Severe bleeding is a rare event in patients receiving lumen-apposing metal stents for the drainage of pancreatic fluid collections

Zeißig, Sebastian; Sulk, Stefan; Brueckner, Stefan; Matthes, Katja; Hohmann, M; Reichel, Stephanie; Ellrichmann, Mark; Arlt, Alexander; Will, Uwe; Hampe, Jochen

doi:10.1136/gutjnl-2018-316581

Cited by 14 publications

(11 citation statements)

References 6 publications

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“…However, 75% (3/4) bleeding cases in LAMS of our study was observed at about 1 week after procedure, indicating that early bleeding might be more frequent than expected. To confirm this finding, studies reporting the time and outcomes of bleeding were systemically retrieved in Table S1 and summarized in Table . Generally, bleeding was reported in 34 patients from eight studies during the first 3 weeks, which was reported in only 16 patients from six studies 3 weeks after intervention.…”

Section: Discussionmentioning

confidence: 90%

Comparison of three different stents for endoscopic ultrasound‐guided drainage of pancreatic fluid collection: A large retrospective study

Wang

Zhao

Meng

et al. 2019

J of Gastro and Hepatol

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Background and Aim Endoscopic transmural drainage has been recognized as the first‐line treatment for pancreatic fluid collection (PFC). Currently, three different types of stents have been extensively applied, including double pigtail plastic stent (PS), fully covered self‐expanding metal stent (FCSEMS), and novel lumen‐apposing metal stent (LAMS). Nonetheless, limited data are available about the comparison among them in terms of their clinical outcomes and safety for endoscopic ultrasound‐guided drainage of PFC. Methods The current retrospective study was carried on 160 PFC patients undergoing endoscopic ultrasound‐guided drainage from 2010 to 2018 at a single tertiary care center. Patients were divided into three groups based on different drainage ways: drainage using PS, FCSEMS, or LAMS. Results A total of 160 PFC patients (104 male and 56 female) were analyzed in this retrospective study, including 62 patients drained with PS, 28 with FCSEMS, and 70 with LAMS. Typically, the technical success (93.5% vs 96.4% vs 94.3%, P = 1.000) and treatment success rates (84.6% vs 85.2% vs 89.2%, P = 0.763) were similar between PS, FCSEMS, and LAMS. With regard to major adverse events, four patients (FCSEMS: n = 2 and LAMS: n = 2) with pseudoaneurysms developed severe bleeding; among them, 75% (3/4) of patients were observed within 2 weeks after intervention, and two patients in LAMS group died. Conclusions There are no significant differences in the clinical outcomes of PFC patients treated with PS, FCSEMS, or LAMS. Nonetheless, severe (or even fatal) bleeding may occur at the early stage after metal stent placement, which should be paid particular attention to.

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Section: Discussionmentioning

confidence: 90%

Comparison of three different stents for endoscopic ultrasound‐guided drainage of pancreatic fluid collection: A large retrospective study

Wang

Zhao

Meng

et al. 2019

J of Gastro and Hepatol

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“…Currently, endoscopic drainage has become the first-line approach for treating symptomatic WON, comparing favorably with minimally invasive surgical intervention[ 20 - 22 ]. Although traditional endoscopic drainage involves stenting of some sort to ensure a patent fistula and effective drainage, the inefficiency of plastic stents[ 10 , 11 ], the complications (especially delayed bleeding) that may develop[ 13 , 14 , 17 ], and cost[ 13 ] of LAMS devices are problematic. Liu et al [ 19 ] reported the emergency use of endoscopic gastric mural fenestration under EUS and CT guidance to treat a recurrent pancreatic pseudocyst.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic gastric fenestration of debriding pancreatic walled-off necrosis: A pilot study

Liu¹,

Wang

et al. 2020

WJG

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BACKGROUND Endoscopic drainage of walled-off necrosis (WON) is still a challenge due to stent-associated problems. We explored endoscopic gastric fenestration (EGF) as an innovative alternative intervention. AIM To assess the feasibility, efficacy and safety of EGF for WON. METHODS Between March 2019 and March 2020, five patients with symptomatic WON in close contact with the stomach wall were treated by EGF. Endoscopic ultrasound (EUS) was used to select appropriate sites for gastric fenestration, which then proceeded layer by layer as in endoscopic submucosal dissection. Both the stomach muscularis propria and pseudocyst capsule were penetrated. Fenestrations were expanded up to 1.5-3 cm for drainage or subsequent necrosectomy. RESULTS EGF failed in Case 1 due to nonadherence of WON to the gastric wall. EGF was successfully implemented in the other four cases by further refinement of fenestration site selection according to computed tomography, endoscopy and EUS features. The average procedure time for EGF was 124 min (EUS assessment, 32.3 min; initial fenestration, 28.8 min; expanded fenestration, 33 min), and tended to decrease as experience gradually increased. The diameter of the fenestration site was 1.5-3 cm, beyond the caliber of a lumen-apposing metal stent (LAMS), to ensure effective drainage or subsequent necrosectomy. Fenestration sites showed surprising capacity for postoperative self-healing within 1-3 wk. No EGF-related complications were seen. WON disappeared within 3 wk after EGF. In Case 3, another separate WON, treated by endoscopic LAMS drainage, recurred within 4 d after LAMS removal due to stent-related hemorrhage, and resolved slowly over almost 3 mo. No recurrences were observed in the five patients. CONCLUSION EGF is an innovative and promising alternative intervention for WON adherent to the gastric wall. The challenge resides in the gauging of actual adherence and in selecting appropriate fenestration sites.

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“…Recently, various studies assessing LAMS have published disparate safety findings, with overall adverse event (AE) rates ranging from 0 % to 50 % 9 10 11 12 . Specific adverse events (AEs) such as bleeding also have widely varying reported rates, ranging from 0 % to 25 %, with some studies (including those with small sample size) suggesting a higher rate of bleeding with LAMS compared to DPPS 9 13 14 15 16 . In addition, the relatively large variations in reported complication rates may be partially attributable to their different definitions 17 .…”

Section: Introductionmentioning

confidence: 99%

Safety and efficacy of lumen-apposing metal stents versus plastic stents to treat walled-off pancreatic necrosis: systematic review and meta-analysis

et al. 2020

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Background and study aims Lumen-apposing metal stents (LAMS) are increasingly used for drainage of walled-off pancreatic necrosis (WON). Recent studies suggested greater adverse event (AE) rates with LAMS for WON. We conducted a systematic review and meta-analysis to compare the safety and efficacy of LAMS with double-pigtail plastic stents (DPPS) for endoscopic drainage of WON. The primary aim was to evaluate stent-related AEs. Methods In October 2019, we searched the Ovid (Embase, MEDLINE, Cochrane) and Scopus databases for studies assessing a specific LAMS or DPPS for WON drainage conducted under EUS guidance. Safety outcomes were AE rates of bleeding, stent migration, perforation, and stent occlusion. Efficacy outcomes were WON resolution and number of procedures needed to achieve resolution. A subanalysis including non-EUS-guided cases was performed. Results Thirty studies including one randomized controlled trial (total 1,524 patients) were analyzed. LAMS were associated with similar bleeding (2.5 % vs. 4.6 %, P = 0.39) and perforation risk (0.5 % vs. 1.1 %, P = 0.35) compared to DPPS. WON resolution (87.4 % vs. 87.5 %, P = 0.99), number of procedures to achieve resolution (2.09 vs. 1.88, P = 0.72), stent migration (5.9 % vs. 6.8 %, P = 0.79), and stent occlusion (3.8 % vs. 5.2 %, P = 0.78) were similar for both groups. Inclusion of non-EUS-guided cases led to significantly higher DPPS bleeding and perforation rates. Conclusions LAMS and DPPS were associated with similar rates of AEs and WON resolution when limiting analysis to EUS-guided cases. Higher bleeding rates were seen in historical studies of DPPS without EUS guidance. Additional high-quality studies of WON treatment using consistent outcome definitions are needed.

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Severe bleeding is a rare event in patients receiving lumen-apposing metal stents for the drainage of pancreatic fluid collections

Cited by 14 publications

References 6 publications

Comparison of three different stents for endoscopic ultrasound‐guided drainage of pancreatic fluid collection: A large retrospective study

Comparison of three different stents for endoscopic ultrasound‐guided drainage of pancreatic fluid collection: A large retrospective study

Endoscopic gastric fenestration of debriding pancreatic walled-off necrosis: A pilot study

Safety and efficacy of lumen-apposing metal stents versus plastic stents to treat walled-off pancreatic necrosis: systematic review and meta-analysis

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