The Role of Lumen-Apposing Metal Stents in Transmural Endoscopic Drainage of Postinflammatory Pancreatic and Peripancreatic Fluid Collections.

Mateusz Jagielski,Marek Jackowski,Mohit Girotra

doi:10.1155/2021/4351151

Mateusz Jagielski, Marek Jackowski + Show 1 more

Open Access

https://doi.org/10.1155/2021/4351151

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Abstract

Rapid development of advanced gastrointestinal endoscopic techniques contributed to the appearance of new biomedical materials including polymers, which are used for the production of different types of endoprostheses. Endotherapy (ET) of postinflammatory pancreatic and peripancreatic fluid collections (PPFCs) with the use of lumen-apposing metal stent (LAMS) is an effective method of treatment. This paper describes the high efficacy of ET and its potential complications, which are mostly related to the design of the LAMS used. The high efficacy of LAMS in the transmural drainage of PPFCs is associated with lower safety of treatment. Complications of ET presented in the manuscript are mainly related to endoprosthesis' construction. This paper presents possible directions of development in the field of transmural LAMSs, which in the future may contribute to the invention of an innovative type of LAMS based on new biomedical technologies. Possibly, subsequent novel endoprosthesis projects, based on the above results, will be able to meet the current needs and requirements associated with endoscopic transmural drainage procedures in cases of postinflammatory PPFCs. The ultimate goal is to improve safety of minimally invasive techniques for treatment of the local consequences of pancreatitis.

Highlights

Acute pancreatitis (AP) of moderate and severe clinical course is associated with high risk of local complications and organ failure leading to increased mortality [1,2,3,4]
This paper describes the outcomes of lumen-apposing metal stent (LAMS)-based endoscopic treatment of postinflammatory peripancreatic fluid collections (PPFCs)
This paper describes a management technique in which the LAMS used for transmural drainage was replaced or removed every four weeks, which lowered the risk of endotherapy complications

Summary

Introduction

Acute pancreatitis (AP) of moderate and severe clinical course is associated with high risk of local complications and organ failure leading to increased mortality [1,2,3,4]. Pancreatic and peripancreatic fluid collections (PPFCs) that may appear in the late phase of pancreatitis in the form of pancreatic pseudocysts (Figures 1(a) and 1(b)) and walled-off pancreatic necrosis (WOPN) (Figure 2). These types of PPFCs are the most common local complications of acute and chronic pancreatitis [1,2,3,4,5,6,7]. While endoscopic treatment is an established method of managing these complications, some aspects of endotherapy are still a source of much controversy [7, 13, 14]. One of the most debated issues in interventional endoscopy of local complications in pancreatitis is the use of transmural self-expanding metallic stents (SEMSs)

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