Feasibility, safety, and outcomes of a single-step endoscopic ultrasonography-guided drainage of pancreatic fluid collections without fluoroscopy using a novel electrocautery-enhanced lumen-apposing, self-expanding metal stent

Abstract

Background and Objectives:There are currently limited data available regarding the safety of endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collections (PFCs) using the lumen-apposing metal stent without fluoroscopic guidance. This study aims to evaluate clinical outcomes and safety of EUS-guided drainage of PFC using the electrocautery-enhanced lumen-apposing metal stents (EC-LAMSs) without fluoroscopic guidance.Methods:We conducted a retrospective study on patients with symptomatic PFC who underwent EUS-guided drainage using EC-LAMS without fluoroscopy. All patients were followed clinically until resolution of their PFC. Technical success (successful placement of EC-LAMS), number of patients who achieved complete resolution of PFC without additional intervention and adverse events were noted.Results:We evaluated 25 patients, including three with pancreatic pseudocysts and 22 with walled-off necrosis (WON). The etiology of the patient's pancreatitis was gallstones (42%), alcohol (27%), and other causes (31%). The mean cyst size was 82 mm (range, 60–170 mm). The indications for endoscopic drainage were abdominal pain, infected WON, or gastric outlet obstruction. Technical success with placement of the EC-LAMS was achieved in all 25 patients. There were no procedure-related complications. The mean patient follow-up was 7.8 months. PFCs resolved in 24 (96%) patients; the one failure was in a patient with WON. Stent occlusion was seen in one patient. There was a spontaneous migration of one stent into the enteral lumen after resolution of WONs. The EC-LAMS were successfully removed using a snare in all the remaining patients. The median number of endoscopy sessions to achieve PFCs resolution was 2 (range, 2–6).Conclusions:Single-step EUS-guided drainage of PFCs without fluoroscopic guidance using the novel EC-LAMS is a safe and effective endoscopic technique for drainage of PFCs with excellent technical and clinical success rates and no complications. Due to its ease of use, EC-LAMS may simplify and streamline EUS-guided management of PFC and help in its widespread adoption as an alternative to surgery.

Through the LAMS towards the future: current uses and outcomes of lumen-apposing metal stents

“…2 , 3 ). Reports in the literature concerning LAMS and PFC are continually increasing ( Table 1 ) [ 4 - 10 ]. A recent meta-analysis [ 11 ], including technical and clinical success rate, and percentage of adverse events, included 14 studies from 2012 to 2016 and 812 patients (608 WON, 204 PP).…”

Endoscopic ultrasound-guided drainage of pancreatic walled-off necrosis using self-expanding metal stents without fluoroscopy

“…However, it remains unclear whether fluoroscopy has been used additionally in these cases and the visibility of the deployment steps has not been reported. Another retrospective recent study reports on 25 selected patients in whom EUS-guided stent insertion was safely performed without fluoroscopy[ 15 ].…”

Advancements in the endoscopic treatment of pancreatic fluid collections

“…This one-step approach facilitates the passage of the LAMS deployment device without first dilating the fistulous tract, which streamlines the procedure. Yoo et al 22 and Lakhtakia et al 23 report that single-step EUS-guided drainage of PFCs without fluoroscopic guidance using the novel EC-LAMS is a safe and effective method for draining PFCs. The method has good technical and clinical success rates, and causes no complications.…”