PDF herunterladen
CC BY-NC-ND 4.0 · Endosc Int Open 2019; 07(03): E347-E354
DOI: 10.1055/a-0828-7630
Original article
Owner and Copyright © Georg Thieme Verlag KG 2019

Lumen apposing metal stents are superior to plastic stents in pancreatic walled-off necrosis: a large international multicenter study

Yen-I Chen
 1   Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
15   Division of Gastroenterology and Hepatology, McGill University Health Center, McGill University, Montreal, QC, Canada
,
Juliana Yang
 1   Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
,
Shai Friedland
 2   Division of Gastroenterology, Stanford University School of Medicine, Stanford, CA, USA
,
Ian Holmes
 2   Division of Gastroenterology, Stanford University School of Medicine, Stanford, CA, USA
,
Ryan Law
 3   Division of Gastroenterology, University of Michigan, Ann Arbor, MI, USA
,
Amy Hosmer
 3   Division of Gastroenterology, University of Michigan, Ann Arbor, MI, USA
,
Tyler Stevens
 4   Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
,
Matheus C. Franco
 4   Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
,
Sunguk Jang
 4   Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
,
Rishi Pawa
 5   Division of Gastroenterology and Hepatology, Wake Forest School of Medicine, Winston Salem, NC, USA
,
Nihar Mathur
 5   Division of Gastroenterology and Hepatology, Wake Forest School of Medicine, Winston Salem, NC, USA
,
Divyesh V. Sejpal
 6   Division of Gastroenterology, Hofstra Northwell School of Medicine, Northwell Health System, Manhasset, NY, USA
,
Sumant Inamdar
 6   Division of Gastroenterology, Hofstra Northwell School of Medicine, Northwell Health System, Manhasset, NY, USA
,
Arvind J. Trindade
 6   Division of Gastroenterology, Hofstra Northwell School of Medicine, Northwell Health System, Manhasset, NY, USA
,
Jose Nieto
 7   Division of Gastroenterology and Hepatology, Borland Groover Clinic, Jacksonville, FL, USA
,
Tyler M. Berzin
 8   Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
,
Mandeep Sawhney
 8   Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
,
Michael L. DeSimone
 8   Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
,
Christopher DiMaio
 9   Division of Gastroenterology and Hepatology, Mount Sinai, New York, NY, USA
,
Nikhil A. Kumta
 9   Division of Gastroenterology and Hepatology, Mount Sinai, New York, NY, USA
,
Sanchit Gupta
 9   Division of Gastroenterology and Hepatology, Mount Sinai, New York, NY, USA
,
Patrick Yachimski
10   Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University, Nashville, TN, USA
,
Andrea Anderloni
11   Digestive Endoscopy Unit, Humanitas Research Hospital, Rozzano, Milan, Italy
,
Todd H. Baron
12   Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
,
Theodore W. James
12   Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
,
Laith H. Jamil
13   Division of Digestive and Liver Diseases, Cedars Sinai Medical Center, Los Angeles, CA, USA
,
Mel A. Ona
13   Division of Digestive and Liver Diseases, Cedars Sinai Medical Center, Los Angeles, CA, USA
,
Simon K. Lo
13   Division of Digestive and Liver Diseases, Cedars Sinai Medical Center, Los Angeles, CA, USA
,
Srinivas Gaddam
13   Division of Digestive and Liver Diseases, Cedars Sinai Medical Center, Los Angeles, CA, USA
,
Markus Dollhopf
14   Division of Gastroenterology and Hepatology, Klinikum Neuperlach, Munich, Germany
,
Majidah A. Bukhari
 1   Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
,
Robert Moran
 1   Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
,
Olaya Brewer Gutierrez
 1   Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
,
Omid Sanaei
 1   Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
,
Lea Fayad
 1   Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
,
Saowanee Ngamruengphong
 1   Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
,
Vivek Kumbhari
 1   Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
,
Vikesh Singh
 1   Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
,
Alessandro Repici
12   Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
,
Mouen A. Khashab
 1   Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
› Institutsangaben
Weitere Informationen

Publikationsverlauf

submitted 05. März 2018

accepted after revision 31. Juli 2018

Publikationsdatum:
28. Februar 2019 (online)

Auch verfügbar auf
   Lizenzen und Reprints

Abstract

Background and study aims The use of lumen apposing metal stents (LAMS) during EUS-guided transmural drainage (EUS-TD) of pancreatic walled-off necrosis (WON) has gained popularity. Data supporting their use in WON over plastic stents (PS), however, remain scarce. The aim of this study was to compare the clinical efficacy of LAMS (Axios, Boston Scientific) with PS in WON.

Patients and methods This was a multicenter, retrospective study involving 14 centers. Consecutive patients who underwent EUS-TD of WON (2012 – 2016) were included. The primary end point was clinical success defined as WON size ≤ 3 cm within a 6-month period without need for percutaneous drainage (PCD) or surgery.

Results A total of 189 patients (mean age 55.2 ± 15.6 years, 34.9 % female) were included (102 LAMS and 87 PS). Technical success rates were similar: 100 % in LAMS and 98.9 % in PS (P = 0.28). Clinical success was attained in 80.4 % of LAMS and 57.5 % of PS (P = 0.001). Rate of PCD was similar (13.7 % LAMS vs. 16.3 % PS, P = 0.62), while PS was associated with a greater need for surgery (16.1 % PS vs. 5.6 % LAMS, P = 0.02). Adverse events (AEs) were observed in 9.8 % of LAMS and 10.3 % of PS (P = 0.90) and were rated as severe in 2.0 % and 6.9 %, respectively (P = 0.93). After excluding patients with < 6 months follow-up, the rate of WON recurrence following initial clinical success was greater with PS (22.9 % PS vs. 5.6 % LAMS, P = 0.04).

Conclusions When compared to PS, LAMS in WON is associated with higher clinical success, shorter procedure time, lower need for surgery, and lower rate of recurrence.

Kommentar zu diesem Artikel:

Endoscopy International Open – recently publishedEndoscopy 2019; 51(04): 392-392
DOI: 10.1055/a-0843-3002

 

  • References

  • 1 Isayama H, Nakai Y, Rerknimitr R. et al. Asian consensus statements on endoscopic management of walled-off necrosis Part 1: Epidemiology, diagnosis, and treatment. J Gastroenterol Hepatol 2016; 31: 1546-1554
    CrossrefPubMedGoogle Scholar
  • 2 Banks PA, Freeman ML. Practice Parameters Committee of the American College of Gastroenterology. Practice guidelines in acute pancreatitis. Am J Gastroenterol 2006; 101: 2379-2400
    CrossrefPubMedGoogle Scholar
  • 3 Tenner S, Baillie J, DeWitt J. et al. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol 2013; 108: 1400-1415 ; 1416
    CrossrefPubMedGoogle Scholar
  • 4 Tyberg A, Karia K, Gabr M. et al. Management of pancreatic fluid collections: A comprehensive review of the literature. World J Gastroenterol 2016; 22: 2256-2270
    CrossrefPubMedGoogle Scholar
  • 5 van Santvoort HC, Besselink MG, Bakker OJ. et al. A step-up approach or open necrosectomy for necrotizing pancreatitis. NEJM 2010; 362: 1491-1502
    CrossrefPubMedGoogle Scholar
  • 6 Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology 2013; 13: e1-15
    CrossrefPubMedGoogle Scholar
  • 7 Besselink MG, Verwer TJ, Schoenmaeckers EJ. et al. Timing of surgical intervention in necrotizing pancreatitis. Arch Surg 2007; 142: 1194-1201
    Google Scholar
  • 8 Bakker OJ, van Santvoort HC, van Brunschot S. et al. Endoscopic transgastric vs surgical necrosectomy for infected necrotizing pancreatitis: a randomized trial. JAMA 2012; 307: 1053-1061
    CrossrefPubMedGoogle Scholar
  • 9 Muthusamy VR, Chandrasekhara V. Committee ASoP. et al. The role of endoscopy in the diagnosis and treatment of inflammatory pancreatic fluid collections. Gastrointest Endosc 2016; 83: 481-488
    CrossrefPubMedGoogle Scholar
  • 10 Bang JY, Wilcox CM, Trevino J. et al. Factors impacting treatment outcomes in the endoscopic management of walled-off pancreatic necrosis. J Gastroenterol Hepatol 2013; 28: 1725-1732
    CrossrefPubMedGoogle Scholar
  • 11 Ng PY, Rasmussen DN, Vilmann P. et al. Endoscopic ultrasound-guided drainage of pancreatic pseudocysts: medium-term assessment of outcomes and complications. Endosc Ultrasound 2013; 2: 199-203
    CrossrefPubMedGoogle Scholar
  • 12 Seewald S, Ang TL, Richter H. et al. Long-term results after endoscopic drainage and necrosectomy of symptomatic pancreatic fluid collections. Dig Endosc 2012; 24: 36-41
    CrossrefPubMedGoogle Scholar
  • 13 Varadarajulu S, Christein JD, Wilcox CM. Frequency of complications during EUS-guided drainage of pancreatic fluid collections in 148 consecutive patients. J Gastroenterol Hepatol 2011; 26: 1504-1508
    CrossrefPubMedGoogle Scholar
  • 14 Gluck M, Ross A, Irani S. et al. Dual modality drainage for symptomatic walled-off pancreatic necrosis reduces length of hospitalization, radiological procedures, and number of endoscopies compared to standard percutaneous drainage. J Gastrointest Surg 2012; 16: 248-256 ; discussion 256-257
    CrossrefPubMedGoogle Scholar
  • 15 Ross AS, Irani S, Gan SI. et al. Dual-modality drainage of infected and symptomatic walled-off pancreatic necrosis: long-term clinical outcomes. Gastrointest Endosc 2014; 79: 929-935
    CrossrefPubMedGoogle Scholar
  • 16 Binmoeller KF, Shah J. A novel lumen-apposing stent for transluminal drainage of nonadherent extraintestinal fluid collections. Endoscopy 2011; 43: 337-442
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 17 Chandran S, Efthymiou M, Kaffes A. et al. Management of pancreatic collections with a novel endoscopically placed fully covered self-expandable metal stent: a national experience (with videos). Gastrointest Endosc 2015; 81: 127-135
    CrossrefPubMedGoogle Scholar
  • 18 Rinninella E, Kunda R, Dollhopf M. et al. EUS-guided drainage of pancreatic fluid collections using a novel lumen-apposing metal stent on an electrocautery-enhanced delivery system: a large retrospective study (with video). Gastrointest Endosc 2015; 82: 1039-1046
    CrossrefPubMedGoogle Scholar
  • 19 Shah RJ, Shah JN, Waxman I. et al. Safety and efficacy of endoscopic ultrasound-guided drainage of pancreatic fluid collections with lumen-apposing covered self-expanding metal stents. Clin Gastroenterol Hepatol 2015; 13: 747-752
    CrossrefPubMedGoogle Scholar
  • 20 Siddiqui AA, Adler DG, Nieto J. et al. EUS-guided drainage of peripancreatic fluid collections and necrosis by using a novel lumen-apposing stent: a large retrospective, multicenter U.S. experience (with videos). Gastrointest Endosc 2016; 83: 699-707
    CrossrefPubMedGoogle Scholar
  • 21 Walter D, Will U, Sanchez-Yague A. et al. A novel lumen-apposing metal stent for endoscopic ultrasound-guided drainage of pancreatic fluid collections: a prospective cohort study. Endoscopy 2015; 47: 63-67
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 22 Banks PA, Bollen TL, Dervenis C. et al. Classification of acute pancreatitis – 2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013; 62: 102-111
    CrossrefPubMedGoogle Scholar
  • 23 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
    CrossrefPubMedGoogle Scholar
  • 24 Gardner TB, Chahal P, Papachristou GI. et al. A comparison of direct endoscopic necrosectomy with transmural endoscopic drainage for the treatment of walled-off pancreatic necrosis. Gastrointest Endosc 2009; 69: 1085-1094
    CrossrefPubMedGoogle Scholar
  • 25 Lin H, Zhan XB, Sun SY. et al. Stent selection for endoscopic ultrasound-guided drainage of pancreatic fluid collections: a multicenter study in China. Gastroenterol Res Pract 2014; 2014: 193562
    PubMedGoogle Scholar
  • 26 Rana SS, Bhasin DK, Rao C. et al. Non-fluoroscopic endoscopic ultrasound-guided transmural drainage of symptomatic non-bulging walled-off pancreatic necrosis. Dig Endosc 2013; 25: 47-52
    CrossrefPubMedGoogle Scholar
  • 27 Sharaiha RZ, Tyberg A, Khashab MA. et al. Endoscopic therapy with lumen-apposing metal stents is safe and effective for patients with pancreatic walled-off necrosis. Clin Gastroenterol Hepatol 2016; 14: 1797-1803
    CrossrefPubMedGoogle Scholar
  • 28 Siddiqui AA, Kowalski TE, Loren DE. et al. Fully covered self-expanding metal stents versus lumen-apposing fully covered self-expanding metal stent versus plastic stents for endoscopic drainage of pancreatic walled-off necrosis: clinical outcomes and success. Gastrointest Endosc 2017; 85: 758-765
    CrossrefPubMedGoogle Scholar
  • 29 Varadarajulu S, Bang JY, Phadnis MA. et al. Endoscopic transmural drainage of peripancreatic fluid collections: outcomes and predictors of treatment success in 211 consecutive patients. J Gastrointest Surg 2011; 15: 2080-2088
    CrossrefPubMedGoogle Scholar
  • 30 Puga M, Consiglieri CF, Busquets J. et al. Safety of lumen-apposing stent with or without coaxial plastic stent for endoscopic ultrasound-guided drainage of pancreatic fluid collections: a retrospective study. Endoscopy 2018; 50: 1022-1026
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 31 Kumar N, Conwell DL, Thompson CC. Direct endoscopic necrosectomy versus step-up approach for walled-off pancreatic necrosis: comparison of clinical outcome and health care utilization. Pancreas 2014; 43: 1334-1339
    CrossrefPubMedGoogle Scholar
  • 32 Seifert H, Biermer M, Schmitt W. et al. Transluminal endoscopic necrosectomy after acute pancreatitis: a multicentre study with long-term follow-up (the GEPARD Study). Gut 2009; 58: 1260-1266
    CrossrefPubMedGoogle Scholar
  • 33 Abdelhafez M, Elnegouly M, Hasab Allah MS. et al. Transluminal retroperitoneal endoscopic necrosectomy with the use of hydrogen peroxide and without external irrigation: a novel approach for the treatment of walled-off pancreatic necrosis. Surg Endosc 2013; 27: 3911-3920
    CrossrefPubMedGoogle Scholar
  • 34 Siddiqui AA, Easler J, Strongin A. et al. Hydrogen peroxide-assisted endoscopic necrosectomy for walled-off pancreatic necrosis: a dual center pilot experience. Dig Dis Sci 2014; 59: 687-690
    CrossrefPubMedGoogle Scholar
  • 35 Gornals JB, De la Serna-Higuera C, Sanchez-Yague A. et al. Endosonography-guided drainage of pancreatic fluid collections with a novel lumen-apposing stent. Surg Endosc 2013; 27: 1428-1434
    CrossrefPubMedGoogle Scholar
  • 36 Bang JY, Hasan M, Navaneethan U. et al. Lumen-apposing metal stents (LAMS) for pancreatic fluid collection (PFC) drainage: may not be business as usual. Gut 2017; 66: 2054-2056
    CrossrefPubMedGoogle Scholar
  • 37 Zeissig S, Sulk S, Brueckner S. et al. Severe bleeding is a rare event in patients receiving lumen-apposing metal stents for the drainage of pancreatic fluid collections. Gut 2018; DOI: 10.1136/gutjnl-2018-316581. [Epub ahead of print] pii: gutjnl-2018-316581
    CrossrefPubMedGoogle Scholar