BACKGROUND AND AIMS: EUS-guided drainage using plastic stents may be inadequate for treatment of walled-off necrosis (WON). Recent studies report variable outcomes even when using covered metal stents. The aim of this study was to evaluate the efficacy of a dedicated covered biflanged metal stent (BFMS) when adopting an endoscopic "step-up approach" for drainage of symptomatic WON. METHODS: We retrospectively evaluated consecutive patients with symptomatic WON who underwent EUS-guided drainage using BFMSs over a 3-year period. Reassessment was done between 48 and 72 hours for resolution. Endoscopic reinterventions were tailored in nonresponders in a stepwise manner. Step 1 encompassed declogging the blocked lumen of the BFMS. In step 2, a nasocystic tube was placed via BFMSs with intermittent irrigation. Step 3 involved direct endoscopic necrosectomy (DEN). BFMSs were removed between 4 and 8 weeks of follow-up. The main outcome measures were technical success, clinical success, adverse events, and need for DEN. RESULTS: Two hundred five WON patients underwent EUS-guided drainage using BFMSs. Technical success was achieved in 203 patients (99%). Periprocedure adverse events occurred in 8 patients (bleeding in 6, perforation in 2). Clinical success with BFMSs alone was seen in 153 patients (74.6%). Reintervention adopting the step-up approach was required in 49 patients (23.9%). Incremental success was achieved in 10 patients with step 1, 16 patients with step 2, and 19 patients with step 3. Overall clinical success was achieved in 198 patients (96.5%), with DEN required in 9.2%. Four patients failed treatment and required surgery (2) or percutaneous drainage (2). CONCLUSIONS: The endoscopic step-up approach using BFMSs was safe, effective, and yielded successful outcomes in most patients, reducing the need for DEN.
BACKGROUND AND AIMS: EUS-guided drainage using plastic stents may be inadequate for treatment of walled-off necrosis (WON). Recent studies report variable outcomes even when using covered metal stents. The aim of this study was to evaluate the efficacy of a dedicated covered biflanged metal stent (BFMS) when adopting an endoscopic "step-up approach" for drainage of symptomatic WON. METHODS: We retrospectively evaluated consecutive patients with symptomatic WON who underwent EUS-guided drainage using BFMSs over a 3-year period. Reassessment was done between 48 and 72 hours for resolution. Endoscopic reinterventions were tailored in nonresponders in a stepwise manner. Step 1 encompassed declogging the blocked lumen of the BFMS. In step 2, a nasocystic tube was placed via BFMSs with intermittent irrigation. Step 3 involved direct endoscopic necrosectomy (DEN). BFMSs were removed between 4 and 8 weeks of follow-up. The main outcome measures were technical success, clinical success, adverse events, and need for DEN. RESULTS: Two hundred five WON patients underwent EUS-guided drainage using BFMSs. Technical success was achieved in 203 patients (99%). Periprocedure adverse events occurred in 8 patients (bleeding in 6, perforation in 2). Clinical success with BFMSs alone was seen in 153 patients (74.6%). Reintervention adopting the step-up approach was required in 49 patients (23.9%). Incremental success was achieved in 10 patients with step 1, 16 patients with step 2, and 19 patients with step 3. Overall clinical success was achieved in 198 patients (96.5%), with DEN required in 9.2%. Four patients failed treatment and required surgery (2) or percutaneous drainage (2). CONCLUSIONS: The endoscopic step-up approach using BFMSs was safe, effective, and yielded successful outcomes in most patients, reducing the need for DEN.
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
Authors: Jintao Guo; Adrian Saftoiu; Peter Vilmann; Pietro Fusaroli; Marc Giovannini; Girish Mishra; Surinder S Rana; Sammy Ho; Jan-Werner Poley; Tiing Leong Ang; Evangelos Kalaitzakis; Ali A Siddiqui; Jose G De La Mora-Levy; Sundeep Lakhtakia; Manoop S Bhutani; Malay Sharma; Shuntaro Mukai; Pramod Kumar Garg; Linda S Lee; Juan J Vila; Everson Artifon; Douglas G Adler; Siyu Sun Journal: Endosc Ultrasound Date: 2017 Sep-Oct Impact factor: 5.628
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