Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(01): E6-E12
DOI: 10.1055/a-1031-9295
Original article
Owner and Copyright © Georg Thieme Verlag KG 2020

Lumen-apposing metal stents versus biliary fully-covered metal stents for EUS-guided drainage of pancreatic fluid collections: a case control study

Meeting presentations: European Society of Gastrointestinal Endoscopy ESGE Days 2018
Ana Garcia Garcia de Paredes
1   Gastroenterology and Hepatology Department. Hospital Universitario Ramon y Cajal, IRYCIS, Universidad de Alcala, Madrid, Spain
,
Juan Angel Gonzalez Martin
1   Gastroenterology and Hepatology Department. Hospital Universitario Ramon y Cajal, IRYCIS, Universidad de Alcala, Madrid, Spain
,
Jose Ramon Foruny Olcina
1   Gastroenterology and Hepatology Department. Hospital Universitario Ramon y Cajal, IRYCIS, Universidad de Alcala, Madrid, Spain
,
Diego Juzgado Lucas
2   Department of Gastroenterology. Hospital Universitario Quiron Madrid. Madrid, Spain
,
Fernando Gonzalez Panizo
2   Department of Gastroenterology. Hospital Universitario Quiron Madrid. Madrid, Spain
,
Sergio Lopez Duran
1   Gastroenterology and Hepatology Department. Hospital Universitario Ramon y Cajal, IRYCIS, Universidad de Alcala, Madrid, Spain
,
Alba Martinez Sanchez
1   Gastroenterology and Hepatology Department. Hospital Universitario Ramon y Cajal, IRYCIS, Universidad de Alcala, Madrid, Spain
,
Alfonso Sanjuanbenito
3   Surgery Department. Hospital Universitario Ramon y Cajal, IRYCIS, Universidad de Alcala, Madrid, Spain
,
Alejandra Caminoa
4   Pathology Department. Hospital Universitario Ramon y Cajal, IRYCIS, Universidad de Alcala, Madrid, Spain
,
Agustin Albillos
1   Gastroenterology and Hepatology Department. Hospital Universitario Ramon y Cajal, IRYCIS, Universidad de Alcala, Madrid, Spain
,
Enrique Vazquez-Sequeiros
1   Gastroenterology and Hepatology Department. Hospital Universitario Ramon y Cajal, IRYCIS, Universidad de Alcala, Madrid, Spain
› Author Affiliations
Further Information

Publication History

submitted 27 March 2019

accepted after revision 06 August 2019

Publication Date:
08 January 2020 (online)

Also available at
   Permissions and Reprints

Abstract

Background and study aims Endoscopic ultrasound (EUS)-guided drainage has become first-line treatment for pancreatic fluid collections (PFC). The aim of this study was to compare the effectiveness and safety of biliary fully-covered self-expandable metal stents (BFCSEMS) and lumen-apposing metal stents with electrocautery (EC-LAMS).

Patients and methods From April 2008 to March 2017, consecutive patients with symptomatic PFC drained under EUS-guidance with metal stents were included. Patients drained with EC-LAMS were considered the study group and those drained with BFCSEMS the control group. Two primary endpoints were evaluated: effectiveness (defined as reduction of ≥ 50 % of PFC size in cross-sectional imaging and improvement of symptoms 6 months after the transmural drainage) and safety.

Results Thirty patients were drained with EC-LAMS and 60 patients with BFCSEMS. Patients and PFC baseline characteristics in both groups were similar. Use of a coaxial double pigtail plastic stent and a nasocystic lavage catheter was significantly less frequent in patients drained with EC-LAMS (33 % vs. 100 %, and 13 % vs. 58 %, respectively; P < 0.0001). Technical success was 100 % in both groups. Procedure time was < 30 minutes in all patients drained with EC-LAMS and over 30 minutes in all patients drained with BFCSEMS (P = 0.0001). Clinical success was higher with a tendency to significance in patients drained with EC-LAMS (96 % vs. 82 %, P = 0.055) and the adverse event rate was lower (4 % vs. 18 %, P = 0.04). No case of procedure-related mortality was recorded.

Conclusions EC-LAMS and BFCSEMS are both effective for EUS-guided drainage of PFC. However, EC-LAMS requires less time to be performed and appears to be safer.

 

  • References

  • 1 Banks PA, Bollen TL, Dervenis C. et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013; 62: 102-111
    CrossrefPubMedGoogle Scholar
  • 2 Cui ML, Kim KH, Kim HG. et al. Incidence, risk factors and clinical course of pancreatic fluid collections in acute pancreatitis. Dig Dis Sci 2014; 59: 1055-1062
    CrossrefPubMedGoogle Scholar
  • 3 Sarathi Patra P, Das K, Bhattacharyya A. et al. Natural resolution or intervention for fluid collections in acute severe pancreatitis. Br J Surg 2014; 101: 1721-1728
    CrossrefPubMedGoogle Scholar
  • 4 Song TJ, Lee SS. Endoscopic drainage of pseudocysts. Clin Endosc 2014; 47: 222-226
    CrossrefPubMedGoogle Scholar
  • 5 Sahel J, Bastid C, Pellat B. et al. Endoscopic cystoduodenostomy of cysts of chronic calcifying pancreatitis: a report of 20 cases. Pancreas 1987; 2: 447-453
    CrossrefPubMedGoogle Scholar
  • 6 Muthusamy VR, Chandrasekhara V. ASGE Standards of Practice Committee. et al. The role of endoscopy in the diagnosis and treatment of inflammatory pancreatic fluid collections. Gastrointest Endosc 2016; 83: 481-488
    CrossrefPubMedGoogle Scholar
  • 7 Varadarajulu S, Christein JD, Tamhane A. et al. Prospective randomized trial comparing EUS and EGD for transmural drainage of pancreatic pseudocysts (with videos). Gastrointest Endosc 2008; 68: 1102-1111
    CrossrefPubMedGoogle Scholar
  • 8 Bakker OJ, van Santvoort HC, van Brunschot S. et al. Endoscopic transgastric vs surgical necrosectomy for infected necrotizing pancreatitis: a randomized trial. JAMA 2012; 307: 1053-1061
    CrossrefPubMedGoogle Scholar
  • 9 Teoh AY, Dhir V, Jin ZD. et al. Systematic review comparing endoscopic, percutaneous and surgical pancreatic pseudocyst drainage. World J Gastrointest Endosc 2016; 8: 310-318
    CrossrefPubMedGoogle Scholar
  • 10 Varadarajulu S, Bang JY, Sutton BS. et al. Equal efficacy of endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage in a randomized trial. Gastroenterology 2013; 145: 583-590 e581
    CrossrefPubMedGoogle Scholar
  • 11 Keane MG, Sze SF, Cieplik N. et al. Endoscopic versus percutaneous drainage of symptomatic pancreatic fluid collections: a 14-year experience from a tertiary hepatobiliary centre. Surg Endosc 2016; 30: 3730-3740
    CrossrefPubMedGoogle Scholar
  • 12 Mortele KJ, Girshman J, Szejnfeld D. et al. CT-guided percutaneous catheter drainage of acute necrotizing pancreatitis: clinical experience and observations in patients with sterile and infected necrosis. Am J Roentgenol 2009; 192: 110-116
    CrossrefPubMedGoogle Scholar
  • 13 Akshintala VS, Saxena P, Zaheer A. et al. A comparative evaluation of outcomes of endoscopic versus percutaneous drainage for symptomatic pancreatic pseudocysts. Gastrointest Endosc 2014; 79: 921-928 ; quiz 983 e922, 983 e925
    CrossrefPubMedGoogle Scholar
  • 14 Ang TL, Teoh AYB. Endoscopic ultrasonography-guided drainage of pancreatic fluid collections. Dig Endosc 2017; 29: 463-471
    CrossrefPubMedGoogle Scholar
  • 15 Siddiqui AA, Kowalski TE, Loren DE. et al. Fully covered self-expanding metal stents versus lumen-apposing fully covered self-expanding metal stent versus plastic stents for endoscopic drainage of pancreatic walled-off necrosis: clinical outcomes and success. Gastrointest Endosc 2017; 85: 758-765
    CrossrefPubMedGoogle Scholar
  • 16 Bang JY, Varadarajulu S. Metal versus Plastic stent for transmural drainage of pancreatic fluid collections. Clin Endosc 2013; 46: 500-502
    CrossrefPubMedGoogle Scholar
  • 17 Vazquez-Sequeiros E, Baron TH, Perez-Miranda M. et al. Evaluation of the short- and long-term effectiveness and safety of fully covered self-expandable metal stents for drainage of pancreatic fluid collections: results of a Spanish nationwide registry. Gastrointest Endosc 2016; 84: 450-457 e452
    CrossrefPubMedGoogle Scholar
  • 18 Siddiqui AA, Adler DG, Nieto J. et al. EUS-guided drainage of peripancreatic fluid collections and necrosis by using a novel lumen-apposing stent: a large retrospective, multicenter U.S. experience (with videos). Gastrointest Endosc 2016; 83: 699-707
    CrossrefPubMedGoogle Scholar
  • 19 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
    CrossrefPubMedGoogle Scholar
  • 20 Bang JY, Hasan MK, Navaneethan U. et al. Lumen-apposing metal stents for drainage of pancreatic fluid collections: When and for whom?. Dig Endosc 2017; 29: 83-90
    CrossrefPubMedGoogle Scholar
  • 21 Rinninella E, Kunda R, Dollhopf M. et al. EUS-guided drainage of pancreatic fluid collections using a novel lumen-apposing metal stent on an electrocautery-enhanced delivery system: a large retrospective study (with video). Gastrointest Endosc 2015; 82: 1039-1046
    CrossrefPubMedGoogle Scholar
  • 22 Cosgrove NLD, Siddiqui AA, Kowalski TE. Effect of scheduled versus ‘step-up’ necrosectomy for walled-off pancreatic necrosis on hospital admissions and necrosis resolution. Gastrointest Endosc 2017; 85: AB101
    PubMedGoogle Scholar
  • 23 van Brunschot S, Fockens P, Bakker OJ. et al. Endoscopic transluminal necrosectomy in necrotising pancreatitis: a systematic review. Surg Endosc 2014; 28: 1425-1438
    CrossrefPubMedGoogle Scholar
  • 24 Gluck M, Ross A, Irani S. et al. Endoscopic and percutaneous drainage of symptomatic walled-off pancreatic necrosis reduces hospital stay and radiographic resources. Clin Gastroenterol Hepatol 2010; 8: 1083-1088
    CrossrefPubMedGoogle Scholar
  • 25 Siddiqui AA, Dewitt JM, Strongin A. et al. Outcomes of EUS-guided drainage of debris-containing pancreatic pseudocysts by using combined endoprosthesis and a nasocystic drain. Gastrointest Endosc 2013; 78: 589-595
    CrossrefPubMedGoogle Scholar
  • 26 Bang JY, Hasan M, Navaneethan U. et al. Lumen-apposing metal stents (LAMS) for pancreatic fluid collection (PFC) drainage: may not be business as usual. Gut 2017; 66: 2054-2056
    CrossrefPubMedGoogle Scholar
  • 27 Shah RJ, Shah JN, Waxman I. et al. Safety and efficacy of endoscopic ultrasound-guided drainage of pancreatic fluid collections with lumen-apposing covered self-expanding metal stents. Clin Gastroenterol Hepatol 2015; 13: 747-752
    CrossrefPubMedGoogle Scholar
  • 28 Lopes CV, Pesenti C, Bories E. et al. Endoscopic-ultrasound-guided endoscopic transmural drainage of pancreatic pseudocysts and abscesses. Scand J Gastroenterol 2007; 42: 524-529
    CrossrefPubMedGoogle Scholar
  • 29 Penn DE, Draganov PV, Wagh MS. et al. Prospective evaluation of the use of fully covered self-expanding metal stents for EUS-guided transmural drainage of pancreatic pseudocysts. Gastrointest Endosc 2012; 76: 679-684
    CrossrefPubMedGoogle Scholar
  • 30 Mukai S, Itoi T, Baron TH. et al. Endoscopic ultrasound-guided placement of plastic vs. biflanged metal stents for therapy of walled-off necrosis: a retrospective single-center series. Endoscopy 2015; 47: 47-55
    Article in Thieme ConnectPubMedGoogle Scholar
  • 31 Arvanitakis M, Delhaye M, Bali MA. et al. Pancreatic-fluid collections: a randomized controlled trial regarding stent removal after endoscopic transmural drainage. Gastrointest Endosc 2007; 65: 609-619
    CrossrefPubMedGoogle Scholar
  • 32 Sanchez-Yague AGCA, Lopez Muñoz C, Sanchez Cantos A. et al. Use of a single-step lumen-apposing covered metal stent delivery system can decrease the cost of pancreatic cyst drainage. Gastrointest Endosc 2015; 81: AB424-AB425
    PubMedGoogle Scholar
  • 33 Chen YI, Barkun AN, Adam V. et al. Cost-effectiveness analysis comparing lumen-apposing metal stents with plastic stents in the management of pancreatic walled-off necrosis. Gastrointest Endosc 2018; 88: 267-276 e261
    CrossrefPubMedGoogle Scholar