Connected or disconnected: What's next after successful transmural drainage of pancreatic fluid collection?

Minaga, Kosuke; Kudo, Masatoshi

doi:10.1111/den.14331

Cited by 1 publication

(1 citation statement)

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“…As Rana et al argued in a letter about this RCT, besides the time after drainage to deploy DPS, other reasons should be considered, such as the amount of functional pancreatic parenchyma left upstream of the disconnection that influences the possibility of PFC recurrence [ 36 ]. DPDS is still an underdiagnosed and challenging condition, many aspects regarding endoscopic management after EUS-drainage are still unanswered, such as the perfect time to replace metal stent to DPS, the clinical impact and safety of long-term indwelling DPS and when to remove or not the indwelling DPS [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

Self-Expandable Metal Stent (SEMS) Versus Lumen-Apposing Metal Stent (LAMS) for Drainage of Pancreatic Fluid Collections: A Randomized Clinical Trial

Santos¹,

Proença²,

Ribeiro³

et al. 2023

Cureus

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Background and aimEndoscopic ultrasound (EUS)-guided drainage is the gold standard approach for the treatment of encapsulated pancreatic collections (EPCs) including pseudocyst and walled-off pancreatic necrosis (WON), and is associated with an equivalent clinical efficacy to surgical drainage with fewer complications and less morbidity. Drainage may be achieved via several types of stents including a fully covered self-expandable metallic stent (SEMS) and lumen-apposing metal stent (LAMS). However, to date there have been no randomized trials to compare these devices. This study aimed to compare the efficacy and safety of the SEMS versus LAMS for EUS-guided drainage of EPCs. MethodsA phase IIB randomized trial was designed to compare the SEMS versus LAMS for the treatment of EPCs. Technical success, clinical success, adverse events (AEs), and procedure time were evaluated. A sample size of 42 patients was determined. ResultsThere was no difference between the two groups in technical (LAMS 80.95% vs 100% SEMS, p=0.107), clinical (LAMS 85.71% vs 95.24% SEMS, p=0.606) or radiological success (LAMS 92.86% vs 83.33% SEMS, p=0.613). There was no difference in AEs including stent migration rate and mortality. The procedure time was longer in the LAMS group (mean time 43.81 min versus 24.43 min, p=0.001). There was also a difference in the number of intra-procedure complications (5 LAMS vs 0 SEMS, p=0.048). ConclusionSEMS and LAMS have similar technical, clinical, and radiological success as well as AEs. However, SEMS has a shorter procedure time and fewer intra-procedure complications compared to non-electrocauteryenhanced LAMS in this phase IIB randomized controlled trial (RCT). The choice of the type of stent used for EUS drainage of EPCs should consider device availability, costs, and personal and local experience.

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Section: Discussionmentioning

confidence: 99%