BACKGROUND AND AIM: Endoscopic ultrasonography (EUS)-guided drainage of walled-off necrosis (WON) may be carried out by placement of multiple plastic stents (MPS) or specially designed fully covered bi-flanged metal stents (BFMS). Comparative data on efficacy of these two stent types for WON drainage are limited. This retrospective study compares outcomes of WON drainage using BFMS and MPS. METHODS: During a 10-year period, 133 patients underwent EUS-guided WON drainage. MPS or BFMS were placed in a WON cavity through a single puncture, and direct endoscopic necrosectomy (DEN) was carried out whenever clinically necessary. Data in the two cohorts were retrospectively compared for primary outcomes - clinical success, adverse events and mortality; and secondary outcomes - DEN requirement, mean DEN sessions, need for salvage surgery and hospital stay. RESULTS: MPS were placed in 61 and BFMS in 72 patients. Patients undergoing BFMS drainage required fewer DEN sessions (mean 1.46 vs 2.74, P < 0.05), had fewer adverse events (5.6% vs 36.1%, P < 0.05), needed salvage surgery less often (2.7% vs 26.2%, P < 0.05), and had significantly shorter hospital stay (4.1 vs 8 days, P < 0.05) compared to those undergoing MPS drainage. There was no difference in DEN requirement (P = 0.217) and mortality (P = 0.5) in both groups. Overall clinical success with BFMS was superior to MPS (94% vs 73.7%, P < 0.05). CONCLUSION: BFMS appear to be superior to MPS for EUS-guided WON drainage in terms of clinical success, number of DEN sessions, adverse events, need for salvage surgery and hospital stay.
BACKGROUND AND AIM: Endoscopic ultrasonography (EUS)-guided drainage of walled-off necrosis (WON) may be carried out by placement of multiple plastic stents (MPS) or specially designed fully covered bi-flanged metal stents (BFMS). Comparative data on efficacy of these two stent types for WON drainage are limited. This retrospective study compares outcomes of WON drainage using BFMS and MPS. METHODS: During a 10-year period, 133 patients underwent EUS-guided WON drainage. MPS or BFMS were placed in a WON cavity through a single puncture, and direct endoscopic necrosectomy (DEN) was carried out whenever clinically necessary. Data in the two cohorts were retrospectively compared for primary outcomes - clinical success, adverse events and mortality; and secondary outcomes - DEN requirement, mean DEN sessions, need for salvage surgery and hospital stay. RESULTS:MPS were placed in 61 and BFMS in 72 patients. Patients undergoing BFMS drainage required fewer DEN sessions (mean 1.46 vs 2.74, P < 0.05), had fewer adverse events (5.6% vs 36.1%, P < 0.05), needed salvage surgery less often (2.7% vs 26.2%, P < 0.05), and had significantly shorter hospital stay (4.1 vs 8 days, P < 0.05) compared to those undergoing MPS drainage. There was no difference in DEN requirement (P = 0.217) and mortality (P = 0.5) in both groups. Overall clinical success with BFMS was superior to MPS (94% vs 73.7%, P < 0.05). CONCLUSION: BFMS appear to be superior to MPS for EUS-guided WON drainage in terms of clinical success, number of DEN sessions, adverse events, need for salvage surgery and hospital stay.
Authors: Linda S Lee; Dana K Andersen; Reiko Ashida; William R Brugge; Mimi I Canto; Kenneth J Chang; Suresh T Chari; John DeWitt; Joo Ha Hwang; Mouen A Khashab; Kang Kim; Michael J Levy; Kevin McGrath; Walter G Park; Aatur Singhi; Tyler Stevens; Christopher C Thompson; Mark D Topazian; Michael B Wallace; Sachin Wani; Irving Waxman; Dhiraj Yadav; Vikesh K Singh Journal: Pancreas Date: 2017 Nov/Dec Impact factor: 3.327
Authors: Ali Siddiqui; Mariam Naveed; Jahangeer Basha; Sundeep Lakhtakia; Jose Nieto; Janak Shah; Kenneth Binmoeller; Megan Murphy; Rupjyoti Talukdar; Mohan K Ramchandani; Zaheer Nabi; Rajesh Gupta; Thomas E Kowalski; David E Loren; Reem Z Sharaiha; Michel Kahaleh; Patrick Ten Eyck; Arish Noor; Tayebah Mumtaz; Rakesh Kalalala; Nageshwar D Reddy; Douglas G Adler Journal: Ann Gastroenterol Date: 2021-01-04