Multicenter experience from the UK and Ireland of use of lumen-apposing metal stent for transluminal drainage of pancreatic fluid collections
submitted 23 August 2017
accepted after revision 22 November 2017
28 February 2018 (online)
Background and study aims Pancreatic fluid collection (PFC) is a common complication of pancreatitis for which endoscopic ultrasound-guided drainage is first-line treatment. A new single-device, lumen-apposing, covered self-expanding metal stent (LAMS) has been licensed for PFC drainage. We therefore present our multicenter experience with the LAMS for PFC drainage in a multicenter prospective case series to assess success and complication rates.
Patients and methods All adult patients from 11 tertiary centers who had LAMS placement for PFC from July 2015 to July 2016 were included. Data including indications, technical success, clinical success, collection resolution, stent removal, early and late adverse events (AEs), mortality and recurrence at 6 months were collected.
Results 116 patients, median age 52.5 years (range 16 – 80) and 67 % male, were treated with a single LAMS in each case. The indication was walled off necrosis (WON) in 70 and pseudocyst in 46. Median size of the PFC was 11 cm (5 – 21 cm) and the estimated median necrotic volume in WON was 30 % (5 % – 90 %). Stent insertion was technically successful in 115 (99.1 %) and clinically successful in 109 (94 %). Early serious AEs (SAEs): n = 7 sepsis, n = 1 stent blockage with food, n = 1 stent migration requiring laparotomy, n = 1 stent dislodgement and n = 1 bleeding requiring emboliZation. Late AEs: n = 1 buried stent and n = 1 esophageal fistula. Non-procedure-related deaths: n = 3 (2.5 %).
Conclusion This multicenter case series demonstrates that use of the new LAMS is feasible, effective and relatively safe in draining PFC with a technical success rate of 99 % and cumulative SAE rate of 11.2 %.
- 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
- 2 Kahaleh 1 M, Shami VM, Conaway MR. et al. Endoscopic ultrasound drainage of pancreatic pseudocyst: a prospective comparison with conventional endoscopic drainage. Endoscopy 04/2006; 38: 355-359
- 3 Binmoeller KF, Seifert H, Walter A. et al. Transpapillary and transmural drainage of pancreatic pseudocysts. Gastrointest Endosc 1995; 42: 219-224
- 4 Varadarajulu S, Rana SS, Bhasin DK. Endoscopic therapy for pancreatic duct leaks and disruptions. Gastrointest Endosc Clin N Am 2013; 23: 863-892
- 5 Singhal S, Rotman SR, Gaidhane M. et al. Pancreatic fluid collection drainage by endoscopic ultrasound: an update. Clin Endosc 2013; 46: 506-514
- 6 Varadarajulu S, Bang JY, Sutton BS. et al. Equal efficacy of endoscopic and surgical cystagastrostomy for pancreatic pseudocyst drainage in a randomized trial. Gastroenterology 2013; 145: 583-590
- 7 van Brunschot S, van Grinsven J, van Santvoort HC. et al. Endoscopic or surgical step-up approach for infected necrotising pancreatitis: a multicentre randomised trial. Lancet 2017; DOI: 10.1016/S0140-6736(17)32404-2.
- 8 Bang JY, Arnoletti JP, Holt BA. et al. Minimally invasive surgery vs endoscopy randomised (MISER) trial for necrotising pancreatitis. United Eur Gastroenterol J 2017; 5: 5S
- 9 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
- 10 Huggett MT, Oppong KW, Pereira SP. et al. Endoscopic drainage of walled-off pancreatic necrosis using a novel self-expanding metal stent. Endoscopy 2015; 47: 929-932
- 11 Chandran S, Efthymiou M, Kaffes A. et al. Management of pancreatic collections with a novel endoscopically placed fully covered self-expandable metal stent: a national experience (with videos). Gastrointest Endoscopy 2014; 2: 1-9
- 12 Varquez-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 Sep 84: 450-457
- 13 Shah RJ, Shah JN, Waxman I. Safety and efficacy of EUS guided drainage of PFC with lumen apposing covered self -expanding metal stents. Clin Gastroenterol Hepatol 2015; 13: 747-752
- 14 Rinninella E, Kunda E, Dollhopf E. 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. Gastrointest Endosc 2015; 82: 1039-1046
- 15 Siddiqui A, 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. Gastrointest Endosc 2016; 83: 699-707
- 16 Sharaiha RZ, Tyberg A, Khashab MA. et al. Endoscopic therapy with lumen-apposing metal stents is safe and effective for patients with pancreatic walled-off necrosis. Clin Gastroenterol Hepatol 2016; 14: 1797-1803
- 17 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
- 18 van Brunschot S, van Stanvoort HC, Gooszen HG. et al. Endoscopic or surgical step-up approach for necrotizing pancreatitis, a multi-center randomized controlled trial. OP004 UEGW abstract 2016
- 19 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 2016; 66: 2054-2056