BACKGROUND AND AIMS: Symptomatic pancreatic walled-off necrosis (WON) may be managed by endoscopic transmural drainage and endoscopic transmural necrosectomy, with stent placement at endoscopic drainage sites. The optimal stent choice is yet to be determined. We compared outcomes after endoscopic management of WON using either large-caliber fully covered self-expandable metal stents (LC-SEMSs) or double-pigtail plastic stents (DPPSs). METHODS: We performed a retrospective comparison of outcomes among patients who received LC-SEMSs or DPPSs before endoscopic transmural necrosectomy for WON. RESULTS: Among 94 patients included, WON resolution rates did not differ between the DPPS (36 patients) and LC-SEMS (58 patients) groups, whether concomitant percutaneous drainage was considered a failure (75% vs 82.8%; P = .36) or not (91.7% vs 94.8%; P = .55). Of 75 patients (80%) successfully treated without percutaneous drainage, 37 (49%) underwent endoscopic transmural drainage without subsequent endoscopic transmural necrosectomy. WON was more likely to resolve without subsequent endoscopic transmural necrosectomy in the LC-SEMS group than the DPPS group (60.4% vs 30.8%; P = .01). WON resolution without subsequent endoscopic transmural necrosectomy remained more likely with LC-SEMSs (odds ratio, 4.5 [95% confidence interval, 1.5-15.5]) after adjusting for patient age and size and location of WON. Rates of adverse events were similar except for clinically significant bleeding requiring endoscopic intervention, which was higher with DPPSs than LC-SEMSs (14% vs 2%; P = .02). CONCLUSION: Management of pancreatic WON with LC-SEMSs appears to decrease both the need for repeated necrosectomy procedures and the risk of intervention-related hemorrhage.
BACKGROUND AND AIMS: Symptomatic pancreatic walled-off necrosis (WON) may be managed by endoscopic transmural drainage and endoscopic transmural necrosectomy, with stent placement at endoscopic drainage sites. The optimal stent choice is yet to be determined. We compared outcomes after endoscopic management of WON using either large-caliber fully covered self-expandable metal stents (LC-SEMSs) or double-pigtail plastic stents (DPPSs). METHODS: We performed a retrospective comparison of outcomes among patients who received LC-SEMSs or DPPSs before endoscopic transmural necrosectomy for WON. RESULTS: Among 94 patients included, WON resolution rates did not differ between the DPPS (36 patients) and LC-SEMS (58 patients) groups, whether concomitant percutaneous drainage was considered a failure (75% vs 82.8%; P = .36) or not (91.7% vs 94.8%; P = .55). Of 75 patients (80%) successfully treated without percutaneous drainage, 37 (49%) underwent endoscopic transmural drainage without subsequent endoscopic transmural necrosectomy. WON was more likely to resolve without subsequent endoscopic transmural necrosectomy in the LC-SEMS group than the DPPS group (60.4% vs 30.8%; P = .01). WON resolution without subsequent endoscopic transmural necrosectomy remained more likely with LC-SEMSs (odds ratio, 4.5 [95% confidence interval, 1.5-15.5]) after adjusting for patient age and size and location of WON. Rates of adverse events were similar except for clinically significant bleeding requiring endoscopic intervention, which was higher with DPPSs than LC-SEMSs (14% vs 2%; P = .02). CONCLUSION: Management of pancreatic WON with LC-SEMSs appears to decrease both the need for repeated necrosectomy procedures and the risk of intervention-related hemorrhage.
Authors: Andrea Anderloni; Carlo Fabbri; Jose Nieto; Will Uwe; Markus Dollhopf; José Ramón Aparicio; Manuel Perez-Miranda; Ilaria Tarantino; Alexander Arlt; Frank Vleggaar; Geoffrey Vanbiervliet; Jochen Hampe; Michel Kahaleh; Juan J Vila; Barham K Abu Dayyeh; Andrew C Storm; Alessandro Fugazza; Cecilia Binda; Antoine Charachon; Sergio Sevilla-Ribota; Amy Tyberg; Moran Robert; Sachin Wani; Alessandro Repici; Amrita Sethi; Mouen A Khashab; Rastislav Kunda Journal: Surg Endosc Date: 2020-04-22 Impact factor: 4.584
Authors: Abed Al Lehibi; Abdullah Al Jabri; Shahem Abbarh; Areej Al Balkhi; Nawwaf Al Otaibi; Thamer Almasoudi; Abdullah Al Mtawa; Adel AlGhamdi; Ahmad Al Eid; Ahmed Al Ghamdi; Abdullah Al Khathlan; Adel Qutub; Khalid Al Sayari; Shameem Ahmad Journal: Saudi J Gastroenterol Date: 2021 Mar-Apr Impact factor: 2.485
Authors: Rebecca Saunders; Jayapal Ramesh; Silvia Cicconi; Jonathan Evans; Vincent S Yip; Michael Raraty; Paula Ghaneh; Robert Sutton; John P Neoptolemos; Christopher Halloran Journal: Surg Endosc Date: 2018-09-06 Impact factor: 4.584
Authors: Phillip S Ge; Joyce Y Young; Pichamol Jirapinyo; William Dong; Marvin Ryou; Christopher C Thompson Journal: Pancreas Date: 2020-02 Impact factor: 3.243