Sujievvan Chandran1, Marios Efthymiou1, Arthur Kaffes2, John Wei Chen3, Vu Kwan4, Michael Murray5, David Williams6, Nam Quoc Nguyen7, William Tam8, Christine Welch9, Andre Chong10, Saurabh Gupta11, Ben Devereaux12, Peter Tagkalidis13, Frank Parker14, Rhys Vaughan15. 1. Department of Gastroenterology, Austin Health Melbourne, Victoria, Australia. 2. Department of Gastroenterology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia. 3. Department of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia. 4. Department of Gastroenterology, Westmead Hospital, Sydney, New South Wales, Australia. 5. Department of Gastroenterology, Pindara Private Hospital, Gold Coast, Queensland, Australia. 6. Department of Gastroenterology, St. Vincent's Hospital, Sydney, New South Wales, Australia. 7. Department of Gastroenterology, Royal Adelaide Hospital, Adelaide, South Australia, Australia. 8. Department of Gastroenterology, Lyell McEwin Hospital, Adelaide, South Australia, Australia. 9. Department of Gastroenterology, Townsville Hospital, Townsville, Queensland, Australia. 10. Department of Gastroenterology, Fremantle Hospital, Fremantle, Western Australia, Australia. 11. Department of Gastroenterology, Princess Alexandra Hospital, Brisbane, Queensland, Australia. 12. Department of Gastroenterology, Royal Brisbane Hospital, Brisbane, Queensland, Australia. 13. Department of Gastroenterology, Royal Melbourne Hospital, Melbourne, Victoria, Australia. 14. Department of Anaesthetics, Austin Health, Melbourne, Victoria, Australia. 15. Department of Gastroenterology, Austin Health Melbourne, Victoria, Australia; Department of Medicine, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.
Abstract
BACKGROUND: Recent medical literature on novel lumen-apposing stents for the treatment of pancreatic fluid collections (PFCs) is limited by small numbers, solo operators, and single-center experience. OBJECTIVE: To evaluate a recently developed lumen-apposing, fully covered self-expandable metal stent (FCSEMS) in the management of PFCs. DESIGN: Retrospective case series. SETTING: Thirteen tertiary and private health care centers across Australia. PATIENTS: Forty-seven patients (median age 51 years) who underwent endoscopic management of PFCs. INTERVENTION: Insertion of FCSEMS after PFC puncture under EUS guidance. A subgroup of 9 patients underwent direct endoscopic necrosectomy. MAIN OUTCOME MEASUREMENTS: Technical and clinical success rate, adverse event rate. RESULTS: The technical success rate was 53 of 54 patients (98.1%), and the initial clinical success rate was 36 of 47 (76.6%), which was sustained for more than 6 months in 34 of 36 (94.4%). Early adverse events included 4 cases (7.4%) of stent migration during direct endoscopic necrosectomy, 4 cases (7.4%) of sepsis, 1 case (1.9%) of bleeding, and 1 case (1.9%) of stent migration into the fistula tract. Late adverse events were 6 (11.1%) spontaneous stent migrations, 3 (5.6%) recurrent stent occlusions, 3 (5.6%) tissue ingrowth/overgrowth, and 2 (3.7%) bleeding into PFC. The majority of stents inserted (48 of 54, 88.9%) and removed (31 of 35, 88.6%) in our study were described by the operator as superior to pigtail stents with regard to ease of use. LIMITATIONS: Retrospective study. CONCLUSION: Although FCSEMSs are technically easier to insert and remove compared with traditional pigtail stents, there are significant limitations to the widespread use of FCSEMSs in the management of PFCs. These include cost, adverse events, and lower-than-expected resolution rates.
BACKGROUND: Recent medical literature on novel lumen-apposing stents for the treatment of pancreatic fluid collections (PFCs) is limited by small numbers, solo operators, and single-center experience. OBJECTIVE: To evaluate a recently developed lumen-apposing, fully covered self-expandable metal stent (FCSEMS) in the management of PFCs. DESIGN: Retrospective case series. SETTING: Thirteen tertiary and private health care centers across Australia. PATIENTS: Forty-seven patients (median age 51 years) who underwent endoscopic management of PFCs. INTERVENTION: Insertion of FCSEMS after PFC puncture under EUS guidance. A subgroup of 9 patients underwent direct endoscopic necrosectomy. MAIN OUTCOME MEASUREMENTS: Technical and clinical success rate, adverse event rate. RESULTS: The technical success rate was 53 of 54 patients (98.1%), and the initial clinical success rate was 36 of 47 (76.6%), which was sustained for more than 6 months in 34 of 36 (94.4%). Early adverse events included 4 cases (7.4%) of stent migration during direct endoscopic necrosectomy, 4 cases (7.4%) of sepsis, 1 case (1.9%) of bleeding, and 1 case (1.9%) of stent migration into the fistula tract. Late adverse events were 6 (11.1%) spontaneous stent migrations, 3 (5.6%) recurrent stent occlusions, 3 (5.6%) tissue ingrowth/overgrowth, and 2 (3.7%) bleeding into PFC. The majority of stents inserted (48 of 54, 88.9%) and removed (31 of 35, 88.6%) in our study were described by the operator as superior to pigtail stents with regard to ease of use. LIMITATIONS: Retrospective study. CONCLUSION: Although FCSEMSs are technically easier to insert and remove compared with traditional pigtail stents, there are significant limitations to the widespread use of FCSEMSs in the management of PFCs. These include cost, adverse events, and lower-than-expected resolution rates.
Authors: Maria Chiara Petrone; Livia Archibugi; Edoardo Forti; Rita Conigliaro; Roberto Di Mitri; Ilaria Tarantino; Carlo Fabbri; Alberto Larghi; Sabrina Gloria Giulia Testoni; Massimiliano Mutignani; Paolo Giorgio Arcidiacono Journal: United European Gastroenterol J Date: 2018-06-17 Impact factor: 4.623