Large-caliber metal stents versus plastic stents for the management of pancreatic walled-off necrosis

Dayyeh, Barham K. Abu; Mukewar, Saurabh; Majumder, Shounak; Zaghlol, Raja; Vargas, Eric J.; Bazerbachi, Fateh; Levy, Michael J.; Baron, Todd H.; Gostout, Christopher J.; Petersen, Bret T.; Martin, John A.; Gleeson, Ferga C.; Pearson, Randall K.; Chari, Suresh T.; Vege, Santhi Swaroop; Topazian, Mark D.

doi:10.1016/j.gie.2017.04.032

Cited by 70 publications

(47 citation statements)

References 19 publications

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“…Because plastic stents were used before SEMS, much of earlier literature related to their use. Large-diameter SEMS (15 mm diameter) appear to provide better egress of necrotic material than plastic stents, 21 while also allowing for endoscopic access to perform necrosectomy. The newer lumen-apposing metal stents (LAMS), a type of SEMS, are being used increasingly, as their short length (1 cm) is more suitable than commercially available covered esophageal SEMS (usually no shorter than 6-7 cm).…”

Section: Endoscopic Necrosectomymentioning

confidence: 99%

American Gastroenterological Association Clinical Practice Update: Management of Pancreatic Necrosis

et al. 2020

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Section: Endoscopic Necrosectomymentioning

confidence: 99%

American Gastroenterological Association Clinical Practice Update: Management of Pancreatic Necrosis

et al. 2020

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“…As compared to the conventional metal stents, the use of LCMS is associated with superior outcomes in terms of number of procedures required for the resolution of WON [26]. Similarly, better clinical outcomes and reduced requirement of endoscopic necrosectomy have been found with the use of metal stents as compared to plastic stents in several studies [27][28][29][30].…”

Section: Endoscopic Transmural Drainage: Choice Of Stentsmentioning

confidence: 97%

Endoscopic Management of Pancreatic Fluid Collections: An Update

Nabi¹,

Reddy²

2019

Pancreatitis

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Pancreatic fluid collections (PFCs) are a frequent complication of acute pancreatitis. PFCs have been categorized according to their content and duration after an episode of pancreatitis. Acute collections (<4 week) and asymptomatic late collections (>4 weeks) can be usually managed conservatively. Late collections including walled off necrosis (WON) and pancreatic pseudocysts (PP) have a well-defined wall. Consequently, it is easier and safer to drain these collections when required. The most common indication to drain PFCs is infection and the available means of drainage include surgical, endoscopic, and percutaneous. Open surgical interventions carry a high risk of morbidity and mortality. Therefore, in the current era, a step up approach is preferred to minimize morbidity over the more aggressive surgical treatments. Endoscopic step-up approach is effective and favored over minimally invasive surgical or percutaneous drainage due to reduced risk of organ failure and external pancreatic fistula. However, the approach to PFCs should be individualized for optimal outcomes. A small subgroup of patients does not respond to endotherapy or percutaneous interventions and requires open surgical debridement. Similarly, not all PFCs are amenable to endoscopic drainage and demand alternative modalities like percutaneous or minimally invasive surgical drainage.

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“…In a retrospective analysis involving 133 patients who underwent endoscopic ultrasound-guided transmural drainage using either double pigtail plastic stents (Figure 5a) or lumen-apposing metal stents (Figure 5b), it was shown that patients who received lumen-apposing metal stents had significantly better outcomes as compared with double pigtail plastic stents in terms of number of endoscopic sessions (1.5 vs. 2.7), adverse events (5.6 vs. 36.1%), need for surgery (2.7 vs. 26.2%), length of hospital stay (4.1 days vs. 8 days) and overall clinical success (94 vs. 73.7% [24]. Regarding the caliber of the stent utilized, it has been reported that a large-caliber fully covered metal stent ( Figure 6) is significantly superior in terms of successful resolution of WON without the need for a direct endoscopic necrosectomy (60 vs. 30.8%) [25]; regarding metal or plastic stents, a systematic review showed that metal stents are superior in terms of overall WON resolution and fewer direct endoscopic necrosectomy sessions are necessary [26]. It should be pointed out that, with the increased availability and use of metal stents in managing WON, it has been reported that when using these devices, there is a higher rate of bleeding as compared with double pigtail plastic stents [27,28].…”

Section: Endoscopic Treatment: Types Of Stents Which Can Be Used and mentioning

confidence: 97%

Walled-Off Necrosis in Acute Pancreatitis: Clinical and Therapeutic Implications

Pezzilli¹

2019

obm hg

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The severe forms of acute pancreatitis may be characterized by the presence of walled-off necrosis (WON), previously called by other names: organized pancreatic necrosis, necroma, pancreatic sequestration, pseudocyst associated with necrosis and subacute pancreatic necrosis. It is defined as a mature, encapsulated collection of pancreatic and/or peripancreatic necrosis that has developed a well-defined inflammatory wall. WON usually occurs more than 4 weeks after the onset of necrotizing pancreatitis. However, it derives from the necrotic pancreatic parenchyma and/or necrotic peripancreatic tissues, and may be sterile or infected, single or multiple, and present at sites distant from the pancreas. In this paper, the current data regarding WON as to its definition, diagnosis and treatment will be narratively reviewed.

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Large-caliber metal stents versus plastic stents for the management of pancreatic walled-off necrosis

Cited by 70 publications

References 19 publications

American Gastroenterological Association Clinical Practice Update: Management of Pancreatic Necrosis

American Gastroenterological Association Clinical Practice Update: Management of Pancreatic Necrosis

Endoscopic Management of Pancreatic Fluid Collections: An Update

Walled-Off Necrosis in Acute Pancreatitis: Clinical and Therapeutic Implications

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