Metal versus plastic for pancreatic pseudocyst drainage: clinical outcomes and success

Sharaiha, Reem Z.; DeFilippis, Ersilia M.; Kedia, Prashant; Gaidhane, Monica; Boumitri, Christine; Lim, Huei-Wen; Han, Eugene; Singh, Harkarit; Prasad, Anand; Kowalski, Thomas E.; Loren, David E.; Kahaleh, Michel; Siddiqui, Ali A.

doi:10.1016/j.gie.2015.02.035

Cited by 117 publications

(78 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A recent meta analysis that included 698 patients found no difference in treatment success, adverse events, or recurrence rates between pseudocysts drained with multiple plastic stents vs metal stents [18,58] . However, a more recent study by Sharaiha et al [59] of 230 patients found that pseudocysts drained with plastic stents were 2.5 times more likely to report adverse events than when FCSEMS were used. Similarly, complete pseudocyst resolution was 89% with plastic stents compared to 98% with FCSEMS.…”

Section: Fully Covered Self-expanding Metal Stentsmentioning

confidence: 99%

See 1 more Smart Citation

Management of pancreatic fluid collections: A comprehensive review of the literature

Tyberg¹,

Karia²,

Gabr³

et al. 2016

WJG

Self Cite

169

154

View full text Add to dashboard Cite

Pancreatic fluid collections (PFCs) are a frequent complication of pancreatitis. It is important to classify PFCs to guide management. The revised Atlanta criteria classifies PFCs as acute or chronic, with chronic fluid collections subdivided into pseudocysts and walled-off pancreatic necrosis (WOPN). Establishing adequate nutritional support is an essential step in the management of PFCs. Early attempts at oral feeding can be trialed in patients with mild pancreatitis. Enteral feeding should be implemented in patients with moderate to severe pancreatitis. Jejunal feeding remains the preferred route of enteral nutrition. Symptomatic PFCs require drainage; options include surgical, percutaneous, or endoscopic approaches. With the advent of newer and more advanced endoscopic tools and expertise, and an associated reduction in health care costs, minimally invasive endoscopic drainage has become the preferable approach. An endoscopic ultrasonography-guided approach using a seldinger technique is the preferred endoscopic approach. Both plastic stents and metal stents are efficacious and safe; however, metal stents may offer an advantage, especially in infected pseudocysts and in WOPN. Direct endoscopic necrosectomy is often required in WOPN. Lumen apposing metal stents that allow for direct endoscopic necrosectomy and debridement through the stent lumen are preferred in these patients. Endoscopic retrograde cholangio pancreatography with pancreatic duct (PD) exploration should be performed concurrent to PFC drainage. PD disruption is associated with an increased severity of pancreatitis, an increased risk of recurrent attacks of pancreatitis and long-term complications, and a decreased rate of PFC resolution after drainage. Any pancreatic ductal disruption should be bridged with endoscopic stenting. However, with improving pathophysiologic under standing and improving diagnostic tools, it became clear that a more detailed organizational system was required. More specifically, one that distinguished between collections containing fluid alone vs those arising from necrosis and/or containing solid components. As such, a new classification system was developed known as the revised Atlanta criteria [4] . Similar to the original Atlanta Criteria, PFCs are classified as acute (< 4 wk after the pancreatitis episode) or chronic (> 4 wk after the pancreatitis episode). However, in the revised criteria, both acute and chronic collections are further subdivided based on the presence of necrosis within the collection. Acute collections are divided into: acute peripancreatic fluid collections (APFC) and acute necrotic collections (ANC); chronic fluid collections are divided into: pseudocysts or walledoff pancreatic necrosis (WOPN). These new classifications are important because the treatment and management varies depending on the type of collection. ENTERAL FEEDINGThe first step in the management of any PFC is ensuring adequate nutritional support. In mild to moderate acute pancreatitis, oral feeding can be initiated when...

show abstract

Section: Fully Covered Self-expanding Metal Stentsmentioning

confidence: 99%

“…Sharaiha et al [59] , WOPN (n = 3), recurrence of a fluid collection (n = 2), cutaneous fistula formation (n = 2), or technical failure, persistence of pancreatic pain, colonic obstruction, perforation, and flank abscess (n = 1 each)…”

Section: %mentioning

confidence: 99%

Management of pancreatic fluid collections: A comprehensive review of the literature

Tyberg¹,

Karia²,

Gabr³

et al. 2016

WJG

Self Cite

169

154

View full text Add to dashboard Cite

show abstract

“…Algunos grupos, como el de Varadarajulu y colaboradores, prefieren solo utilizar 2 stents plásticos doble cola de cerdo; este método ha mostrado buenos resultados y bajas tasas de migración porque las colas del stent se enrollan en el quiste. Otros grupos, como el nuestro, prefieren utilizar stent metálico porque, aunque es más costoso, es más fácil de colocar y al permitir un diá-metro de drenaje mayor (10 mm del stent metálico contra 3 mm del stent plástico doble cola de cerdo) permite un mejor y más rápido drenaje de la colección, aunque tiene más riesgo de migración, lo que se podría evitar con la téc-nica de colocar dentro del stent metálico un stent doble cola de cerdo (5,10,23). Esta serie, al igual que todas las que han usado stent metá-lico, muestra una tasa de resolución excelente (>90%) con ninguna recidiva en el seguimiento a 6 meses y menos eventos adversos, por lo que consideramos que es el método actual de elección para drenaje.…”

Section: Discussionunclassified

Drenaje de pseudoquiste pancreático guiado por ecoendoscopia sin fluoroscopia: serie de casos

Zuleta

Mindiola

Morales

2017

Rev. Colomb. Gastroenterol.

View full text Add to dashboard Cite

ResumenIntroducción: los pseudoquistes pancreáticos pueden ser drenados por métodos quirúrgicos, laparoscópicos, percutáneos y endoscópicos. Este último es el más aceptado en la actualidad dado que es más simple y genera menos morbimortalidad; sin embargo, siempre se ha descrito asociado con el uso de la fluoroscopia, lo cual le suma complejidad. En este trabajo presentamos nuestra técnica de drenaje sin fluoroscopia guiado por ecoendoscopia. Materiales y métodos: el objetivo de este trabajo es describir una técnica de drenaje de pseudoquistes pancreá-ticos sin el uso de fluoroscopia y con la guía del ecoendoscopio. Se reporta una serie de casos de 10 pacientes a quienes se les realizó drenaje transgástrico, en los que se describen la técnica, complicaciones y resultados en el seguimiento. Resultados: se incluyeron 10 pacientes consecutivos, 5 pacientes eran mujeres y 5 hombres. El 90% de los casos comprometía el cuerpo del páncreas. Se implantó exitosamente 1 stent (metálico) transmural (cistogastrostomía) solo con guía ecoendoscópica en 9 pacientes; en 1 paciente no se logró liberar el stent, por lo cual se realizó el drenaje por aspiración. Los 9 pacientes a quienes se les implantó stent no presentaron recidiva; la paciente a quien se realizó drenaje por aspiración presentó recidiva a nivel del cuerpo de páncreas. La principal complicación fue la migración del stent hacia la cavidad del pseudoquiste en 1 paciente, el cual requirió segundo tiempo endoscópico para retirarlo. Conclusiones: el drenaje transmural del pseudoquiste pancreático con implante de stent es una técnica mínimamente invasiva, segura y efectiva para el tratamiento del pseudoquiste pancreático. Palabras clavePancreatitis, pseudoquiste, ecoendoscopia, drenaje. AbstractIntroduction: Pancreatic pseudocysts can be drained by surgical, laparoscopic, percutaneous, and endoscopic methods. Endoscopic methods have become the most widely accepted nowadays since they are simpler and generate less morbidity and mortality. They have always been associated with the use of fluoroscopy, which adds complexity. This study presents our drainage technique which is guided by echoendoscopy rather than fluoroscopy. Materials and methods: The objective of this study is to describe a technique for drainage of pancreatic pseudocysts which does not use fluoroscopy to guide the endoscope. Instead, echoendoscopy guides the instrument. We report a case series of 10 patients who underwent transgastric drainage and describe the technique, complications and results during follow-up. Results: Ten consecutive patients, five women and five men, were included in this study. Ninety percent were cases in which the body of the pancreas had been compromised. Cystogastrostomy was successfully performed in nine patients. It consisted of implantation of a transmural metallic stent under single endoscopic guidance. In one patient the stent was not released and aspiration drainage was performed. The nine patients who had stents implanted have presented no recurrences, but the patient who...

show abstract

“…On multivariate analysis, the use of plastic stents was 2.9 times more likely to experience adverse events. 12 Whilst in a systematic review (17 studies, 881 patients), no difference in overall treatment success between patients treated with plastic and metal stents for both pseudocysts (85% vs 83%) and walled-off necrosis (70% vs 78%). Also, there was no difference in the rates of adverse events (16% vs 23%) or recurrence (10% vs 9%) between plastic and metal stents.…”

Section: Plastic Versus Metallic Stent For Pseuodcyst Drainagementioning

confidence: 96%

Development of the Asian EUS Group consensus in pancreatic pseudocyst drainage

Teoh

Dhir²,

Jin

et al. 2016

Int J Gastrointest Interv

View full text Add to dashboard Cite

A B S T R A C TDrainage of pseudocyst and walled-off pancreatic necrosis has traditionally been achieved by surgical means. Recently, there has been a progressive shift in paradigm to performing endoscopic drainage for these conditions. Endoscopic ultrasound (EUS)-guided drainage is the preferred approach for drainage of pancreatic pseudocyst. However, many controversies still exist on the optimal management and wide variations in techniques exist. There is a pressing need for establishment of a consensus for safe practices in EUS-guided pseudocyst drainage.

show abstract

Metal versus plastic for pancreatic pseudocyst drainage: clinical outcomes and success

Cited by 117 publications

References 22 publications

Management of pancreatic fluid collections: A comprehensive review of the literature

Management of pancreatic fluid collections: A comprehensive review of the literature

Drenaje de pseudoquiste pancreático guiado por ecoendoscopia sin fluoroscopia: serie de casos

Development of the Asian EUS Group consensus in pancreatic pseudocyst drainage

Contact Info

Product

Resources

About