EUS-guided drainage of peripancreatic fluid collections with lumen-apposing metal stents and plastic double-pigtail stents: comparison of efficacy and adverse event rates

Lang, Gabriel; Fritz, Cassandra; Bhat, Trisha; Das, Koushik K.; Murad, Faris; Early, Dayna S.; Edmundowicz, Steven A.; Kushnir, Vladimir; Mullady, Daniel

doi:10.1016/j.gie.2017.06.029

Cited by 128 publications

(126 citation statements)

References 35 publications

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“…Lang et al 30 reported a single-center experience with 84 DPS and 19 LAMS patients that included both PP and WON with similar clinical success between the 2 groups ( P = .78). Fourteen of 84 (16.7%) DPS patients and 9 of 19 (47.3%) LAMS patients were classified as WON.…”

Section: Discussionmentioning

confidence: 85%

“…In our series specifically comparing DPS and LAMS, the number of bleeding events in the LAMS group, and in particular serious pseudoaneurysm bleeding, was higher than previously reported data. 17,22,30 Furthermore, our bleeding events seem to occur within the first 3 weeks of placement, prompting some to consider removal within 4 weeks or earlier if imaging shows resolution. A possible explanation for the bleeding includes rapid collapse of the PFC with LAMS placement, which may cause the distal flange to irritate the back wall of the PFC, promoting pseudoaneurysm formation and subsequent bleeding.…”

Section: Discussionmentioning

confidence: 99%

“…The bleeding was hypothesized to be from rapid collapse of the PFC with LAMS placement and possible exposure to gastric acid. 30 A dual-center retrospective study of various SEMS and DPS to treat WON patients included 106 DPS, 121 fully covered SEMS (FCSEMS), and 86 LAMS. They found that technical success was similar between the groups ( P = .37), but clinical success was superior for FCSEMS and LAMS compared with DPS arms (95% vs 90% vs 81%, respectively; P = .001).…”

Section: Discussionmentioning

confidence: 99%

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Increased Incidence of Pseudoaneurysm Bleeding With Lumen-Apposing Metal Stents Compared to Double-Pigtail Plastic Stents in Patients With Peripancreatic Fluid Collections

Brimhall

Han

Tatman

et al. 2018

Clinical Gastroenterology and Hepatology

125

120

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In a retrospective study of patients undergoing drainage of pancreatic pseudocysts or walled-off necrosis, we found LAMS and DPS to have comparable rates of technical and clinical success and adverse events. Drainage of walled-off necrosis or pancreatic pseudocysts using DPS was associated with fewer bleeding events overall, including pseudoaneurysm bleeding, but bleeding risk with LAMS should be weighed against the trend of higher actionable perforation and infection rates with DPS.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Increased Incidence of Pseudoaneurysm Bleeding With Lumen-Apposing Metal Stents Compared to Double-Pigtail Plastic Stents in Patients With Peripancreatic Fluid Collections

Brimhall

Han

Tatman

et al. 2018

Clinical Gastroenterology and Hepatology

125

120

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“…As a newly invented fully covered metallic braided stent, LAMS with bilateral anchor flanges aimed to reduce migration, and the large diameter even permits endoscopic intervention through the inner lumen . Thus, LAMS triggered a worldwide trend of research and has become increasingly popular in recent years …”

Section: Discussionmentioning

confidence: 99%

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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“…57 The use of LAMSs for drainage of WON has improved the ease and technical success of endoscopic drainage, however, retrospective studies have suggested discrepant results when comparing LAMSs to plastic stents. 15–18 LAMSs have introduced new concerns, including formation of stent-related pseudoaneurysms and segregation of remote areas of WON after rapid collapse of the central cavity drained by a LAMS. In order to address the relatively high adverse event rate and mortality risk associated with endoscopic necrosectomy, each component of the procedure should be analyzed to optimize efficiency and safety.…”

Section: Eus-guided Diagnostics and Therapeuticsmentioning

confidence: 99%

Endoscopic Ultrasound and Related Technologies for the Diagnosis and Treatment of Pancreatic Disease - Research Gaps and Opportunities

et al. 2017

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A workshop was sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases to address the research gaps and opportunities in pancreatic endoscopic ultrasound (EUS). The event occurred on July 26, 2017 in 4 sessions: (1) benign pancreatic diseases, (2) high-risk pancreatic diseases, (3) diagnostic and therapeutics, and (4) new technologies. The current state of knowledge was reviewed, with identification of numerous gaps in knowledge and research needs. Common themes included the need for large multicenter consortia of various pancreatic diseases to facilitate meaningful research of these entities; to standardize EUS features of different pancreatic disorders, the technique of sampling pancreatic lesions, and the performance of various therapeutic EUS procedures; and to identify high-risk disease early at the cellular level before macroscopic disease develops. The need for specialized tools and accessories to enable the safe and effective performance of therapeutic EUS procedures also was discussed.

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EUS-guided drainage of peripancreatic fluid collections with lumen-apposing metal stents and plastic double-pigtail stents: comparison of efficacy and adverse event rates

Cited by 128 publications

References 35 publications

Increased Incidence of Pseudoaneurysm Bleeding With Lumen-Apposing Metal Stents Compared to Double-Pigtail Plastic Stents in Patients With Peripancreatic Fluid Collections

Increased Incidence of Pseudoaneurysm Bleeding With Lumen-Apposing Metal Stents Compared to Double-Pigtail Plastic Stents in Patients With Peripancreatic Fluid Collections

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

Endoscopic Ultrasound and Related Technologies for the Diagnosis and Treatment of Pancreatic Disease - Research Gaps and Opportunities

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