Abstract
BackgroundPancreatic pseudocysts (PC) and walled-off necrosis (WON) are common complications of severe pancreatitis. Endoscopic ultrasound (EUS)-guided drainage has replaced surgery as the standard treatment for PC/WON. We developed a novel lumen-apposing metal stent (LAMS) with an anti-reflux valve to prevent infectious complications caused by food reflux into the cyst cavity. This retrospective study investigated the efficacy and safety of EUS-guided drainage using this LAMS.MethodsWe investigated and compared the treatment outcomes and complications rates between EUS-guided drainage using a novel LAMS (n = 10) versus plastic stents (n = 18) from December 2013 to October 2016. Technical success was defined as successful stent placement without immediate complications. Clinical success was defined as resolution of the PC/WON and disappearance of symptoms.ResultsAmong 10 patients in LAMS group, 4 patients had complicated PC and 6 patients had WON. In the plastic stent group, 15 and 3 patients had PC and WON, respectively. The median fluid collection size before treatment was 82.5 (interquartile range [IQR], 60.75–118.25) mm and 92.0 (IQR, 75.75–130.25) mm in the LAMS and plastic stent groups, respectively. There were no statistically significant differences in technical success rates (90% vs. 94.4%; p = 0.999), clinical success rates (80% vs. 77.8%; p = 0.999), and complication rates (20% vs. 27.8%; p = 0.999) between the two groups.ConclusionsTreatment outcomes of EUS-guided drainage using a novel LAMS were feasible despite the significantly high proportion of WON. The LAMS allowed acceptable treatment outcomes for EUS-guided drainage.
Highlights
Severe acute pancreatitis and chronic pancreatitis result in local complications in the form of peripancreatic fluid collections (PFC)
We developed a novel lumen-apposing metal stent (LAMS) with an anti-reflux valve to prevent infectious complications caused by food reflux into the cyst cavity
We investigated and compared the treatment outcomes and complications rates between endoscopic ultrasound (EUS)-guided drainage using a novel LAMS (n = 10) versus plastic stents (n = 18) from December 2013 to October 2016
Summary
Severe acute pancreatitis and chronic pancreatitis result in local complications in the form of peripancreatic fluid collections (PFC). Treatment is required when symptoms and complications, such as pain, biliary obstruction, or infection occur [2] Surgical interventions, such as drainage and open necrosectomy, were the only modalities of treatment, but these invasive procedures are associated with high rates of complications and mortality [3, 4]. Studies have reported that success rates of EUS-guided fluid collection drainage and endoscopic necrosectomy range from 84% to 94% and 68% to 91%, respectively [7,8,9]. We developed a novel lumen-apposing metal stent (LAMS) with an anti-reflux valve to prevent infectious complications caused by food reflux into the cyst cavity This retrospective study investigated the efficacy and safety of EUSguided drainage using this LAMS
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