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Efficacy of a novel lumen-apposing metal stent for the treatment of symptomatic pancreatic pseudocysts (with video)

      Background and Aims

      Recently, a newly designed lumen-apposing metal stent (LAMS) with a conventional delivery system was developed. The purpose of this study was to evaluate the effectiveness and safety of a newly designed LAMS for EUS-guided drainage to treat symptomatic pancreatic pseudocysts.

      Methods

      This prospective multicenter cohort study included 34 patients with symptomatic pancreatic pseudocysts from 2016 to 2017. The patients underwent EUS-guided drainage with the newly designed LAMS (Niti-S SPAXUS; Taewoong Medical Co, Ltd, Ilsan, South Korea). Effectiveness outcome measurements included technical success rate, clinical success rate, successful stent removal rate, and procedural time. Safety outcome measurements included procedure and/or stent-related adverse events (AEs) and overall AEs. Patients were prospectively followed, and consecutive data were collected at discharge, at stent removal, and 20 days after stent removal.

      Results

      Thirty-four patients (mean age 51.7 ± 13.3 years, 26 men) were enrolled. The mean pseudocyst size was 9.23 ± 3.54 cm. The technical success rate was 97.1% (33/34). The clinical success rate was 94.1% (32/34). All stents were successfully removed. The mean procedural time from needle puncture to stent deployment was 10.3 ± 5.7 minutes. Four patients (11.8%) experienced procedure and/or stent-related AEs, including stent maldeployment (n = 1) and pseudocyst infection (n = 3). All patients completely recovered from the AEs. Bleeding caused by the stent or buried LAMS syndrome was not observed. No unplanned endoscopic procedures were required.

      Conclusions

      This study showed that EUS-guided drainage using the newly designed LAMS is technically feasible and effective for the treatment of symptomatic pancreatic pseudocysts. (Clinical trial registration number: NCT02730663.)

      Graphical abstract

      Abbreviations:

      AE (adverse event), LAMS (lumen-apposing metallic stent), PFC (pancreatic fluid collection)
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      References

        • Banks P.A.
        • Bollen T.L.
        • Dervenis C.
        • et al.
        Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus.
        Gut. 2013; 62: 102-111
        • Yusuf T.E.
        • Baron T.H.
        Endoscopic transmural drainage of pancreatic pseudocysts: results of a national and an international survey of ASGE members.
        Gastrointest Endosc. 2006; 63: 223-227
        • Varadarajulu S.
        • Lopes T.L.
        • Wilcox C.M.
        • et al.
        EUS versus surgical cyst-gastrostomy for management of pancreatic pseudocysts.
        Gastrointest Endosc. 2008; 68: 649-655
        • Song T.J.
        • Lee S.S.
        Endoscopic drainage of pseudocysts.
        Clin Endosc. 2014; 47: 222-226
        • Lee B.U.
        • Song T.J.
        • Lee S.S.
        • et al.
        Newly designed, fully covered metal stents for endoscopic ultrasound (EUS)-guided transmural drainage of peripancreatic fluid collections: a prospective randomized study.
        Endoscopy. 2014; 46: 1078-1084
        • Teoh A.Y.
        • Ng E.K.
        • Chan S.M.
        • et al.
        Ex vivo comparison of the lumen-apposing properties of EUS-specific stents (with video).
        Gastrointest Endosc. 2016; 84: 62-68
        • Binmoeller K.F.
        • Shah J.
        A novel lumen-apposing stent for transluminal drainage of nonadherent extraintestinal fluid collections.
        Endoscopy. 2011; 43: 337-342
        • Moon J.H.
        • Choi H.J.
        • Kim D.C.
        • et al.
        A newly designed fully covered metal stent for lumen apposition in EUS-guided drainage and access: a feasibility study (with videos).
        Gastrointest Endosc. 2014; 79: 990-995
        • Shah R.J.
        • Shah J.N.
        • 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
        • Gornals J.B.
        • 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
        • Bang J.Y.
        • 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
        • Fabbri C.
        • Luigiano C.
        • Marsico M.
        • et al.
        A rare adverse event resulting from the use of a lumen-apposing metal stent for drainage of a pancreatic fluid collection: “the buried stent”.
        Gastrointest Endosc. 2015; 82: 585-587
        • Sanchez-Ocana R.
        • Penas-Herrero I.
        • Santos-Santamarta F.
        • et al.
        EUS-guided removal of a buried lumen-apposing metal stent caused by delayed inward migration after cyst-gastrostomy.
        Gastrointest Endosc. 2017; 86: 229
        • Cho D.H.
        • Jo S.J.
        • Lee J.H.
        • et al.
        Feasibility and safety of endoscopic ultrasound-guided gallbladder drainage using a newly designed lumen-apposing metal stent.
        Surg Endosc. 2019; 33: 2135-2141
        • Cahen D.
        • Rauws E.
        • Fockens P.
        • et al.
        Endoscopic drainage of pancreatic pseudocysts: long-term outcome and procedural factors associated with safe and successful treatment.
        Endoscopy. 2005; 37: 977-983
        • Arvanitakis M.
        • Delhaye M.
        • Bali M.A.
        • et al.
        Pancreatic-fluid collections: a randomized controlled trial regarding stent removal after endoscopic transmural drainage.
        Gastrointest Endosc. 2007; 65: 609-619