Endoscopic drainage of pancreatic fluid collections by use of a novel biflanged stent with electrocautery-enhanced delivery system

Lakhtakia, Sundeep; Nabi, Zaheer; Lee, Moon Sung; Gupta, Rajesh; Chavan, Radhika; Basha, Jahangeer; Reddy, D. Nageshwar

doi:10.1016/j.vgie.2018.07.001

Cited by 10 publications

(8 citation statements)

References 10 publications

(19 reference statements)

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“…The drainage of PFCs is indicated when the patients present persistent symptoms or when they produce biliary or gastroduodenal obstruction 3 . The introduction of LAMS (Axios stent, Boston Scientific, Massachusets, USA), Niti‐S Spaxus stent (Taewong Medical, South Korea), or Hot Spaxus (Taewong Medical, South Korea) 28,29 have revolutionized the management of PFCs since they allow shortening of the steps for traditional endoscopic drainage with DPPS and in this way reduce the complications of a long procedure time. In addition, the larger diameter of the lumen of these stents allows for a lower probability of obstruction than with DPPS 3,13 …”

Section: Discussionmentioning

confidence: 99%

Head‐to‐head comparison between endoscopic ultrasound guided lumen apposing metal stent and plastic stents for the treatment of pancreatic fluid collections: A systematic review and meta‐analysis

Guzmán-Calderón

Chacaltana

Díaz

et al. 2021

J Hepato Biliary Pancreat

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Background/Aims Peripancreatic fluid collections (PFCs) result from acute or chronic pancreatic inflammation that suffers a rupture of its ducts. Currently, there exists three options for drainage or debridement of pancreatic pseudocysts and walled‐off necrosis (WON). The traditional procedure is drainage by placing double pigtail plastic stents (DPPS); lumen‐apposing metal stent (LAMS) has a biflanged design with a wide lumen that avoids occlusion with necrotic tissue, which is more common with DPPS and reduces the possibility of migration. We performed a systematic review and meta‐analyses head‐to‐head, including only studies that compare the two main techniques to drainage of PFCs: LAMS vs DPPS. Methods We conducted a systematic review in different databases, such as PubMed, OVID, Medline, and Cochrane Databases. This meta‐analysis considers studies published from 2014 to 2020, including only studies that compare the two main techniques to drainage of PFCs: LAMS vs DPPS. Results Thirteen studies were included in the meta‐analyses. Only one of all studies was a randomized controlled trial. These studies comprise 1584 patients; 68.2% were male, and 31.8% were female. Six hundred sixty‐three patients (41.9%) were treated with LAMS, and 921 (58.1%) were treated with DPPS. Six studies included only WON in their analysis, two included only pancreatic pseudocysts, and five studies included both pancreatic pseudocysts and WON. The technical success was similar in patients treated with LAMS and DPPS (97.6% vs 97.5%, respectively, P = .986, RR = 1.00 [95% CI 0.93‐1.08]). The clinical success was similar in both groups (LAMS: 90.1% vs DPPS: 84.2%, P = .139, RR = 1.063 [95% CI 0.98‐1.15]). Patients treated with LAMS had a lower complication rate than the DPPS groups, with a significant statistical difference (LAMS: 16.0% vs DPPS: 20.2%, P = .009, RR = 0.746 [95% CI 0.60‐0.93]). Bleeding was the most common complication in the LAMS group (33 patients, [5.0%]), whereas infection was the most common complication in the DPPS group (56 patients, [6.1%]). The LAMS migration rate was lower than in the DPPS (0.9% vs 2.2%, respectively, P = .05). The mortality rate was similar in both groups, 0.6% in the LAMS group (four patients) and 0.4% in the DPPS group (four patients; P = .640). Conclusion The PFCs drainage is an indication when persistent symptoms or PFCs‐related complications exist. EUS guided drainage with LAMS has similar technical and clinical success to DPPS drainage for the management of PFCs. The technical and clinical success rates are high in both groups. However, LAMS drainage has a lower adverse events rate than DPPS drainage. More randomized controlled trials are needed to confirm the real advantage of LAMS drainage over DPPS drainage.

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Section: Discussionmentioning

confidence: 99%

Head‐to‐head comparison between endoscopic ultrasound guided lumen apposing metal stent and plastic stents for the treatment of pancreatic fluid collections: A systematic review and meta‐analysis

Guzmán-Calderón

Chacaltana

Díaz

et al. 2021

J Hepato Biliary Pancreat

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“… 24 2018 US 2010–2016 Multi-center Retrospective 122 64 58 AXIOS 60 43/79 7 9 Sundeep et al. 25 2018 Korea NA NA Prospective 5 4 1 Nagi 29 0/5 6 10 Maria et al. 26 2018 Italy 2013–2016 7 Retrospective 67 23 44 Nagi 59 21/46 8 11 Rajat et al.…”

Section: Resultsmentioning

confidence: 99%

“…The included literature also reported LAMS placement combining with other reasonable endoscopic treatments based on the available clinical expertise, such as the double pigtail plastic stent placed coaxially in LAMS, 24 the double pigtail plastic stent replaced after the removal of LAMS, 27 nasal cyst drainage tube placement, endoscopic retrograde pancreatic drainage, and percutaneous catheter drainage. 20 , 23 , 25 All of them may have a contribution in the outcome of PFCs. Even with an inevitable effect of the above combination therapies, the clinical success rate of WON is still lower than that of PPC.…”

Section: Discussionmentioning

confidence: 99%

Comparative outcomes of endoscopic ultrasound‐guided lumen‐apposing mental stents drainage for pancreatic pseudocysts and walled‐off necrosis: Case series and meta‐analysis

Zhang

Zhou

et al. 2021

Chronic Diseases and Translational Medicine

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Background Endoscopic ultrasound (EUS)-guided transmural drainage for pancreatic fluid collections (PFCs) has become the first-line treatment with quicker recovery and more minor injury compared with surgery and percutaneous drainage. The efficacy of stents implantation and drainage for different PFCs remains controversial, especially lumen-apposing metal stents (LAMS). This study aimed to compare the efficacy and safety of LAMS drainage for pancreatic pseudocysts (PPC) and walled-off necrosis (WON). Methods A meta-analysis was performed for LAMS drainage for WON and PPC by systematically searching PubMed, Cochrane, and Embase databases from January 2010 to January 2020. From 2017 to 2019, 12 patients who were treated with LAMS drainage for PFCs in our medical center were also reviewed and included in this study. Results Combining 11 copies of documents with the data from our medical center, a total of 585 patients with PFCs were enrolled in this meta-analysis, including 343 patients with WON and 242 with PPC. The technical success rate in WON is not significantly different from that of PPC ( P = 0.08 > 0.05). The clinical success of LAMS placement was achieved in 99% vs 89% in PPC and WON, respectively (RR = 0.92, 95% CI: 0.86–0.98, P = 0.01 < 0.05). The further intervention of direct endoscopic necrosectomy was required by 60% of patients in WON group. There was no significant difference in the incidence of adverse events, including infection, bleeding, stent migration and stent occlusion, after LAMS placement between WON and PPC. Conclusions Endoscopic ultrasound-guided LAMS for PFCs are feasible, effective with preferable technical and clinical success rates. The clinical effect of LAMS on PPC is slightly better than that of WON, but its adverse reactions still need to be verified in a large-sample prospective study.

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“…Due to paucity of data about the use of DEN in both arms provided, a good comparison for the use of DEN was not performed. The included literature also reported LAMS placement combining with other reasonable endoscopic treatments based on the available clinical expertise, such as the double pigtail plastic stent placed coaxially in LAMS 25 , the double pigtail plastic stent replaced after the removal of LAMS 28 , nasal cyst drainage tube placement, endoscopic retrograde pancreatic drainage 21 and percutaneous catheter drainage 24,26 , which may have a contribution in the outcome of PFCs. Even with an inevitable effect of the above combination therapies, the clinical success rate of WON is still lower than that of PPC.…”

Section: Discussionmentioning

confidence: 99%

Comparative Outcomes of EUS-Guided Lumen-Apposing Mental Stents Drainage for Pancreatic Pseudocysts and Walled-off Necrosis: Case Series and Meta-Analysis

Zhang

Zhou

et al. 2020

Preprint

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Background and Aims: Endoscopic ultrasound-guided transmural drainage for pancreatic fluid collections (PFCs) has become the first-line treatment with quicker recovery and less injury compared with surgery and percutaneous drainage. The efficacy of stents implantation and drainage for different types of PFCs remains controversial, especially lumen-apposing mental stents (LAMS). This study aims to compare efficacy and safety of LAMS drainage for pancreatic pseudocysts (PPC) and walled-off necrosis (WON).Methods: A meta-analysis was performed for LAMS drainage for WON and PPC by systematically searching PubMed, Cochrane, and Embase databases from January 2010 to January 2020. From 2017 to 2019, 12 patients who were treated with LAMS drainage for PFCs in our medical center were also reviewed and included in this study.Results: Combining 11 searched literatures with the data from our medical center, a total of 585 patients with PFCs were enrolled in this meta-analysis, including 343 patients with WON and 242 with PPC. The technical success rate in WON is not significant different from that of PPC (P = 0.08 > 0.05). The clinical success of LAMS placement was achieved in 99% versus 89% in PPC and WON, respectively (RR = 0.92, 95% CI: 0.86–0.98, P = 0.01 < 0.05). Further intervention of direct endoscopic necrosectomy was required in 60% of patients in WON group. There was no significant difference in the incidence of adverse events after LAMS placement between WON and PPC, including infection, bleeding, stent migration and stent occlusion.Conclusions: Endoscopic ultrasound-guided LAMS for PFCs is feasible, effective with preferable technical and clinical success rates. The clinical effect of LAMS on PPC is better than that of WON, but its adverse reactions still need to be verified in a large-sample prospective study.

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Endoscopic drainage of pancreatic fluid collections by use of a novel biflanged stent with electrocautery-enhanced delivery system

Cited by 10 publications

References 10 publications

Head‐to‐head comparison between endoscopic ultrasound guided lumen apposing metal stent and plastic stents for the treatment of pancreatic fluid collections: A systematic review and meta‐analysis

Head‐to‐head comparison between endoscopic ultrasound guided lumen apposing metal stent and plastic stents for the treatment of pancreatic fluid collections: A systematic review and meta‐analysis

Comparative outcomes of endoscopic ultrasound‐guided lumen‐apposing mental stents drainage for pancreatic pseudocysts and walled‐off necrosis: Case series and meta‐analysis

Comparative Outcomes of EUS-Guided Lumen-Apposing Mental Stents Drainage for Pancreatic Pseudocysts and Walled-off Necrosis: Case Series and Meta-Analysis

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