Endoscopic ultrasound-guided placement of plastic vs. biflanged metal stents for therapy of walled-off necrosis: a retrospective single-center series

Shuntaro Mukai; Takao Itoi; Todd H. Baron; Atsushi Sofuni; Fumihide Itokawa; Toshio Kurihara; Takayoshi Tsuchiya; Kentaro Ishii; Shujiro Tsuji; Nobuhito Ikeuchi; Reina Tanaka; Junko Umeda; Ryosuke Tonozuka; Mitsuyoshi Honjo; Takuji Gotoda; Fuminori Moriyasu; Ichiro Yasuda

doi:10.1055/s-0034-1377966

Endoscopy, Table of Contents

Endoscopy 2015; 47(01): 47-55
DOI: 10.1055/s-0034-1377966

Original article

Endoscopic ultrasound-guided placement of plastic vs. biflanged metal stents for therapy of walled-off necrosis: a retrospective single-center series

Authors

Shuntaro Mukai

¹Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
Takao Itoi

¹Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
Todd H. Baron

²University of North Carolina, Chapel Hill, North Carolina, United States
Atsushi Sofuni

¹Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
Fumihide Itokawa

¹Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
Toshio Kurihara

¹Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
Takayoshi Tsuchiya

¹Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
Kentaro Ishii

¹Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
Shujiro Tsuji

¹Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
Nobuhito Ikeuchi

¹Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
Reina Tanaka

¹Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
Junko Umeda

¹Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
Ryosuke Tonozuka

¹Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
Mitsuyoshi Honjo

¹Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
Takuji Gotoda

¹Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
Fuminori Moriyasu

¹Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
Ichiro Yasuda

³First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan

Abstract

Background and study aims: Recently, a novel fully covered and biflanged metal stent (BFMS) dedicated to the drainage of walled-off necrosis (WON) was developed. The aim of this study was to retrospectively evaluate the safety, efficacy, and cost performance of drainage of WON using the novel BFMS compared with a traditional plastic stent.

Patients and methods: A total of 70 patients with symptomatic WON were treated under endoscopic ultrasound (EUS) guidance. Initial drainage was conducted using the single gateway technique with placement of one or more plastic stents or a single BFMS. If drainage was unsuccessful, direct endoscopic necrosectomy (DEN) was performed.

Results: There were no statistically significant differences in rates of technical success, clinical success, and adverse events between plastics stents and BFMS, despite the size of WON in the BFMS group being significantly larger than that in the plastic stent group (105.6 vs. 77.1 mm; P = 0.003). The mean procedure times for the first EUS-guided drainage and for re-intervention were significantly shorter in the BFMS group than in the plastic stent group (28.8 ± 7.1 vs. 42.6 ± 14.2, respectively, for drainage, P < 0.001; and 34.9 ± 8.5 vs. 41.8 ± 7.6, respectively, for re-intervention, P < 0.001). There was no statistically significant difference in the total cost between plastic stent and BFMS use in the treatment of WON ($ 5352 vs. $ 6274; P = 0.25).

Conclusions: Plastic stents and BFMS were safe and effective for the treatment of WON. In particular, BFMS placement appeared to be preferable for initial EUS-guided drainage and additional re-intervention (e. g. DEN) as it reduced the procedure time. Prospective randomized controlled trials are warranted.

Full Text

References

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