Novel lumen‐apposing metal stent for the drainage of pancreatic fluid collections: An Italian multicentre experience

Abstract

Background: Endoscopic ultrasound (EUS)-guided drainage is the procedure of choice for pancreatic fluid collection (PFC) management. Recently developed lumen-apposing fully covered self-expandable metal stents (LAMSs) may facilitate drainage, especially of necrotic and complex PFCs. Objective: To evaluate the feasibility and efficacy of a newly developed LAMS (Nagi, Taiwong Medical Co. Ltd, South Korea) in the drainage of PFCs. Methods: Retrospective analysis of LAMS drainage of PFCs from seven centres. Patient demographic, EUS and radiological findings, PFCs aetiology, procedural technical and clinical success, and adverse events were evaluated. Results: Sixty-seven patients with mean age 58.8 AE 14 years (68.7% males) were included in the analysis. Of these, 44 patients had pseudocyst (PP) and 23 patients had walled-off pancreatic necrosis (WOPN). Technical success was achieved in 98.5% of cases and clinical success in 94%. The adverse event rate was 24.2%, higher and mostly due to stent migration and occlusion in the WOPN group as compared to the PP group, despite the time to stent removal being significantly lower in the WOPN group. Conclusions: PFC drainage using the Nagi stent is highly feasible and effective, with a relatively safe profile. Future studies enrolling more patients with complex PFCs are needed to clearly establish the role of this stent in PFC management.

Endoscopic gastric fenestration of debriding pancreatic walled-off necrosis: A pilot study

“…Unfortunately, plastic stents have proven significantly less effective overall in the setting of WON (as opposed to pancreatic pseudocyst) due to their small calibers. Metal stents are now increasingly used for draining WON endoscopically, despite current controversial reports ( vs plastic stents)[ 8 - 13 ], and the sparseness of pertinent long-term data. Furthermore, certain complications of stenting, namely delayed bleeding, stent migration, and jaundice-producing biliary strictures, have occurred significantly more often when using metal ( vs plastic) stents, especially > 3 wk after intervention[ 13 - 18 ].…”

Comparative outcomes of endoscopic ultrasound‐guided lumen‐apposing mental stents drainage for pancreatic pseudocysts and walled‐off necrosis: Case series and meta‐analysis

“… 25 2018 Korea NA NA Prospective 5 4 1 Nagi 29 0/5 6 10 Maria et al. 26 2018 Italy 2013–2016 7 Retrospective 67 23 44 Nagi 59 21/46 8 11 Rajat et al. 27 2019 US 2014–2017 1 Retrospective 27 15 12 AXIOS 54 15/12 7 12 This center NA China 2016–2019 1 Retrospective 12 10 2 AXIOS and DMHS 47 4/8 NA a The age derived from Sujievvan et al was median age, and ages derived from other studies were mean ages.…”

Comparative Outcomes of EUS-Guided Lumen-Apposing Mental Stents Drainage for Pancreatic Pseudocysts and Walled-off Necrosis: Case Series and Meta-Analysis

“…The study from Varadarajulu et al 30 in favor of our ndings also showed clinical success was signi cantly higher for PPC and pancreatic abscess compared to WON. This may be explained by the fact that WON containing varying amounts of necrotic uid and solid debris, comparing to PPC with minimal or no necrosis, has lower response rate to EUS-guided drainage and higher risk of complications, such as stent occlusion and stent migration 11,27 .…”