Endoscopic ultrasonography‐guided transmural drainage of walled‐off pancreatic necrosis: Comparison between a specially designed fully covered bi‐flanged metal stent and multiple plastic stents

Bapaye, Amol; Dubale, Nachiket; Sheth, Keyur A.; Bapaye, Jay; Ramesh, Jayapal; Gadhikar, Harshal; Mahajani, Sheetal a.; Date, Suhas; Pujari, Rajendra; Gaadhe, Ravindra

doi:10.1111/den.12704

Cited by 92 publications

(105 citation statements)

References 19 publications

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“…However, 75% (3/4) bleeding cases in LAMS of our study was observed at about 1 week after procedure, indicating that early bleeding might be more frequent than expected. To confirm this finding, studies reporting the time and outcomes of bleeding were systemically retrieved in Table S1 and summarized in Table . Generally, bleeding was reported in 34 patients from eight studies during the first 3 weeks, which was reported in only 16 patients from six studies 3 weeks after intervention.…”

Section: Discussionmentioning

confidence: 90%

Comparison of three different stents for endoscopic ultrasound‐guided drainage of pancreatic fluid collection: A large retrospective study

Wang

Zhao

Meng

et al. 2019

J of Gastro and Hepatol

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Background and Aim Endoscopic transmural drainage has been recognized as the first‐line treatment for pancreatic fluid collection (PFC). Currently, three different types of stents have been extensively applied, including double pigtail plastic stent (PS), fully covered self‐expanding metal stent (FCSEMS), and novel lumen‐apposing metal stent (LAMS). Nonetheless, limited data are available about the comparison among them in terms of their clinical outcomes and safety for endoscopic ultrasound‐guided drainage of PFC. Methods The current retrospective study was carried on 160 PFC patients undergoing endoscopic ultrasound‐guided drainage from 2010 to 2018 at a single tertiary care center. Patients were divided into three groups based on different drainage ways: drainage using PS, FCSEMS, or LAMS. Results A total of 160 PFC patients (104 male and 56 female) were analyzed in this retrospective study, including 62 patients drained with PS, 28 with FCSEMS, and 70 with LAMS. Typically, the technical success (93.5% vs 96.4% vs 94.3%, P = 1.000) and treatment success rates (84.6% vs 85.2% vs 89.2%, P = 0.763) were similar between PS, FCSEMS, and LAMS. With regard to major adverse events, four patients (FCSEMS: n = 2 and LAMS: n = 2) with pseudoaneurysms developed severe bleeding; among them, 75% (3/4) of patients were observed within 2 weeks after intervention, and two patients in LAMS group died. Conclusions There are no significant differences in the clinical outcomes of PFC patients treated with PS, FCSEMS, or LAMS. Nonetheless, severe (or even fatal) bleeding may occur at the early stage after metal stent placement, which should be paid particular attention to.

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Section: Discussionmentioning

confidence: 90%

Comparison of three different stents for endoscopic ultrasound‐guided drainage of pancreatic fluid collection: A large retrospective study

Wang

Zhao

Meng

et al. 2019

J of Gastro and Hepatol

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“…In recent studies comparing plastic with metal stents - the AEs were either similar or lower in the metal stent group (Table 2)[52-55,76]. Metal stents can tamponade the edges of cysto-gastrostomy site, thereby reducing the occurrence of bleeding from puncture site.…”

Section: Adverse Eventsmentioning

confidence: 99%

Endoscopic management of pancreatic fluid collections-revisited

Nabi

Basha

Reddy

2017

WJG

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The development of pancreatic fluid collections (PFC) is one of the most common complications of acute severe pancreatitis. Most of the acute pancreatic fluid collections resolve and do not require endoscopic drainage. However, a substantial proportion of acute necrotic collections get walled off and may require drainage. Endoscopic drainage of PFC is now the preferred mode of drainage due to reduced morbidity and mortality as compared to surgical or percutaneous drainage. With the introduction of new metal stents, the efficiency of endoscopic drainage has improved and the task of direct endoscopic necrosectomy has become easier. The requirement of re-intervention is less with new metal stents as compared to plastic stents. However, endoscopic drainage is not free of adverse events. Severe complications including bleeding, perforation, sepsis and embolism have been described with endoscopic approach to PFC. Therefore, the endoscopic management of PFC is a multidisciplinary affair and involves interventional radiologists as well as GI surgeons to deal with unplanned adverse events and failures. In this review we discuss the recent advances and controversies in the endoscopic management of PFC.

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“…Since the publication of this systematic review, multiple studies have demonstrated improved outcomes for the treatment of WON when using metal stents, with fewer endoscopic necrosectomy sessions required to achieve resolution, fewer adverse events, shorter hospital stay and reduced need for salvage surgery [27,31]. Furthermore, a recent study found superior resolution rates of WON at 6 months follow-up when drainage had been performed with metal stents (both straight FcSEMS and LAMS) than with PS [27].…”

Section: Metal Vs Plastic Stentsmentioning

confidence: 99%

Endoscopic Ultrasound-Guided Management of Pancreatic Fluid Collections: Update and Review of the Literature

et al. 2017

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Severe acute pancreatitis is often complicated by the development of pancreatic fluid collections (PFCs), which may be associated with significant morbidity and mortality. It is crucial to accurately classify these collections as a pseudocyst or walled-off necrosis (WON) given significant differences in outcomes and management. Interventions for PFCs have increasingly shifted to less invasive strategies, with endoscopic ultrasound (EUS)-guided methods being shown to be safer and equally effective as more invasive surgical techniques. In recent years, many new developments have improved the safety and efficacy of EUS-guided interventions, such as the introduction of lumen-apposing metal stents (LAMS), direct endoscopic necrosectomy (DEN) and multiple other adjunctive techniques. Despite these developments, treatment of PFCs, and infected WON in particular, continues to be associated with significant morbidity and mortality. In this article, we discuss the EUS-guided management of PFCs while reviewing the latest developments and controversies in the field. We end by summarizing our own approach to managing PFCs.

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Endoscopic ultrasonography‐guided transmural drainage of walled‐off pancreatic necrosis: Comparison between a specially designed fully covered bi‐flanged metal stent and multiple plastic stents

Abstract: BFMS appear to be superior to MPS for EUS-guided WON drainage in terms of clinical success, number of DEN sessions, adverse events, need for salvage surgery and hospital stay.

Cited by 92 publications

References 19 publications

Comparison of three different stents for endoscopic ultrasound‐guided drainage of pancreatic fluid collection: A large retrospective study

Comparison of three different stents for endoscopic ultrasound‐guided drainage of pancreatic fluid collection: A large retrospective study

Endoscopic management of pancreatic fluid collections-revisited

Endoscopic Ultrasound-Guided Management of Pancreatic Fluid Collections: Update and Review of the Literature

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