Endoscopy 2018; 50(04): S39
DOI: 10.1055/s-0038-1637142
ESGE Days 2018 oral presentations
20.04.2018 – EUS: pancreas therapeutic
Georg Thieme Verlag KG Stuttgart · New York

LUMEN-APPOSING FULLY-COVERED SELF-EXPANDABLE METAL STENTS VERSUS BILIARY FULLY-COVERED SELF-EXPANDABLE METAL STENTS FOR EUS-GUIDED DRAINAGE OF PANCREATIC FLUID COLLECTIONS: WHICH METAL STENT SHOULD BE USED?

E Vázquez Sequeiros
1   Hospital Universitario Ramón y Cajal. IRYCIS. Universidad de Alcalá, Gastroenterology and Hepatology, Madrid, Spain
,
AG García de Paredes
1   Hospital Universitario Ramón y Cajal. IRYCIS. Universidad de Alcalá, Gastroenterology and Hepatology, Madrid, Spain
,
JR Foruny Olcina
1   Hospital Universitario Ramón y Cajal. IRYCIS. Universidad de Alcalá, Gastroenterology and Hepatology, Madrid, Spain
,
J Ángel González Martín
1   Hospital Universitario Ramón y Cajal. IRYCIS. Universidad de Alcalá, Gastroenterology and Hepatology, Madrid, Spain
,
F Gonzalez Panizo
2   Hospital Universitario Quiron de Madrid, Madrid, Spain
,
D Juzgado
2   Hospital Universitario Quiron de Madrid, Madrid, Spain
,
A Albillos Martínez
1   Hospital Universitario Ramón y Cajal. IRYCIS. Universidad de Alcalá, Gastroenterology and Hepatology, Madrid, Spain
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

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Aims:

EUS-guided drainage has become first line treatment of encapsulated pancreatic fluid collections (PFC). It is not well established which stent should be used.

Aim: To compare the effectiveness and safety of biliary fully-covered self-expandable metal stents (BFCSEMS) versus lumen-apposing fully covered self-expandable metal stents with electrocautery (LAMS).

Methods:

Retrospective comparative study. Consecutive patients from 2 centers with encapsulated and symptomatic PFC (pseudocysts or walled-off necrosis) managed by EUS-guided drainage. Period: April 2008-March 2017. Study group: Patients drained with LAMS (Hot-AxiosTM 15 × 10 mm), control group: BFCSEMS (WallflexTM 10 × 60 mm). Technical success (ability to access and drain a PFC by placement of transmural stent), time of procedure, adverse events and clinical success (reduction of ≥50% of PFC'size and improvement of symptoms) were evaluated.

Results:

30 patients were drained using LAMS and 60 with BFCSEMS. Patient and PFC characteristics were comparable (p > 0.05): sex (male 66 vs. 67%), age (61.3 ± 10.2 vs. 63.1 ± 9.8 years), cause of pancreatitis (gallstone/alcohol 70/30% vs. 75/25%), chronic pancreatitis (23% vs. 17%), type of PFC (pseudocyst/walled-off necrosis 47/53% vs. 53/47%), size (74.6 ± 14.5 vs. 73.9 ± 11.9 mm), time since diagnosis (45.7 ± 8.2 mm vs. 43.8 ± 7.3 days), previous failed drainage (13% vs. 10%) and necrosectomy (3.3% vs. 1.6%). Use of coaxial double pigtail plastic stent and nasocystic lavage catheter was significantly lower in LAMS grou p (33% vs. 100%, p < 0.0001 and 13% vs. 58%, p < 0.0001). Technical success was 100% in both groups. Procedure time was < 30 minutes in all patients drained with LAMS and over 30 minutes in all patients drained with BFCSEMS (p = 0.0001). Clinical success was significantly higher and occurrence of adverse events significantly lower in LAMS group (96% vs. 82%, p = 0.04 and 4% vs. 18%, p = 0.04).

Conclusions:

This study suggests that LAMS are more effective and safer than BFCSEMS in EUS-guided drainage of PFC. Time procedure with LAMS was significantly lower.