Safety and Efficacy of Endoscopic Ultrasound-Guided Drainage of Pancreatic Fluid Collections With Lumen-Apposing Covered Self-Expanding Metal Stents

Shah, Raj J.; Shah, Janak N.; Waxman, Irving; Kowalski, Thomas E.; Sánchez-Yagüe, Andrés; Nieto, José; Brauer, Brian C.; Gaidhane, Monica; Kahaleh, Michel

doi:10.1016/j.cgh.2014.09.047

Cited by 229 publications

(168 citation statements)

References 31 publications

Supporting

Mentioning

159

Contrasting

Unclassified

Order By: Relevance

“…Several additional studies validated this initial reported success. A prospective study by Shah et al [61] looking at 33 patients found a technical success rate of 91% with a cyst resolution rate of 93%. Gornals et al [62] looked at 9 patients who underwent pseudocyst drainage with placement of a lumenapposing metal stent (LAMS) and reported a technical success 89%, a pseudocyst resolution rate of 100%, and 1 significant complication (pneumothorax).…”

Section: Novel Lumen-apposing Metal Stentmentioning

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

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: Novel Lumen-apposing Metal Stentmentioning

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

“…32 Recent studies confirm high technical and clinical success rates when using LAMS for drainage of necrotic pancreatic collections. 31,33,34 A recent report comparing outcomes of EUS-guided transmu-A B ral drainage of PCs versus combined transmural-transpapillary drainage found no added benefit with placement of a transpapillary PD stent. 35 This study included 174 patients from 15 centers, of which 79 underwent combined transmural-transpapillary drainage.…”

Section: Pancreatic Fluid Collection Drainagementioning

confidence: 99%

“…31 No head-to-head trials comparing plastic stents versus LAMS in drainage of walled-off pancreatic fluid collections have been reported. A retrospective study showed no difference on clinical outcomes; however, there were significant differences in procedural duration (less when using LAMS) and expense (higher when using LAMS); the economical difference in cost was not significantly different when used in drainage of walled-off pancreatic necrosis.…”

Section: Pancreatic Fluid Collection Drainagementioning

confidence: 99%

Advances in endotherapy in chronic pancreatitis

Coronel

DaVee

Lee

2017

Int J Gastrointest Interv

View full text Add to dashboard Cite

Patients with chronic pancreatitis may develop complications such as chronic debilitating abdominal pain related to neuropathy, pancreatic duct leaks, pseudocysts, pancreatic carcinoma, pancreatic duct calcifications and strictures. Management of mechanical complications of chronic pancreatitis may pose a significant challenge to the interventional endoscopist. The purpose of this manuscript is to explore the latest developments in interventional techniques and to set the stage for future investigations.

show abstract

“…57,58 Several other series confirmed the high success rate in complete cyst resolution and a very low rate of serious complications with the use of these lumen-apposing metallic stents (LAMS). [59][60][61][62] These and other studies collectively demonstrate that EUSguided transmural drainage of PFCs (especially those containing solid necrotic material and often needing several necrosectomy sessions) is feasible and safe. However, even in the most experienced hands, serious and potentially life-threatening complications may occur and a multidisciplinary approach (i.e., endoscopists, interventional radiologists and hepatopancreatobiliary surgeons) is essential for a positive outcome.…”

mentioning

confidence: 99%

Endoscopic ultrasound-guided extraluminal drainage: Novel concepts, challenges and future directions

Madácsy

Kaltsidis²

2017

Int J Gastrointest Interv

View full text Add to dashboard Cite

A B S T R A C TEndoscopic ultrasound (EUS)-guided management of abdominal fluid collections adjacent to the gastroduodenal lumen is a relatively new concept attracting a lot of interest in recent years. The ability of EUS to identify and drain these collections in the same session accounts for the surge of interest in these novel techniques. On the other hand, the complexity of these interventions and associated serious complications has moderated the enthusiasm of novice endoscopists to some extent and reiterated that focused research and technical innovations are needed to make EUS-guided drainage simpler and safer. Self-expandable metallic stents (SEMS) have emerged in the last decade in the endoscopic management of malignant luminal gastrointestinal strictures. The use of SEMS in the management of benign conditions (biliary, pancreatic, and colonic strictures) is also rapidly expanding. Recently, fully-covered (FC)-SEMS have been successfully used for drainage of peripancreatic and pericholecystic fluid collections. Here we will review the existing data and future directions in the use of FC-SEMS for such drainage procedures. We will also review the literature on novel "purpose-made" prostheses, such as the lumen-apposing metallic stents, which aim to address technical problems arising in EUS-guided drainage procedures when conventional SEMS are used. Further development of these and other similar devices may transform EUS-guided drainage procedures from an esoteric concept to "mainstream", first-line intervention.

show abstract

Safety and Efficacy of Endoscopic Ultrasound-Guided Drainage of Pancreatic Fluid Collections With Lumen-Apposing Covered Self-Expanding Metal Stents

Cited by 229 publications

References 31 publications

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

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

Advances in endotherapy in chronic pancreatitis

Endoscopic ultrasound-guided extraluminal drainage: Novel concepts, challenges and future directions

Contact Info

Product

Resources

About