Which Are the Most Suitable Stents for Interventional Endoscopic Ultrasound?

Se Woo Park,Sang Soo Lee

doi:10.3390/jcm9113595

Abstract

Endoscopic ultrasound (EUS)-guided interventions provide easy access to structures adjacent to the gastrointestinal tract, effectively targeting them for therapeutic purposes. They play an important role in the management of pancreatic fluid collections (PFC) and bile duct (BD) and pancreatic duct (PD) drainage in cases of failed endoscopic retrograde cholangiopancreatography (ERCP) or gallbladder (GB) drainage. Specially designed stents and delivery systems for EUS-guided transluminal interventions allow various new applications and improve the efficacy and safety of these procedures. In fact, EUS-guided drainage has emerged as the treatment of choice for the management of PFC, and recent innovations such as fully covered metal stents (including lumen-apposing metal stents) have improved outcomes in patients with walled-off necrosis. Similarly, EUS-guided BD and PD drainage with specially designed stents can be beneficial for patients with failed ERCP due to an inaccessible papilla, gastric outlet obstruction, or surgically altered anatomy. EUS-guided GB drainage is also performed using dedicated stents in patients with acute cholecystitis who are not fit for surgery. Although the field of dedicated stents for interventional EUS is rapidly advancing with increasing innovations, the debate on the most appropriate stent for EUS-guided drainage has resurfaced. Furthermore, some important questions remain unaddressed, such as which stent improves clinical outcomes and safety in EUS-guided drainage. Herein, the current status and problems of the available stents are reviewed, including the applicable indications, long-term clinical outcomes, comparison between each stent, and their future prospects.

Highlights

Endoscopic ultrasound (EUS)-guided drainage procedures are potentially disruptive alternatives to invasive surgery; therapeutic strategies are undergoing a paradigm shift towards minimally invasive treatments, and a number of devices and techniques are being developed for easier and safer procedures
EUS-guided drainage procedures play an important role in the management of peripancreatic fluid collections (PFC) [1] and bile duct (BD) and pancreatic duct (PD) drainage in cases of failed endoscopic retrograde cholangiopancreatography (ERCP), gallbladder (GB) drainage, and entero-enteric anastomosis
Stent for EUS-Guided Peripancreatic Fluid Collection (PFC) Drainage According to the revised Atlanta classification

Summary

Introduction

Endoscopic ultrasound (EUS)-guided drainage procedures are potentially disruptive alternatives to invasive surgery; therapeutic strategies are undergoing a paradigm shift towards minimally invasive treatments, and a number of devices and techniques are being developed for easier and safer procedures. Recent innovations, such as the lumen-apposing metal stents (LAMS) designed for EUS-guided interventions with bidirectional anchoring flanges, have improved outcomes in patients who require drainage [2,3,4]. 2. Selection of Appropriate Stents for Endoscopic Ultrasound (EUS)-Guided Drainage Procedures. Stent for EUS-Guided Peripancreatic Fluid Collection (PFC) Drainage According to the revised Atlanta classification (proposed by a recent international consensus). UUssee ooff tthhee SSeellff--EExxppaannddaabbllee MMeettaall SStteenntt ((SSEEMMSS)) TToo oovveerrccoommee tthhee tthheeoorreettiiccaall lliimmiittaattiioonnss ooff tthhee ppllaassttiicc sstteenntt,, aa ddeeddiiccaatteedd bbii--ffllaannggeedd FFCCSSEEMMSS wwaass iinnttrroodduucceedd dduueetotoitsitasdavdavnatangteagoef aolfloawllionwg ianlgaragelra-rdgiaerm-detiaermdertaeirnadgrea,inwahgiec,hwcahnicihmpcaronviemthperopvaetenthcey patency of the stent, reduce secondary infections and, reduce the frequency of revisions for stent dysfunction and sustain the tract for sequential sessions of direct endoscopic necrosectomy (DEN) (Figure 6) [15]. Most cases of stent dysfunction that shorten the stent patency can occur from stent migration or clogging by food materials [28]

Use of the Plastic Stent

Use of the SEMS

Stent for EUS-Guided Creation of Entero-Enteric Anastomosis

Findings

Conclusions