The Role of Lumen-Apposing Metal Stents in Transmural Endoscopic Drainage of Postinflammatory Pancreatic and Peripancreatic Fluid Collections

Abstract

Rapid development of advanced gastrointestinal endoscopic techniques contributed to the appearance of new biomedical materials including polymers, which are used for the production of different types of endoprostheses. Endotherapy (ET) of postinflammatory pancreatic and peripancreatic fluid collections (PPFCs) with the use of lumen-apposing metal stent (LAMS) is an effective method of treatment. This paper describes the high efficacy of ET and its potential complications, which are mostly related to the design of the LAMS used. The high efficacy of LAMS in the transmural drainage of PPFCs is associated with lower safety of treatment. Complications of ET presented in the manuscript are mainly related to endoprosthesis’ construction. This paper presents possible directions of development in the field of transmural LAMSs, which in the future may contribute to the invention of an innovative type of LAMS based on new biomedical technologies. Possibly, subsequent novel endoprosthesis projects, based on the above results, will be able to meet the current needs and requirements associated with endoscopic transmural drainage procedures in cases of postinflammatory PPFCs. The ultimate goal is to improve safety of minimally invasive techniques for treatment of the local consequences of pancreatitis.

Percutaneous Endoscopic Necrosectomy—A Review of the Literature

“…Since the first reports on the dual-modality drainage technique [56], the methods for endoscopic and percutaneous treatment of pancreatic necrosis have evolved toward a more aggressive [1][2][3][4][5][6][7][8][9][10][11][12][13][14]16,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]35,36,[38][39][40][41]59], necrosectomy-based approach, which is also reflected in the aforementioned PEN approach, as well as in the multiple-access strategy in which PEN is combined with transmural endoscopic access techniques [37,[42][43][44][45][46][47][48][49]…”

“…The next stage of the endoscopic step-up approach, which uses transmural access, consists of direct endoscopic necrosectomy, which is performed during the course of transmural drainage. The procedure involves the insertion of the endoscope along the fistula into the collection lumen and the mechanical removal of necrotic debris using various endoscopic instruments [1,2,[4][5][6][7][8]12,31,32].…”

“…However, isolated cases of an alternative approach that combines the elements of the endoscopic step-up approach with those of the surgical step-up approach and is referred to as PEN have been published recently [42][43][44][45][46][47][48]. acute necrotizing pancreatitis has limitations [1,[4][5][6][7][8]. The main limitation of endoscopic techniques that utilize transmural access in the treatment of pancreatic necrosis is the distance between the gastrointestinal lumen and the necrotic collection, which should not exceed 40 mm on endosonographic scans [6][7][8].…”

The Role of Antibiotics in Endoscopic Transmural Drainage of Post-Inflammatory Pancreatic and Peripancreatic Fluid Collections

“…The next stage of the endoscopic procedure consists of enlarging the pancreatogastric or pancreatoduodenal fistula ( Loveday et al., 2008 ; Freeman et al., 2012 ; da Costa et al., 2014 ; Jagielski et al., 2018 ; Jagielski et al., 2020 ). After enlargement, a self-expanding stent (lumen-apposing metal stent [LAMS]) or plastic endoprosthesis(-ses) is introduced via the fistula to enable free passive transmural drainage of the collection contents into the lumen of the gastrointestinal tract ( Arvanitakis et al., 2018 ; Jagielski et al., 2018 ; Jagielski et al., 2020 ; Jagielski and Jackowski, 2021 ). Passive transmural drainage (without flushing through nasocystic drainage) is an effective method for endoscopic treatment of sterile pancreatic pseudocysts with liquid serous content alone ( Arvanitakis et al., 2018 ; Jagielski et al., 2018 ; Jagielski et al., 2020 ; Jagielski and Jackowski, 2021 ).…”

“…After enlargement, a self-expanding stent (lumen-apposing metal stent [LAMS]) or plastic endoprosthesis(-ses) is introduced via the fistula to enable free passive transmural drainage of the collection contents into the lumen of the gastrointestinal tract ( Arvanitakis et al., 2018 ; Jagielski et al., 2018 ; Jagielski et al., 2020 ; Jagielski and Jackowski, 2021 ). Passive transmural drainage (without flushing through nasocystic drainage) is an effective method for endoscopic treatment of sterile pancreatic pseudocysts with liquid serous content alone ( Arvanitakis et al., 2018 ; Jagielski et al., 2018 ; Jagielski et al., 2020 ; Jagielski and Jackowski, 2021 ). With regards to infected pseudocysts and sterile or infected necrotic collections that contain necrotic tissue in addition to liquefied necrotic contents, active (with flushing through nasocystic drainage) transmural drainage is required, consisting of additional saline irrigation introduced via the fistula to rinse the collection cavity in the postoperative period ( Arvanitakis et al., 2018 ; Jagielski et al., 2018 ; Jagielski et al., 2020 ; Jagielski and Jackowski, 2021 ).…”