EUS-guided drainage of pancreatic fluid collections using a novel lumen-apposing metal stent on an electrocautery-enhanced delivery system: a large retrospective study (with video)

Rinninella, Emanuele; Kunda, Rastislav; Dollhopf, Markus; Sánchez-Yagüe, Andrés; Will, Uwe; Tarantino, Ilaria; Soler, Joan Gornals; Ullrich, Sebastian; Meining, Alexander; Esteban, José M.; Enz, Thomas; Vanbiervliet, Geoffroy; Vleggaar, Frank P.; Attili, Fabia; Larghi, Alberto

doi:10.1016/j.gie.2015.04.006

Cited by 185 publications

(141 citation statements)

References 23 publications

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“…Walter et al [63] published their data of 15 patients with a clinical success rate of 93%, resolution rate of 100%, and 1 significant complication (perforation). And most recently, Rinninella et al [64] documented a 98% cyst resolution rate with adverse events in 2 out of 41 patients. In summary, pancreatic pseudocysts can be efficaciously managed endoscopically.…”

Section: Novel Lumen-apposing Metal Stentmentioning

confidence: 96%

Management of pancreatic fluid collections: A comprehensive review of the literature

Tyberg¹,

Karia²,

Gabr³

et al. 2016

WJG

161

154

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Pancreatic fluid collections (PFCs) are a frequent complication of pancreatitis. It is important to classify PFCs to guide management. The revised Atlanta criteria classifies PFCs as acute or chronic, with chronic fluid collections subdivided into pseudocysts and walled-off pancreatic necrosis (WOPN). Establishing adequate nutritional support is an essential step in the management of PFCs. Early attempts at oral feeding can be trialed in patients with mild pancreatitis. Enteral feeding should be implemented in patients with moderate to severe pancreatitis. Jejunal feeding remains the preferred route of enteral nutrition. Symptomatic PFCs require drainage; options include surgical, percutaneous, or endoscopic approaches. With the advent of newer and more advanced endoscopic tools and expertise, and an associated reduction in health care costs, minimally invasive endoscopic drainage has become the preferable approach. An endoscopic ultrasonography-guided approach using a seldinger technique is the preferred endoscopic approach. Both plastic stents and metal stents are efficacious and safe; however, metal stents may offer an advantage, especially in infected pseudocysts and in WOPN. Direct endoscopic necrosectomy is often required in WOPN. Lumen apposing metal stents that allow for direct endoscopic necrosectomy and debridement through the stent lumen are preferred in these patients. Endoscopic retrograde cholangio pancreatography with pancreatic duct (PD) exploration should be performed concurrent to PFC drainage. PD disruption is associated with an increased severity of pancreatitis, an increased risk of recurrent attacks of pancreatitis and long-term complications, and a decreased rate of PFC resolution after drainage. Any pancreatic ductal disruption should be bridged with endoscopic stenting. However, with improving pathophysiologic under standing and improving diagnostic tools, it became clear that a more detailed organizational system was required. More specifically, one that distinguished between collections containing fluid alone vs those arising from necrosis and/or containing solid components. As such, a new classification system was developed known as the revised Atlanta criteria [4] . Similar to the original Atlanta Criteria, PFCs are classified as acute (< 4 wk after the pancreatitis episode) or chronic (> 4 wk after the pancreatitis episode). However, in the revised criteria, both acute and chronic collections are further subdivided based on the presence of necrosis within the collection. Acute collections are divided into: acute peripancreatic fluid collections (APFC) and acute necrotic collections (ANC); chronic fluid collections are divided into: pseudocysts or walledoff pancreatic necrosis (WOPN). These new classifications are important because the treatment and management varies depending on the type of collection. ENTERAL FEEDINGThe first step in the management of any PFC is ensuring adequate nutritional support. In mild to moderate acute pancreatitis, oral feeding can be initiated when...

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Section: Novel Lumen-apposing Metal Stentmentioning

confidence: 96%

Management of pancreatic fluid collections: A comprehensive review of the literature

Tyberg¹,

Karia²,

Gabr³

et al. 2016

WJG

161

154

View full text Add to dashboard Cite

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“…57,58 Several other series confirmed the high success rate in complete cyst resolution and a very low rate of serious complications with the use of these lumen-apposing metallic stents (LAMS). [59][60][61][62] These and other studies collectively demonstrate that EUSguided transmural drainage of PFCs (especially those containing solid necrotic material and often needing several necrosectomy sessions) is feasible and safe. However, even in the most experienced hands, serious and potentially life-threatening complications may occur and a multidisciplinary approach (i.e., endoscopists, interventional radiologists and hepatopancreatobiliary surgeons) is essential for a positive outcome.…”

mentioning

confidence: 70%

Endoscopic ultrasound-guided extraluminal drainage: Novel concepts, challenges and future directions

Madácsy

Kaltsidis²

2017

Int J Gastrointest Interv

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A B S T R A C TEndoscopic ultrasound (EUS)-guided management of abdominal fluid collections adjacent to the gastroduodenal lumen is a relatively new concept attracting a lot of interest in recent years. The ability of EUS to identify and drain these collections in the same session accounts for the surge of interest in these novel techniques. On the other hand, the complexity of these interventions and associated serious complications has moderated the enthusiasm of novice endoscopists to some extent and reiterated that focused research and technical innovations are needed to make EUS-guided drainage simpler and safer. Self-expandable metallic stents (SEMS) have emerged in the last decade in the endoscopic management of malignant luminal gastrointestinal strictures. The use of SEMS in the management of benign conditions (biliary, pancreatic, and colonic strictures) is also rapidly expanding. Recently, fully-covered (FC)-SEMS have been successfully used for drainage of peripancreatic and pericholecystic fluid collections. Here we will review the existing data and future directions in the use of FC-SEMS for such drainage procedures. We will also review the literature on novel "purpose-made" prostheses, such as the lumen-apposing metallic stents, which aim to address technical problems arising in EUS-guided drainage procedures when conventional SEMS are used. Further development of these and other similar devices may transform EUS-guided drainage procedures from an esoteric concept to "mainstream", first-line intervention.

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“…In a similar retrospective study of 93 patients (80% with complex collections) with PFCs at 13 European centers, Rinninella et al 20 successfully placed LAMS in 92/93 patients (98.9%). Overall clinical success occurred in 86/93 patients (92.5%) without evidence of recurrence during average follow-up of 320 days.…”

mentioning

confidence: 98%

“…The average duration of follow-up was 13 months with only 1 recurrence at 12 months after stent removal (Table 1). [14][15][16][17][18][19][20][21] With regard to the safety of LAMS versus plastic stents, a recent ongoing randomized trial for drainage of PFCs via LAMS versus plastic stents demonstrated stent-related adverse events in 50.0% (6/12) patients who received LAMS and no adverse events in patients who received plastic stents. 22 Similar results were seen in a previous study using both LAMS and plastic stents for drainage of PFCs where stent-related adverse events occurred in 10.0% (2/20) of patients who received LAMS and 2.5% (1/40) patients who received plastic stents.…”

mentioning

confidence: 99%

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Lumen apposing metal stents: A review of current uses and outcomes

Bank

Adler

2017

Int J Gastrointest Interv

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A B S T R A C TLumen-apposing metal stents (LAMS) represent a new innovation in gastrointestinal endoscopy. These devices have a saddle-shaped design and larger inner lumen diameter than either plastic or metal biliary stents, which should decrease the risk of migration and allows for an endoscope to pass into pancreatic fluid collections as well as the ability to perform direct endoscopic necrosectomy. LAMS were originally conceived and designed for transmural pancreatic fluid collection drainage but are currently also being used for many off label indications. There are three different LAMS available at this time around the globe. This manuscript will review the current state of the art with regards to LAMS and their indications, usage, and outcomes.

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EUS-guided drainage of pancreatic fluid collections using a novel lumen-apposing metal stent on an electrocautery-enhanced delivery system: a large retrospective study (with video)

Cited by 185 publications

References 23 publications

Management of pancreatic fluid collections: A comprehensive review of the literature

Management of pancreatic fluid collections: A comprehensive review of the literature

Endoscopic ultrasound-guided extraluminal drainage: Novel concepts, challenges and future directions

Lumen apposing metal stents: A review of current uses and outcomes

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