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DOI: 10.1055/s-0038-1637416
EUS-GUIDED DRAINAGE OF PERIPANCREATIC FLUID COLLECTIONS WITH LUMEN-APPOSING METAL STENTS: PRELIMINARY RESULTS OF A PROSPECTIVE MULTICENTER STUDY IN GREECE
Publication History
Publication Date:
27 March 2018 (online)
Aims:
Endoscopic ultrasound (EUS)-guided transmural drainage using lumen-apposing metal stents (LAMSs) is a promising approach for symptomatic peripancreatic fluid collections (PFCs). We aim to assess their use in terms of technical success, clinical success and adverse events (AEs).
Methods:
Preliminary results of a prospective study in 5 tertiary centers evaluating EUS-guided drainage of symptomatic PFCs with LAMSs (Hot Axios, Boston Scientific Corporation, Marlborough, MA, USA).
Results:
Twenty patients (18 male, median age 57.5 years) with symptomatic PFCs (13 pseudocysts, 6 walled-off necroses, 1 gallbladder empyema), 12 (range, 6.4 – 16.3)cm in median diameter, are included. Twenty LAMS (10 mm, n = 16; 15 mm, n = 4) were placed in a median duration of 10 (range, 3 – 30)min. under EUS-guidance using transgastric (n = 18) or transbulbar (n = 2) approach. Technical and initial clinical success was achieved in all procedures. Three (15%) early AEs occurred, including 1 bleeding managed with plastic stent placed within the LAMS, 1 stent occlusion by debris treated by balloon dilation and snare necrosectomy and 1 peritonitis managed conservatively. LAMSs were left in place for a median of 7 (range, 2 – 60) weeks. One stent migrated spontaneously into the intestine, 1 patient died of cholangiocarcinoma prior to LAMS removal and 1 was lost to follow-up. LAMSs were successfully removed using snare and/or forceps in 16/17 of the remaining patients. During removal, partial epithelial overgrowth was observed in 2 cases, while significant bleeding treated with embolization was appreciated in one. A case of buried stent syndrome with small bowel obstruction was managed surgically. Two collections recurred after a median of 10 months follow-up.
Conclusions:
EUS-guided drainage of symptomatic PFCs with LAMSs is technically feasible and effective. Adverse events both during placement and removal may occur, necessitating endoscopist's awareness.