Single-center experience demonstrating low adverse events and high efficacy with self-expandable metal esophageal and biliary stents for pseudocyst and walled off necrosis drainage

Ronald Dungca Ortizo; Farid Jalali; Daniel Thieu; Allen Yu; Robert Bucayu; Christopher Paiji; Kyle Fortinsky; Kenneth Chang; John Gunn Lee; Jason Buddika Samarasena

doi:10.1055/a-1178-0185

Endoscopy International Open, Table of Contents

CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(09): E1156-E1160
DOI: 10.1055/a-1178-0185

Original article

Single-center experience demonstrating low adverse events and high efficacy with self-expandable metal esophageal and biliary stents for pseudocyst and walled off necrosis drainage

Ronald Dungca Ortizo

H. H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Orange, California, United States

,

Farid Jalali

H. H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Orange, California, United States

,

Daniel Thieu

H. H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Orange, California, United States

,

Allen Yu

H. H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Orange, California, United States

,

Robert Bucayu

H. H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Orange, California, United States

,

Christopher Paiji

H. H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Orange, California, United States

,

Kyle Fortinsky

H. H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Orange, California, United States

,

Kenneth Chang

H. H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Orange, California, United States

,

John Gunn Lee

H. H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Orange, California, United States

,

Jason Buddika Samarasena

H. H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Orange, California, United States

› Author Affiliations

Abstract

Background and study aims Lumen-apposing metal stents (LAMS) have been designed as proprietary stents for the management of pseudocysts (PC)/walled off necrosis (WON). There has been concern about adverse events (AEs) with LAMS including bleeding, buried stent syndrome and migration. Prior to LAMS becoming available, fully-covered self-expandable metal esophageal and biliary stents (FCSEMSs) were used off-label for management of PC/WON with many centers demonstrating low rates of AEs. The primary aim of this study was to study the safety and efficacy of FCSEMS for the management of pseudocysts/WON.

Patients and methods This was a retrospective review of all endoscopic ultrasound (EUS)-guided placement of FCSEMSs for drainage of PC/WON cases performed at our institution over 4-year period. The primary outcomes studied were technical success, AEs, PC/WON resolution, and salvage surgical/radiologic intervention.

Results Technical success achieved in 65 of 65 (100 %) study patients. An AE occurred 0 of 25 patients (0 %) with PC, and in 10 of 40 patients (25 %) with WON: bleeding (3 %), migration (5 %) and stent dysfunction/infection (18 %). There was resolution in 25 of 25 patients (100 %) with a PC and 31 of 40 patients (78 %) with a WON. Salvage therapy by interventional radiology or surgery was performed in nine of 40 patients (22 %).

Conclusions This single-center 4-year experience in the pre-LAMS era showed that FCSEMS was safe and effective in all patients with PC and over 75 % of patients with WON. Given the large cost differential between LAMS and FCSEMS and the efficacy and safety shown with FCSEMS, we believe that FCSEMS should still be considered a first-line option for patients with pancreatic fluid collections, particularly in patients with PCs.

Full Text

References

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