter LAMS (22 mm) [ 46 ].…”

Section: Drainage and Stent Typesmentioning

confidence: 99%

Endoscopic management of pancreatic walled-off necrosis

Ramai¹

2023

aog

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Pancreatic walled-off necrosis (WON) is a complication of severe pancreatitis. Endoscopic transmural drainage has been recognized as the first-line treatment for pancreatic fluid collections. Endoscopy offers a minimally invasive approach when compared to surgical drainage. Today, endoscopists may choose to use self-expanding metal stents, pigtail stents, or lumen-apposing metal stents to facilitate drainage of fluid collections. Current data suggest that all 3 approaches yield similar outcomes. It was previously thought that drainage should be performed 4 weeks from the initial event of pancreatitis, theoretically allowing the capsule to mature. However, current data show that both early (<4 weeks) and standard (≥4 weeks) endoscopic drainage are comparable. Herein, we provide an up-to-date state-of-the-art review of the indications, techniques, innovations, outcomes, and future perspectives following drainage of pancreatic WON.

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“…The HOT AXIOS stent was developed to enable the endoscopist to an immediate release of the stent following an access to the target lumen with a stent-loaded delivery catheter using the electro-cautery tip under endoscopic ultrasound instead of a needle or guidewire insertion or preliminary dilation ( 3 , 5 , 8 ). The operation process of HOT AXIOS stent mainly includes two steps: cyst puncture and stent release.…”

Section: Design Of Ec-lams and Procedures Processmentioning

confidence: 99%

“…In a nationwide survey from Italy, 97.2% of endoscopists perform LAMS positioning for PFC ( 13 ). The performance of EC-LAMS can reach high technical rate of 97.1%, clinical success rate of 88.8%, and cumulative adverse effects (AE) of 18.3% (7.4% for stent migration, 7.9% for stent occlusion and infection, 2% for major bleeding, and 1% for buried stents) ( 8 ). Factors related to higher risks of AEs include pre-procedural evidence of pancreatic duct leak/disruption, vessel alteration, requiring percutaneous drainage, or a multigate technique, and as well hospital volume is significantly associated with improved outcomes ( 14 , 15 ).…”

Section: Indications and Outcomes Of Ec-lamsmentioning

confidence: 99%

Current uses of electro-cautery lumen apposing metal stents in endoscopic ultrasound guided interventions

Liu

et al. 2022

Front. Med.

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The electro-cautery lumen apposing metal stent (EC-LAMS) is a newly developed device that integrates the electro-cautery cyctotome with the one-step metal stent delivery and releasing system in recent years. LAMS was first designed to complete the drainage of pancreatic fluid collection under endoscopic ultrasound guidance, and the technological innovation of EC-LAMS has made more off-labeled indications of endoscopic intervention for gastrointestinal diseases realized, such as abdominal fluid drainage, bile duct, or gallbladder drainage through stomach or duodenum, gastrointestinal anastomosis, and the establishment of fistulous channel for further endoscopic operation when necessary. The unique feature of this metal stent is that it has the design of a saddle shape and a large lumen, and can almost connect the adjacent structures to minimize the risk of perforation and leakage. Compared with traditional LAMS, EC-LAMS, an advanced integrated device, can greatly simplify the endoscopic process, shorten the procedure time and reduce the technical difficulty, thus it can help endoscopists complete more complex endoscopic interventions. In this review, we discuss the state of art with regard to EC-LAMS and its endoscopic process, current indications, outcomes, adverse events, and future application prospects.

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Drainage of pancreatic fluid collections using a lumen‐apposing metal stent with an electrocautery‐enhanced delivery system

Cited by 18 publications

References 25 publications

Early versus delayed interventions for necrotizing pancreatitis: A systematic review and meta‐analysis

Early versus delayed interventions for necrotizing pancreatitis: A systematic review and meta‐analysis

Endoscopic management of pancreatic walled-off necrosis

Current uses of electro-cautery lumen apposing metal stents in endoscopic ultrasound guided interventions

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