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Gastrointest Endosc. 2016 Sep;84(3):450-457.e2. doi: 10.1016/j.gie.2016.02.044. Epub 2016 Mar 10.

Evaluation of the short- and long-term effectiveness and safety of fully covered self-expandable metal stents for drainage of pancreatic fluid collections: results of a Spanish nationwide registry.

Author information

1
Endoscopy Unit, Gastroenterology Division, University Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain; Gastroenterology Division, University Hospital Quirón, Madrid, Spain.
2
Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA.
3
Department of Gastroenterology and Hepatology, Hospital Universitario Rio Hortega, Valladolid, Spain.
4
Gastroenterology Department, Hospital Costa del Sol, Marbella, Spain; Gastroenterology Department, Vithas Xanit Internacional Hospital, Benalmadena, Spain.
5
Endoscopy Unit, Digestive Disease Department, Hospital Universitari de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain.
6
Endoscopy Unit, Clinica Girona, Girona, Spain.
7
Endoscopy Unit, Gastroenterology Division, University Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain.
8
Gastroenterology Department, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Spain.
9
Gastroenterology Department, Araba University Hospital, Vitoria-Gasteiz, Spain.
10
Complejo Hospitalario Universitario Insular Materno Infantil, Gran Canaria, Spain.
11
Gastroenterology Department, Unidad de Gestión Clínica Digestivo, Hospital Clinico Universitario de la Arrixava, Murcia, Spain.
12
Department of Gastroenterology, Hospital de Navarra, Pamplona, Spain.
13
Endoscopy Unit, Hospital General Universitario de Alicante, Alicante, Spain.
14
Gastroenterology Department, Hospital General La Mancha Centro, Alcázar de San Juan, Spain.
15
Endoscopy Unit, Gastroenterology Department, Institute of Digestive and Metabolic Diseases, Hospital Clínic, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, University of Barcelona, Barcelona, Spain.
16
Gastroenterology Department, Servei Aparell Digestiu-Unitat d'Endoscòpia, Hospital Universitari Mútua de Terrassa, Terrassa, Spain.
17
Gastroenterology Department, Clínica Universidad de Navarra, Pamplona, Spain.
18
Gastroenterology Department, Hospital Clínico Universitario "Lozano Blesa," Zaragoza, Spain.
19
Endoscopy Unit, Gastroenterology Department, Servicio de Medicina de Aparato Digestivo, Hospital Universitario 12 de Octubre, Madrid, Spain.
20
Endoscopy Unit, Gastroenterology Department, Hospital Universitario Central de Asturias, Oviedo, Spain.
21
Endoscopy Unit, Gastroenterology Department, Hospital Virgen de la Salud, Toledo, Spain.
22
Endoscopy Unit, Gastroenterology Department. Hospital Son Llatzer, Palma de Mallorca, Spain.
23
Gastroenterology Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain.
24
Gastroenterology Department, Complejo Asistencial Universitario de Zamora, Zamora, Spain.
25
Endoscopy Unit, Hospital Clínico San Carlos, Madrid, Spain.
26
Gastroenterology Division, University Hospital Quirón, Madrid, Spain.

Abstract

BACKGROUND AND AIMS:

Initial reports suggest that fully covered self-expandable metal stents (FCSEMSs) may be better suited for drainage of dense pancreatic fluid collections (PFCs), such as walled-off pancreatic necrosis. The primary aim was to analyze the effectiveness and safety of FCSEMSs for drainage of different types of PFCs in a large cohort. The secondary aim was to investigate which type of FCSEMS is superior.

METHODS:

This was a retrospective, noncomparative review of a nationwide database involving all hospitals in Spain performing EUS-guided PFC drainage. From April 2008 to August 2013, all patients undergoing PFC drainage with an FCSEMS were included in a database. The main outcome measurements were technical success, short-term (2 weeks) and long-term (6 months) effectiveness, adverse events, and need for surgery.

RESULTS:

The study included 211 patients (pseudocyst/walled-off pancreatic necrosis, 53%/47%). The FCSEMSs used were straight biliary (66%) or lumen-apposing (34%). Technical success was achieved in 97% of patients (95% confidence interval [CI], 93%-99%). Short-term- and long-term clinical success was obtained in 94% (95% CI, 89%-97%) and 85% (95% CI, 79%-89%) of patients, respectively. Adverse events occurred in 21% of patients (95% CI, 16%-27%): infection (11%), bleeding (7%), and stent migration and/or perforation (3%). By multivariate analysis, patient age (>58 years) and previous failed drainage were the most important factors associated with negative outcome.

CONCLUSIONS:

An FCSEMS is effective and safe for PFC drainage. Older patients with a history of unsuccessful drainage are more likely to fail EUS-guided drainage. The type of FCSEMS does not seem to influence patient outcome.

PMID:
26970012
DOI:
10.1016/j.gie.2016.02.044
[Indexed for MEDLINE]

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