Prashant R Mudireddy1, Amrita Sethi2, Ali A Siddiqui3, Douglas G Adler4, Jose Nieto5, Harshit Khara1, Arvind Trindade6, Sammy Ho7, Petros C Benias6, Peter V Draganov8, Dennis Yang8, Shaffer Mok1, Bradley Confer1, David L Diehl1. 1. Department of Gastroenterology, Geisinger Medical Center, Danville, Pennsylvania, USA. 2. Department of Gastroenterology, Columbia University Medical Center, New York, New York, USA. 3. Department of Gastroenterology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA. 4. Department of Gastroenterology, University of Utah School of Medicine, Salt Lake City, Utah, USA. 5. Department of Gastroenterology, Borland-Groover Clinic, Jacksonville, Florida, USA. 6. Department of Gastroenterology, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, New York, USA. 7. Department of Gastroenterology, Montefiore Medical Center, Bronx, New York, USA. 8. Department of Gastroenterology, University of Florida, Gainesville, Florida, USA.
Abstract
BACKGROUND AND AIMS: Postsurgical fluid collections (PSFCs) are traditionally drained either percutaneously or surgically. Endoscopic drainage offers several advantages compared with either percutaneous or surgical approaches, including avoiding repeat surgery or the need to have a percutaneous drain in place for weeks. There are very little data regarding the use of lumen-apposing metal stents (LAMSs) in the drainage of PSFCs. We aim to study the technical and clinical success and adverse events (AEs) of using LAMSs in the drainage of PSFCs. METHODS: Collaborators from 8 centers retrospectively reviewed their endoscopic databases to find procedures using LAMSs for drainage of PSFCs. Technical success (successful placement of LAMSs into the fluid collection), clinical success (complete resolution of the fluid collection on repeat imaging or endoscopy), and intraprocedure and postprocedure AEs were measured. RESULTS: Forty-seven patients were identified with PSFCs after various surgeries. Thirteen patients had failed previous percutaneous or surgical drainage attempts. Fluid collections averaged 78.6 mm (range, 47-150 mm) in size. The most common site of stent placement was transgastric, followed by rectum and duodenum. Technical success rate was 93.6% and clinical success rate 89.3%. The intraprocedural AE rate was 4.25% and postprocedural AE rate 6.4%. There was 1 death unrelated to the procedure. CONCLUSIONS: The use of LAMSs to drain PSFCs has a high technical and clinical success rate with low AEs. For collections that are favorably located adjacent to the stomach, duodenum, or rectum, LAMS placement is a viable alternative to repeat surgery or percutaneous drainage.
BACKGROUND AND AIMS: Postsurgical fluid collections (PSFCs) are traditionally drained either percutaneously or surgically. Endoscopic drainage offers several advantages compared with either percutaneous or surgical approaches, including avoiding repeat surgery or the need to have a percutaneous drain in place for weeks. There are very little data regarding the use of lumen-apposing metal stents (LAMSs) in the drainage of PSFCs. We aim to study the technical and clinical success and adverse events (AEs) of using LAMSs in the drainage of PSFCs. METHODS: Collaborators from 8 centers retrospectively reviewed their endoscopic databases to find procedures using LAMSs for drainage of PSFCs. Technical success (successful placement of LAMSs into the fluid collection), clinical success (complete resolution of the fluid collection on repeat imaging or endoscopy), and intraprocedure and postprocedure AEs were measured. RESULTS: Forty-seven patients were identified with PSFCs after various surgeries. Thirteen patients had failed previous percutaneous or surgical drainage attempts. Fluid collections averaged 78.6 mm (range, 47-150 mm) in size. The most common site of stent placement was transgastric, followed by rectum and duodenum. Technical success rate was 93.6% and clinical success rate 89.3%. The intraprocedural AE rate was 4.25% and postprocedural AE rate 6.4%. There was 1 death unrelated to the procedure. CONCLUSIONS: The use of LAMSs to drain PSFCs has a high technical and clinical success rate with low AEs. For collections that are favorably located adjacent to the stomach, duodenum, or rectum, LAMS placement is a viable alternative to repeat surgery or percutaneous drainage.
Authors: Prabin Sharma; Thomas R McCarty; Ankit Chhoda; Antonio Costantino; Caroline Loeser; Thiruvengadam Muniraj; Marvin Ryou; Christopher C Thompson Journal: World J Gastroenterol Date: 2020-06-07 Impact factor: 5.742