Background and Aims
Initial reports suggest that fully covered self-expandable metal stents (FCSEMSs)
may be better suited for drainage of dense pancreatic fluid collections (PFCs), such
as walled-off pancreatic necrosis. The primary aim was to analyze the effectiveness
and safety of FCSEMSs for drainage of different types of PFCs in a large cohort. The
secondary aim was to investigate which type of FCSEMS is superior.
Methods
This was a retrospective, noncomparative review of a nationwide database involving
all hospitals in Spain performing EUS-guided PFC drainage. From April 2008 to August
2013, all patients undergoing PFC drainage with an FCSEMS were included in a database.
The main outcome measurements were technical success, short-term (2 weeks) and long-term
(6 months) effectiveness, adverse events, and need for surgery.
Results
The study included 211 patients (pseudocyst/walled-off pancreatic necrosis, 53%/47%).
The FCSEMSs used were straight biliary (66%) or lumen-apposing (34%). Technical success
was achieved in 97% of patients (95% confidence interval [CI], 93%-99%). Short-term-
and long-term clinical success was obtained in 94% (95% CI, 89%-97%) and 85% (95%
CI, 79%-89%) of patients, respectively. Adverse events occurred in 21% of patients
(95% CI, 16%-27%): infection (11%), bleeding (7%), and stent migration and/or perforation
(3%). By multivariate analysis, patient age (>58 years) and previous failed drainage
were the most important factors associated with negative outcome.
Conclusions
An FCSEMS is effective and safe for PFC drainage. Older patients with a history of
unsuccessful drainage are more likely to fail EUS-guided drainage. The type of FCSEMS
does not seem to influence patient outcome.
Abbreviations:
AE (adverse event), CI (confidence interval), F (French), FCSEMS (fully covered self-expandable metal stent), LAMS (lumen-apposing metal stent), LTCS (long-term clinical success), MRI (magnetic resonance imaging), OR (odds ratio), PFC (pancreatic fluid collection), RSS (required salvage surgery), SBFCSEMS (straight biliary fully covered self-expandable metal stent), SD (standard deviation), STCS (short-term clinical success), TS (technical success), WOPN (walled-off pancreatic necrosis)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 09, 2016
Accepted:
February 17,
2016
Received:
November 11,
2015
Footnotes
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
If you would like to chat with an author of this study, you may contact Dr Vazquez-Sequeiros at [email protected]
Identification
Copyright
Copyright © 2016 by the American Society for Gastrointestinal Endoscopy
