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Gastrointest Endosc. 2015 Dec;82(6):1039-46. doi: 10.1016/j.gie.2015.04.006. Epub 2015 May 23.

EUS-guided drainage of pancreatic fluid collections using a novel lumen-apposing metal stent on an electrocautery-enhanced delivery system: a large retrospective study (with video).

Author information

1
Digestive Endoscopy Unit, Catholic University, Rome, Italy.
2
Department of Surgical Gastroenterology, L Aarhus University Hospital, Aarhus, Denmark.
3
Department of Gastroenterology, Klinikum Neuperlach, Munich, Germany.
4
Endoscopy Unit, Hospital Costa del Sol, Marbella, Spain.
5
Department of Gastroenterology, Municipal Hospital, Gera, Germany.
6
Endoscopy Unit, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy.
7
Endoscopy Unit, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain.
8
Department of Internal Medicine I, Asklepios Klinik Altona, Hamburg, Germany.
9
Department of Medicine II Klinikum rects der Isar, Technical University of Munich, Munich, Germany.
10
Endoscopy Unit, Hospital Clinico San Carlos, Madrid, Spain.
11
Department of Gastroenterology, Kliniken Nagold, Nagold, Germany.
12
Digestive Endoscopy Unit, Hôpital L'Archet 2, University Hospital of Nice, Nice, France.
13
Department Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, Netherlands.

Abstract

BACKGROUND AND AIMS:

A lumen-apposing, self-expanding metal stent incorporated in an electrocautery-enhanced delivery system for EUS-guided drainage of pancreatic fluid collections (PFCs) recently has become available. The aim of this study was to analyze the safety and clinical effectiveness of this newly developed device in this clinical setting.

METHODS:

This was a retrospective analysis of all consecutive patients with PFCs who underwent EUS-guided drainage using the study device in 13 European centers.

RESULTS:

Ninety-three patients with PFCs (80% with complex collections) underwent drainage using the study device. Penetration of the PFC was accomplished directly with the study device in 74.2% of patients, and successful stent placement was accomplished in all but 1 patient, mostly without fluoroscopic assistance. Direct endoscopic necrosectomy (DEN) was carried out in 31 of 52 cases (59.6%) of walled-off necrosis and in 2 of 4 cases (50%) of acute peripancreatic fluid collection. Complete resolution of the PFC was obtained in 86 cases (92.5%), with no recurrence during follow-up. Treatment failure occurred in 6 patients because of persistent infection requiring surgery (n = 3), perforation and massive bleeding caused by the nasocystic drainage catheter (NCDC) (n = 2), and the need for a larger opening to extract large necrotic tissue pieces (n = 1). Major adverse events occurred in 5 patients (perforation and massive bleeding caused by the NCDC in 2 patients, 1 pneumoperitoneum and 1 stent dislodgement during DEN, and 1 postdrainage infection) and were mostly not related to the drainage procedure.

CONCLUSIONS:

EUS-guided drainage with the electrocautery-enhanced delivery system is a safe, easy to perform, and a highly effective minimally invasive treatment modality for PFCs.

PMID:
26014960
DOI:
10.1016/j.gie.2015.04.006
[Indexed for MEDLINE]

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