Endoscopic treatment of large pancreatic fluid collections (PFC) using self-expanding metallic stents (SEMS) – a two-center experience

Chaves, Dalton Marques; Mönkemüller, Klaus; Carneiro, Fred Olavo Aragão Andrade; Medrado, Bruno Frederico; Santos, Marcos dos; Wodak, Stephanie; Reimão, Sílvia Mansur; Sakai, Paulo; Moura, Eduardo Guimarães Hourneaux de

doi:10.1055/s-0034-1390796

Cited by 3 publications

(5 citation statements)

References 19 publications

(39 reference statements)

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“…Traditional tubular biliary metal stent and BFMS have been widely used for EUS-guided drainage of PPC in recent years, but most of these studies were usually restricted to small case series and observation reports. [14,20,24] To the best of our knowledge, there has been only 1 comparative study showing distinctions among different types of metal and plastic stents for PPC drainage. [25]…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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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.

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Section: Discussionmentioning

confidence: 99%

“…[10–13] It is indicated that quite a number of patients using tubular metal stent (TMS) required additional interventions to avoid procedure-related complications. [14,15]…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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“…Actualmente, el drenaje endoscópico del pseudoquiste pancreático es la opción preferida en muchos centros de referencia, con reportes de éxito superiores al 93% y morbilidad inferior al 10%, sin mortalidad (10,17) . El drenaje por USE se asocia a un aumento del éxito técnico y disminución de la incidencia de complicaciones (4) . Este estudio demostró éxito técnico en el 100% (13/13) de pacientes, con pocas complicaciones relacionadas al procedimiento (1/13 pacientes) y resolución del cuadro superior al 90% (el éxito clínico fue del 92,3%); esto evidencia que el drenaje guiado por USE usando LAMS (Niti-S HOT SPAXUS; Taewoong Medical Co, Ltd, Ulsan, Corea del Sur) con diámetros de 16 mm y 10 mm y con una longitud de 20 mm es una alternativa para ser tenida en cuenta, pues es técnicamente factible y efectiva para el tratamiento de pseudoquistes pancreáticos sintomáticos, acompañada de pocas complicaciones al ser usado en nuestro medio.…”

Section: A B Cunclassified

“…La clasificación actualizada de Atlanta (3) describe que, en la fase tardía de la pancreatitis, después de más de 4 semanas, se desarrollan los pseudoquistes pancreáticos a partir de pancreatitis edematosa intersticial o necrosis amurallada resultante de pancreatitis necrosante. Los pseudoquistes sobreinfectados o sintomáticos requieren de manejo intervencionista y las modalidades terapéuticas actuales incluyen drenaje quirúrgico, endoscópico o percutáneo (4) .…”

Section: Introductionunclassified

Drenaje de pseudoquistes pancreáticos usando stent metálico luminal de aposición (LAMS): experiencia en dos centros de referencia en Colombia

Flórez Sarmiento,

Parra Izquierdo,

Frías Ordoñez

et al. 2023

Rev. colomb. Gastroenterol.

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Introducción: el drenaje guiado por ultrasonido endoscópico (USE) y el uso de stent metálico luminal de aposición (LAMS) son de elección en el manejo de los pseudoquistes pancreáticos sintomáticos. Objetivo: evaluar la efectividad y seguridad del LAMS para el drenaje por USE de pseudoquistes pancreáticos sintomáticos en dos centros de referencia en Colombia. Materiales y métodos: estudio de cohorte prospectivo multicéntrico entre junio de 2019 y diciembre de 2021, se incluyeron a 13 pacientes con diagnóstico de pseudoquistes pancreáticos sintomáticos sometidos a drenaje por USE con LAMS. Se evaluaron como desenlaces el éxito técnico, el éxito clínico y la extracción exitosa del stent. Y los desenlaces de seguridad incluyeron eventos adversos relacionados con el stent y los eventos adversos generales. Se realizó seguimiento a 8 semanas, en las que se recopilaron datos relacionados con el retiro del stent. Resultados: la edad promedio fue 53,4 años, 8/13 fueron hombres. El tamaño medio del pseudoquiste fue de 9,56 ± 2,3 cm. El éxito técnico fue del 100% y el éxito clínico fue 92,3%. Los stents fueron retirados en promedio a las 8 ± 2 semanas. El tiempo medio del procedimiento desde la punción hasta el despliegue del stent fue 3,2 ± 2,4 minutos. En el control imagenológico hubo un adecuado drenaje de las colecciones en todos los casos. Hubo baja frecuencia de complicaciones, se documentó sangrado en 1 caso con requerimiento quirúrgico. Conclusiones: el uso de LAMS es seguro y efectivo en el manejo de pseudoquistes pancreáticos sintomáticos, disminuye la estancia hospitalaria y sobrecostos. La sintomatología clínica prima en la decisión de intervención.

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“…Advantages of LAMS include their large diameter (10 – 15 mm), bi-flared flanges preventing stent migration, and ease of insertion as one-step devices including cautery without need for needle puncture, wire guidance, tract dilation, or fluoroscopic guidance. Prospective and retrospective series have shown excellent efficacy and safety of LAMS in management of PP 6 7 8 9 10 11 12 13 14 15 ; however, LAMS are also known as considerably more expensive than traditional plastic stents (PS). Insertion of a stent could also generate possible adverse events and therefore the need for unplanned endoscopy, percutaneous drainage (PCD) or even surgery that should be taken into account in the comparison.…”

Section: Introductionmentioning

confidence: 99%

Plastic stents are more cost-effective than lumen-apposing metal stents in management of pancreatic pseudocysts

et al. 2018

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Background and study aims Endoscopic ultrasound-guided drainage is an effective and accepted primary modality for management of pancreatic pseudocyst (PP). A lumen-apposing metal stent (LAMS) has recently been developed specifically for drainage of pancreatic fluid collections which may be superior to using traditional plastic stents (PS) but is more expensive. Because use of a stent involves a risk of unplanned endoscopy, percutaneous drainage (PCD) and surgery, their costs should also be included in the comparison and a cost-effectiveness analysis of LAMS and PS should therefore be performed Patients and methods A decision tree was developed assessing both endoscopic drainage strategies for patients with PP: LAMS and PS over a 6-month time horizon. For each strategy, inpatients received a stent and were followed for subsequent need for direct further interventions or adverse events leading to unplanned endoscopy, PCD, surgery, or successful endoscopic drainage using probabilities obtained from the literature. The unit of effectiveness was successful endoscopic drainage without need for PCD or surgery. Sensitivity analyses were performed. Results Success rates were 93.9 % for LAMS and 96.96 % for PS. Respective costs per successful drainage were US $ 18,129 (LAMS) and US $ 10,403 (PS). The LAMS strategy was thus characterized as dominated by the PS approach because it was costlier and less effective than PS. Both deterministic and probabilistic sensitivity analyses confirmed the robustness of these findings. Conclusion Use of LAMS is not less effective and more costly than PS in management of patients with PP. As such, PS should be preferred over LAMS as initial management of these patients.

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Endoscopic treatment of large pancreatic fluid collections (PFC) using self-expanding metallic stents (SEMS) – a two-center experience

Cited by 3 publications

References 19 publications

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

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

Drenaje de pseudoquistes pancreáticos usando stent metálico luminal de aposición (LAMS): experiencia en dos centros de referencia en Colombia

Plastic stents are more cost-effective than lumen-apposing metal stents in management of pancreatic pseudocysts

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