Transenteric drainage of pancreatic-fluid collections with fully covered self-expanding metallic stents (with video)

Background

Drainage of pancreatic-fluid collections (PFCs) by using fully covered self-expanding metallic stents (CSEMSs) offers the option of providing a larger-diameter access fistula for drainage when compared with plastic stents.

Objective

To evaluate the efficacy and safety of transenteric drainage of PFCs by using CSEMSs.

Design

A prospective case series.

Setting

A tertiary-referral center.

Patients

Between January 2007 and September 2007, 18 patients underwent drainage of PFCs by using CSEMSs. Follow-up and final results were prospectively recorded until May 2008.

Interventions

Placement of CSEMSs with a double-pigtail stent placed alongside (4 cases) or into the CSEMS (14 cases) to prevent migration.

Main Outcome Measurements

The number of sessions and time to resolution of the PFCs.

Results

A median of 1 session was required to achieve drainage (range 1-4) when using CSEMSs. Complications included superinfection (5), bleeding (2), and inner migration (1). A total of 17 of 18 patients (95%) responded successfully, with 14 patients (78%) achieving complete resolution of their PFC. The mean (± SD) time of follow-up until final resolution was 77 ± 80 days (range 15-310 days).

Conclusions

Placement of CSEMSs seems to offer an effective and safe alternative for the drainage of PFCs. A randomized controlled trial should be performed to compare this technique with plastic-stent drainage.

Abbreviations: CSEMS, fully covered self-expanding metal stent, PCMS, partially covered metal stent, PFC, pancreatic fluid collection, SEMS, self-expanding metallic stent