EUS-guided treatment of WON using lumen-apposing metal stents: protocol standardisation based on the occurrence of natural healing processes

Rimbaș, Mihai; Pizzicanella, Margherita; Larghi, Alberto

doi:10.1136/gutjnl-2018-316994

Cited by 5 publications

(5 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It could be argued that the bleeding episodes observed in our study were detected beyond the usual timeframe described in the guidelines. However, this axiom has been questioned in recent large nationwide studies [22,23], hence our results are in line with the recent literature in this field.…”

Section: Overallsupporting

confidence: 92%

“…Conversely, in more recent years, rates of bleeding requiring transfusion and/or intervention of 13.4 %-25 % have been observed [21,22], reaching 32.4 % in post-marketing surveillance from the FDA-MAUDE [8]. It is plausible to hypothesize that this risk is related to the conformation of the intracavitary flange of the Hot-Axios stent, which presents at its terminal portion rigid spikes that can scrape and/or perforate the surface of the contralateral wall of the cavity when it shrinks, creating erosion of vessels and subsequent bleeding [23].…”

Section: Discussionmentioning

confidence: 99%

“…Device Experience (MAUDE), which highlighted the high frequency of AEs relating to use of the Hot-Axios for the treatment of PFCs, with a bleeding rate of 32.4 % [8]. Bleeding occurs as the PFC is resolving and the pseudoaneurysms in the contralateral collection wall, previously compressed by the pressure of the cavity, come into contact with the rigid spikes of the terminal end of the intracavitary flange, causing wall erosion and consequent bleeding [9].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Lumen-apposing metal stents for the treatment of pancreatic and peripancreatic fluid collections and bleeding risk: a propensity matched study

Mangiavillano,

Lakhtakia,

Samanta

et al. 2024

Endoscopy

Self Cite

View full text Add to dashboard Cite

Introduction Endoscopic ultrasound (EUS)-guided drainage of symptomatic pancreatic fluid collections (PFCs) using the Hot-Axios device has recently been associated with a significant risk of bleeding. This adverse event (AE) seems to occur less frequently with the use of a different device, the Spaxus stent. The aim of the current study was to compare the rates of bleeding between the two stents. Methods Patients admitted for treatment of PFCs by EUS plus lumen-apposing metal stent in 18 endoscopy referral centers between 10 July 2019 and 28 February 2022 were identified and their outcomes compared using a propensity-matching analysis. Results 363 patients were evaluated. After a 1-to-1 propensity score match, 264 patients were selected (132 per group). The technical and clinical success rates were comparable between the two groups. Significantly more bleeding requiring transfusion and/or intervention occurred in the Hot-Axios group than in the Spaxus group (6.8% vs. 1.5%; P = 0.03); stent type was a significant predictor of bleeding in both univariate and multivariate regression analyses (P = 0.03 and 0.04, respectively). Bleeding necessitating arterial embolization did not however differ significantly between the two groups (3.0% vs. 0%; P = 0.12). In addition, the Hot-Axios was associated with a significantly higher rate of overall AEs compared with the Spaxus stent (9.8% vs. 3.0%; P = 0.04). Conclusion Our study showed that, in patients with PFCs, bleeding requiring transfusion and/or intervention occurred significantly more frequently with use of the Hot-Axios stent than with the Spaxus stent, although this was not the case for bleeding requiring embolization.

show abstract

Section: Overallsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Lumen-apposing metal stents for the treatment of pancreatic and peripancreatic fluid collections and bleeding risk: a propensity matched study

Mangiavillano,

Lakhtakia,

Samanta

et al. 2024

Endoscopy

Self Cite

View full text Add to dashboard Cite

show abstract

“…The type of PFC, percentage necrotic content, and the presence of infection have a major impact on the decision as to how to perform EUS-guided drainage, even though a clear-cut standardization of the procedure is still lacking [9,26]. Indeed, in the last few years, the introduction of lumen-apposing metal stents (LAMSs) with a cystotome on the catheter tip, allowing a onestep procedure without the need for accessory exchange, has dramatically revolutionized the approach to PFC treatment [27,28].…”

Section: Discussionmentioning

confidence: 99%

“…This lack of an EUS-based PFC morphological classification is responsible for the high variability and lack of therapeutic standardized approaches used by endosonographers to treat these conditions [9]. Differentiation of acute from chronic PFCs is mandatory because the method of drainage and out-comes following therapeutic intervention differ substantially [10].…”

Section: Introductionmentioning

confidence: 99%

The endoscopic ultrasound features of pancreatic fluid collections and their impact on therapeutic decisions: an interobserver agreement study

et al. 2021

Self Cite

View full text Add to dashboard Cite

Background and study aims: A validated classification of endoscopic ultrasound (EUS) morphological characteristics and consequent therapeutic intervention(s) in pancreatic and peripancreatic fluid collections (PFCs) is lacking. We performed an interobserver agreement study among expert endosonographers assessing EUS related PFCs features and therapeutic approaches utilized. Patients and methods: Fifty EUS videos of PFCs were independently reviewed by 12 experts and evaluated for PFC type, percentage of solid component, presence of infection, recognition and communication of the main pancreatic duct (MPD), stent choice for drainage, and direct endoscopic necrosectomy (DEN) performance and timing. The Gwet’s AC1 coefficient was used to assess interobserver agreement. Results: A moderate agreement was found for lesion type (AC1, 0.59), presence of infection (AC1, 0.41), and need for DEN (AC1, 0.50), while fair or poor agreements were stated for percentage of solid component (AC1, 0.15) and MPD recognition (AC1, 0.31). Substantial agreement was rated for ability to assess PFC-MPD communication (AC1, 0.69), decision between placing a plastic versus lumen-apposing metal stent (AC1, 0.62), and timing of DEN (AC1, 0.75). Conclusions: Interobserver agreement between expert endosonographers regarding morphological features of PFCs appeared suboptimal, while decisions on therapeutic approaches seemed more homogeneous. Studies to achieve standardization of the diagnostic endosonographic criteria and therapeutic approaches to PFCs are warranted.

show abstract

Interobserver Agreement on “Assessment of Debris” During Endoscopic Ultrasound-guided Drainage of Walled-off Pancreatic Necrosis

Pal

Lakhtakia

Jagtap

et al. 2023

Techniques and Innovations in Gastrointestinal Endoscopy

View full text Add to dashboard Cite

EUS-guided treatment of WON using lumen-apposing metal stents: protocol standardisation based on the occurrence of natural healing processes

Cited by 5 publications

References 7 publications

Lumen-apposing metal stents for the treatment of pancreatic and peripancreatic fluid collections and bleeding risk: a propensity matched study

Lumen-apposing metal stents for the treatment of pancreatic and peripancreatic fluid collections and bleeding risk: a propensity matched study

The endoscopic ultrasound features of pancreatic fluid collections and their impact on therapeutic decisions: an interobserver agreement study

Interobserver Agreement on “Assessment of Debris” During Endoscopic Ultrasound-guided Drainage of Walled-off Pancreatic Necrosis

Contact Info

Product

Resources

About