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Endosonography-guided transmural drainage of pancreatic fluid collections: comparative outcomes by stent type

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Abstract

Background

Pancreatic fluid collections (PFCs), including walled-off necrosis (WON), are commonly described sequelae of pancreatitis. Endosonography-guided PFC drainage can be performed using plastic stents (PS), fully covered self-expanding metal stents (FCSEMS), or lumen-apposing metal stents (LAMS). We performed a retrospective study comparing clinical outcomes and adverse events by stent type.

Methods

In this historical cohort, patients undergoing endosonography-guided PFC drainage from 2010 to 2019 were divided into groups: those treated with (1) PS, (2) FCSEMS, and (3) LAMS. Clinical success, the primary outcome, was defined as complete resolution or size reduction of ≥ 50%, with resolution of symptoms and no reintervention required at 3 months following the index procedure. Adverse events (AEs) and procedure times were also evaluated.

Results

Fifty-eight patients were included. Procedure times were significantly shorter with LAMS (21.4 ± 10.8 min versus 53.0 ± 24.4 min for FCSEMS and 65.9 ± 23.4 min for PS, p < 0.001). Clinical success rates for WON were higher with LAMS compared with FCSEMS (95.7% vs 66.7%, respectively; p = 0.04). For all PFCs, treatment with LAMS trended towards higher clinical success rates compared with PS and FCSEMS (96.3% vs 81.8% vs 77.8%, respectively; p = 0.14). Early AEs (within 1 week) occurred at significantly lower rates in the LAMS group compared to PS and FCSEMS (0% vs 33.3% vs 10.6%, respectively; p = 0.006), as did late AEs (7.4% vs 44.5% vs 40%, respectively; p = 0.01).

Conclusions

LAMS is superior in terms of WON clinical success, favorable in terms of lower adverse event profile, and shorter in terms of procedural time compared to FCSEMS and PS. LAMS can be considered as an initial approach for WON, given that clinical success in WON is lower when using PS or FCSEMS, though more high-quality data are needed.

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Abbreviations

AE:

Adverse event

AP:

Acute pancreatitis

ANOVA:

Analysis of variance

DEN:

Direct endoscopic necrosectomy

EUS:

Endoscopic ultrasound

FCSEMS:

Fully covered self-expanding metal stents

LAMS:

Lumen-apposing metal stents

PFC:

Pancreatic fluid collection

PS:

Plastic stents

WON:

Walled-off necrosis

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Author notes

  1. Ahmed Kayal and Niloofar Taghizadeh have contributed equally to this work.

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, University of Calgary, TRW 6D19, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada

    Ahmed Kayal, Takuya Ishikawa, Emmanuel Gonzalez-Moreno, Sydney Bass, Martin J. Cole, Steven J. Heitman, Rachid Mohamed, Christian Turbide & Nauzer Forbes

  2. Department of Community Health Sciences, University of Calgary, Calgary, Canada

    Ahmed Kayal, Emmanuel Gonzalez-Moreno, Steven J. Heitman & Nauzer Forbes

  3. Forzani & MacPhail Colon Cancer Screening Centre, University of Calgary, Calgary, Canada

    Niloofar Taghizadeh & Steven J. Heitman

  4. Department of Gastroenterology, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Takuya Ishikawa

  5. Division of Gastroenterology, Internal Medicine Department, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México

    Emmanuel Gonzalez-Moreno

  6. Division of Gastroenterology and Hepatology, McGill University, Montreal, Canada

    Yen-I Chen

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Contributions

Conception and design: AK, NT, RM, and NF. Analysis and/or interpretation of the data: all authors. Drafting of the article: AK, NT, and NF. Critical revision of the article for important intellectual content: all authors. Final approval of the article: all authors.

Corresponding author

Correspondence to Nauzer Forbes.

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Disclosures

Dr. Forbes is a consultant for Boston Scientific and has received research funding and speaker’s fees from Pentax Medical. Dr. Mohamed is a consultant for Boston Scientific. Dr. Chen is a consultant for Boston Scientific. Drs. Kayal, Taghizadeh, Ishikawa, Gonzalez-Moreno, Bass, Cole, Heitman, and Turbide have no conflicts of interest or financial ties to disclose.

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Kayal, A., Taghizadeh, N., Ishikawa, T. et al. Endosonography-guided transmural drainage of pancreatic fluid collections: comparative outcomes by stent type. Surg Endosc 35, 2698–2708 (2021). https://doi.org/10.1007/s00464-020-07699-x

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