Safety and efficacy of the use of lumen-apposing metal stents in the management of postoperative fluid collections: a large, international, multicenter study

Juliana Yang; Jeremy H. Kaplan; Amrita Sethi; Enad Dawod; Reem Z. Sharaiha; Austin Chiang; Thomas Kowalski; Jose Nieto; Ryan Law; Hazem Hammad; Sachin Wani; Mihir S. Wagh; Dennis Yang; Peter V. Draganov; Ahmed Messallam; Qiang Cai; Vladimir Kushnir; Natalie Cosgrove; Ali Mir Ahmed; Andrea Anderloni; Douglas G. Adler; Nikhil A. Kumta; Satish Nagula; Frank P. Vleggaar; Shayan Irani; Carlos Robles-Medranda; Abdul Hamid El Chafic; Rishi Pawa; Olaya Brewer; Omid Sanaei; Mohamad Dbouk; Vikesh K. Singh; Vivek Kumbhari; Mouen A. Khashab

doi:10.1055/a-0924-5591

Endoscopy, Table of Contents

Endoscopy 2019; 51(08): 715-721
DOI: 10.1055/a-0924-5591

Original article

Safety and efficacy of the use of lumen-apposing metal stents in the management of postoperative fluid collections: a large, international, multicenter study

Juliana Yang

¹Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA

,

Jeremy H. Kaplan

²Division of Digestive and Liver Disease, Columbia University Medical Center, New York, New York, USA

,

Amrita Sethi

²Division of Digestive and Liver Disease, Columbia University Medical Center, New York, New York, USA

,

Enad Dawod

³Division of Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York, USA

,

Reem Z. Sharaiha

³Division of Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York, USA

,

Austin Chiang

⁴Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA

,

Thomas Kowalski

⁴Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA

,

Jose Nieto

⁵Division of Gastroenterology and Hepatology, Borland Groover Clinic, Jacksonville, Florida, USA

,

Ryan Law

⁶Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA

,

Hazem Hammad

⁷Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA

,

Sachin Wani

⁷Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA

,

Mihir S. Wagh

⁷Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA

,

Dennis Yang

⁸Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, USA

,

Peter V. Draganov

⁸Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, USA

,

Ahmed Messallam

⁹Division of Digestive Disease, Emory University School of Medicine, Atlanta, Georgia, USA

,

Qiang Cai

⁹Division of Digestive Disease, Emory University School of Medicine, Atlanta, Georgia, USA

,

Vladimir Kushnir

¹⁰Division of Gastroenterology, Washington University in Saint Louis, St. Louis, Missouri, USA

,

Natalie Cosgrove

¹⁰Division of Gastroenterology, Washington University in Saint Louis, St. Louis, Missouri, USA

,

Ali Mir Ahmed

¹¹Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, Alabama, USA

,

Andrea Anderloni

¹²Division of Gastroenterology, Digestive Endoscopy Unit, Humanitas Research Hospital, Rozzano, Milan, Italy

,

Douglas G. Adler

¹³Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA

,

Nikhil A. Kumta

¹⁴Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA

,

Satish Nagula

¹⁴Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA

,

Frank P. Vleggaar

¹⁵Division of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands

,

Shayan Irani

¹⁶Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA

,

Carlos Robles-Medranda

¹⁷Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas, University Hospital OMNI, Guayaquil, Ecuador

,

Abdul Hamid El Chafic

¹⁸Division of Gastroenterology, Ochsner Medical Center, New Orleans, Louisiana, USA

,

Rishi Pawa

¹⁹Division of Gastroenterology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA

,

Olaya Brewer

¹Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA

,

Omid Sanaei

¹Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA

,

Mohamad Dbouk

¹Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA

,

Vikesh K. Singh

¹Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA

,

Vivek Kumbhari

¹Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA

,

Mouen A. Khashab

¹Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA

› Author Affiliations

Abstract

Background Multiple studies have examined the use of lumen-apposing metal stents (LAMSs) for the drainage of peripancreatic fluid collections. Data on the use of LAMSs for postoperative fluid collections (POFCs) are scarce. POFCs may lead to severe complications without appropriate treatment. We aimed to study the outcomes (technical success, clinical success, rate/severity of adverse events, length of stay, recurrence) of the use of LAMSs for the drainage of POFCs.

Methods This international, multicenter, retrospective study involved 19 centers between January 2012 and October 2017. The primary outcome was clinical success. Secondary outcomes included technical success and rate/severity of adverse events using the ASGE lexicon.

Results A total of 62 patients were included during the study period. The most common etiology of the POFCs was distal pancreatectomy (46.8 %). The mean (standard deviation) diameter was 84.5 mm (30.7 mm). The most common indication for drainage was infection (48.4 %) and transgastric drainage was the most common approach (82.3 %). Technical success was achieved in 60/62 patients (96.8 %) and clinical success in 57/62 patients (91.9 %) during a median (interquartile range) follow-up of 231 days (90 – 300 days). Percutaneous drainage was needed in 8.1 % of patients. Adverse events occurred intraoperatively in 1/62 patients (1.6 %) and postoperatively in 7/62 (11.3 %). There was no procedure-related mortality.

Conclusion This is the largest study on the use of LAMSs for POFCs. It suggests good clinical efficacy and safety of this approach. The use of LAMSs in the management of POFCs is a feasible alternative to percutaneous and surgical drainage.

Full Text

References

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Supplementary Material

Supplementary material