Endoscopy 2015; 47(01): 47-55
DOI: 10.1055/s-0034-1377966
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic ultrasound-guided placement of plastic vs. biflanged metal stents for therapy of walled-off necrosis: a retrospective single-center series

Shuntaro Mukai
1  Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
,
Takao Itoi
1  Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
,
Todd H. Baron
2  University of North Carolina, Chapel Hill, North Carolina, United States
,
Atsushi Sofuni
1  Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
,
Fumihide Itokawa
1  Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
,
Toshio Kurihara
1  Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
,
Takayoshi Tsuchiya
1  Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
,
Kentaro Ishii
1  Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
,
Shujiro Tsuji
1  Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
,
Nobuhito Ikeuchi
1  Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
,
Reina Tanaka
1  Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
,
Junko Umeda
1  Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
,
Ryosuke Tonozuka
1  Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
,
Mitsuyoshi Honjo
1  Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
,
Takuji Gotoda
1  Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
,
Fuminori Moriyasu
1  Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
,
Ichiro Yasuda
3  First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
› Author Affiliations
Further Information

Publication History

submitted 17 January 2014

accepted after revision 07 July 2014

Publication Date:
29 September 2014 (online)

Background and study aims: Recently, a novel fully covered and biflanged metal stent (BFMS) dedicated to the drainage of walled-off necrosis (WON) was developed. The aim of this study was to retrospectively evaluate the safety, efficacy, and cost performance of drainage of WON using the novel BFMS compared with a traditional plastic stent.

Patients and methods: A total of 70 patients with symptomatic WON were treated under endoscopic ultrasound (EUS) guidance. Initial drainage was conducted using the single gateway technique with placement of one or more plastic stents or a single BFMS. If drainage was unsuccessful, direct endoscopic necrosectomy (DEN) was performed.

Results: There were no statistically significant differences in rates of technical success, clinical success, and adverse events between plastics stents and BFMS, despite the size of WON in the BFMS group being significantly larger than that in the plastic stent group (105.6 vs. 77.1 mm; P = 0.003). The mean procedure times for the first EUS-guided drainage and for re-intervention were significantly shorter in the BFMS group than in the plastic stent group (28.8 ± 7.1 vs. 42.6 ± 14.2, respectively, for drainage, P < 0.001; and 34.9 ± 8.5 vs. 41.8 ± 7.6, respectively, for re-intervention, P < 0.001). There was no statistically significant difference in the total cost between plastic stent and BFMS use in the treatment of WON ($ 5352 vs. $ 6274; P = 0.25).

Conclusions: Plastic stents and BFMS were safe and effective for the treatment of WON. In particular, BFMS placement appeared to be preferable for initial EUS-guided drainage and additional re-intervention (e. g. DEN) as it reduced the procedure time. Prospective randomized controlled trials are warranted.