Plastic Versus Metal EUS-Guided Drainage of Pancreatic Fluid Collections: Do We Really Know When to Use the Hard Way?

Vanella, Giuseppe; Dell’Anna, Giuseppe; Arcidiacono, Paolo Giorgio

doi:10.1016/j.cgh.2021.07.002

Cited by 3 publications

(6 citation statements)

References 8 publications

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“…While this might appear to be an argument in favor of LAMS, a recent randomized controlled trial found an increased rate of stent-related complications (mostly bleeding) in the LAMS group 14 , and therefore, advantages (i. e. the possibility of endoscopic necrosectomy) must be weighed against these safety issues. It is our opinion that the two procedures are to be used for different indications: LAMS for walled-off necrotic collections whereas DPPS for pseudocysts or “clear” collections 3 .…”

Section: Discussionmentioning

confidence: 99%

“…Briefly, in our Institution EUS-CDS and EUS-GBD are usually performed through free-hand placement of electrocautery-enhanced LAMS. EUS-FCD are performed either by free-hand LAMS placement (necrotic collections) or with double-pigtail plastic stents (DPPS) through a sequence involving needle-guidewire-cystotome-stent (homogeneously fluid collections) 3 . For EUS-GBD and EUS-FCD with LAMS, we usually place coaxial DPPS, for which fluoroscopy is used according to endoscopist preference.…”

Section: Methodsmentioning

confidence: 99%

“…the possibility of endoscopic necrosectomy) must be weighed against these safety issues. It is our opinion that the 2 procedures are to be used for different indications: LAMS for walled-off necrotic collections whereas DPPS for pseudocysts or "clear" collections [3].…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…Fluid collection drainage (EUS-FCD) with lumen apposing metal stents (LAMS, N = 26) were performed fluoroless, while EUS-FCD with double-pigtail plastic stents (DPPS, N = 28) required higher RE (KAP = 23 ). EUS-guided gallbladder drainage (EUS-GBD, N = 6) required scarce RE (KAP = 9 [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]) for coaxial DPPS placement. EUS-GE (N = 27) required higher RE than duodenal stenting (KAP = 44 versus 29 , P = 0.03).…”

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confidence: 99%

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Radiation exposure during modern therapeutic endoscopic ultrasound procedures and standard alternatives

et al. 2022

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Background. Therapeutic EUS (t-EUS) is increasingly adopted in clinical practice of tertiary referral centres; however, little is known about Radiation Exposure (RE) metrics and Diagnostic Reference Limits. Methods. Kerma-Area Product (KAP [Gy·cm2]), Air Kerma and Fluoroscopy Time were retrospectively evaluated for all consecutive t-EUS procedures performed in San Raffaele Institute between 2019-2021. For EUS-guided Choledochoduoenostomies (EUS-CDS) and Gastroenterostomies (EUS-GE) an equal number of ERCPs + metal stenting and Duodenal Stentings were included for comparison. Results. 141 t-EUS procedures were retrieved (49% pancreatic cancer, 38% peripancreatic fluid collections). EUS-CDS (N=44) were mainly performed fluoroless, while ERCPs required a significantly higher RE (KAP=25 [17-55], p<0.0001). Fluid collection drainage (EUS-FCD) with Lumen Apposing stents (LAMS, N=26) were performed fluoroless, while EUS-FCD with double-pigtail plastic stents (DPPS, N=28) required higher RE (KAP=23 [13-45]). EUS-guided gallbladder drainage (EUS-GBD, N=6) required scarce RE (KAP=9 [3-21]) for coaxial DPPS placement. EUS-GE (N=27) required higher RE than Duodenal Stenting (KAP=44 [28-88] versus 29 [19-46], p=0.03). EUS-guided Hepatico-Gastrostomies (EUS-HGS, N=10) had the highest RE amongst t-EUS procedures (KAP=81 [49-123]). Procedure complexity or intervening complications were evaluated and resulted in higher RE within each procedure. Conclusions. t-EUS procedures have different RE (p<0.000001). EUS-Choledochoduodenostomy, Gallbladder Drainage and Fluid Collection Drainage with LAMS can be performed with no-to-mild radioscopy, unlike standard alternatives. However, radioscopy remains essential in case of technical difficulties or complications. EUS-Gastroenterostomy and EUS-Hepaticogastrostomy involve a high RE. Endoscopists involved in t-EUS might experience a RE superior to category standards, claiming for increased awareness and personalized preventive measures.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Accepted Manuscriptmentioning

confidence: 99%

mentioning

confidence: 99%

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Radiation exposure during modern therapeutic endoscopic ultrasound procedures and standard alternatives

et al. 2022

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“…However, despite different retrospective data showed a higher clinical efficacy, [13][14][15] in a recent RCT, LAMS was found not to be superior to DPPS with regard to clinical success or total number of procedures, with a significantly higher occurrence of stent-related AEs in the LAMS group (32.3% vs. 6.9%, P = 0.01), [16] thus demanding a better definition of the best candidates to one approach or the other and a better-standardized revision policy. [17] A reasonable algorithm may involve LAMS drainage for WON with a significant amount of necrosis, whereas pseudocysts or "clear" collections can be adequately addressed through DPPS.…”

Section: Eus-guided Fluid Collection Drainagementioning

confidence: 99%

Current landscape of therapeutic EUS: Changing paradigms in gastroenterology practice

Arcidiacono

Merwe

Vanella

et al. 2022

Endoscopic Ultrasound

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Therapeutic EUS has witnessed exponential growth in the last decade, but it has been considered investigational until recently. An increasing body of good-quality evidence is now demonstrating clear advantages over established alternatives, adding therapeutic EUS to management algorithms of complex hepato-pancreato-biliary (HPB) and gastrointestinal (GI) conditions. In this review, the available evidence and clinical role of therapeutic EUS in established and evolving applications will be discussed. A Graphical Summary for each scenario will provide (1) technical steps, (2) anatomical sketch, (3) best-supporting evidence, and (4) role in changing current and future GI practice. Therapeutic EUS has accepted well-established applications such as drainage of symptomatic peripancreatic fluid collections, biliary drainage in failed endoscopic retrograde cholangiopancreatography, and treatment of acute cholecystitis in unfit-for-surgery patients. In addition, good-quality evidence on several emerging indications (e.g., treatment of gastric outlet obstruction, local ablation of pancreatic solid lesions, etc.) is promising. Specific emphasis will be given to how these technical innovations have changed management paradigms and algorithms and expanded the possibilities of gastroenterologists to provide therapeutic solutions to old and emerging clinical needs. Therapeutic EUS is cementing its role in everyday practice, radically changing the treatment of different HPB diseases and other conditions (e.g., GI obstruction). The development of dedicated accessories and increased training opportunities will How to cite this article:

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Tailoring treatment to the circumstance: reasoning behind metal versus plastic drainage of pancreatic collections

Vanella,

Bronswijk,

Van der Merwe

et al. 2023

Gut

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Plastic Versus Metal EUS-Guided Drainage of Pancreatic Fluid Collections: Do We Really Know When to Use the Hard Way?

Cited by 3 publications

References 8 publications

Radiation exposure during modern therapeutic endoscopic ultrasound procedures and standard alternatives

Radiation exposure during modern therapeutic endoscopic ultrasound procedures and standard alternatives

Current landscape of therapeutic EUS: Changing paradigms in gastroenterology practice

Tailoring treatment to the circumstance: reasoning behind metal versus plastic drainage of pancreatic collections

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