Endoscopy 2019; 51(08): 715-721
DOI: 10.1055/a-0924-5591
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Safety and efficacy of the use of lumen-apposing metal stents in the management of postoperative fluid collections: a large, international, multicenter study

Juliana Yang
1  Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
,
Jeremy H. Kaplan
2  Division of Digestive and Liver Disease, Columbia University Medical Center, New York, New York, USA
,
Amrita Sethi
2  Division of Digestive and Liver Disease, Columbia University Medical Center, New York, New York, USA
,
Enad Dawod
3  Division of Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York, USA
,
Reem Z. Sharaiha
3  Division of Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York, USA
,
Austin Chiang
4  Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
,
Thomas Kowalski
4  Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
,
Jose Nieto
5  Division of Gastroenterology and Hepatology, Borland Groover Clinic, Jacksonville, Florida, USA
,
Ryan Law
6  Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA
,
Hazem Hammad
7  Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
,
Sachin Wani
7  Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
,
Mihir S. Wagh
7  Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
,
Dennis Yang
8  Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, USA
,
Peter V. Draganov
8  Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, USA
,
Ahmed Messallam
9  Division of Digestive Disease, Emory University School of Medicine, Atlanta, Georgia, USA
,
Qiang Cai
9  Division of Digestive Disease, Emory University School of Medicine, Atlanta, Georgia, USA
,
Vladimir Kushnir
10  Division of Gastroenterology, Washington University in Saint Louis, St. Louis, Missouri, USA
,
Natalie Cosgrove
10  Division of Gastroenterology, Washington University in Saint Louis, St. Louis, Missouri, USA
,
Ali Mir Ahmed
11  Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
,
Andrea Anderloni
12  Division of Gastroenterology, Digestive Endoscopy Unit, Humanitas Research Hospital, Rozzano, Milan, Italy
,
Douglas G. Adler
13  Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA
,
Nikhil A. Kumta
14  Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
,
Satish Nagula
14  Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
,
Frank P. Vleggaar
15  Division of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
,
Shayan Irani
16  Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA
,
Carlos Robles-Medranda
17  Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas, University Hospital OMNI, Guayaquil, Ecuador
,
Abdul Hamid El Chafic
18  Division of Gastroenterology, Ochsner Medical Center, New Orleans, Louisiana, USA
,
Rishi Pawa
19  Division of Gastroenterology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
,
Olaya Brewer
1  Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
,
Omid Sanaei
1  Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
,
Mohamad Dbouk
1  Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
,
Vikesh K. Singh
1  Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
,
Vivek Kumbhari
1  Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
,
Mouen A. Khashab
1  Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
› Author Affiliations
Further Information

Publication History

submitted: 28 November 2018

accepted after revision: 10 April 2019

Publication Date:
07 June 2019 (eFirst)

Abstract

Background Multiple studies have examined the use of lumen-apposing metal stents (LAMSs) for the drainage of peripancreatic fluid collections. Data on the use of LAMSs for postoperative fluid collections (POFCs) are scarce. POFCs may lead to severe complications without appropriate treatment. We aimed to study the outcomes (technical success, clinical success, rate/severity of adverse events, length of stay, recurrence) of the use of LAMSs for the drainage of POFCs.

Methods This international, multicenter, retrospective study involved 19 centers between January 2012 and October 2017. The primary outcome was clinical success. Secondary outcomes included technical success and rate/severity of adverse events using the ASGE lexicon.

Results A total of 62 patients were included during the study period. The most common etiology of the POFCs was distal pancreatectomy (46.8 %). The mean (standard deviation) diameter was 84.5 mm (30.7 mm). The most common indication for drainage was infection (48.4 %) and transgastric drainage was the most common approach (82.3 %). Technical success was achieved in 60/62 patients (96.8 %) and clinical success in 57/62 patients (91.9 %) during a median (interquartile range) follow-up of 231 days (90 – 300 days). Percutaneous drainage was needed in 8.1 % of patients. Adverse events occurred intraoperatively in 1/62 patients (1.6 %) and postoperatively in 7/62 (11.3 %). There was no procedure-related mortality.

Conclusion This is the largest study on the use of LAMSs for POFCs. It suggests good clinical efficacy and safety of this approach. The use of LAMSs in the management of POFCs is a feasible alternative to percutaneous and surgical drainage.