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Endoscopy. 2019 Jun 7. doi: 10.1055/a-0924-5591. [Epub ahead of print]

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

Author information

1
Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA.
2
Division of Digestive and Liver Disease, Columbia University Medical Center, New York, New York, USA.
3
Division of Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York, USA.
4
Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
5
Division of Gastroenterology and Hepatology, Borland Groover Clinic, Jacksonville, Florida, USA.
6
Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA.
7
Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
8
Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, USA.
9
Division of Digestive Disease, Emory University School of Medicine, Atlanta, Georgia, USA.
10
Division of Gastroenterology, Washington University in Saint Louis, St. Louis, Missouri, USA.
11
Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
12
Division of Gastroenterology, Digestive Endoscopy Unit, Humanitas Research Hospital, Rozzano, Milan, Italy.
13
Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA.
14
Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
15
Division of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
16
Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA.
17
Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas, University Hospital OMNI, Guayaquil, Ecuador.
18
Division of Gastroenterology, Ochsner Medical Center, New Orleans, Louisiana, USA.
19
Division of Gastroenterology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.

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.

PMID:
31174225
DOI:
10.1055/a-0924-5591

Conflict of interest statement

Dr. Amrita Sethi is a Consultant for Olympus and Boston Scientific. Dr. Reem Z. Sharaiha is a consultant for Boston Scientific and Apollo Endosurgery. Dr. Thomas Kowalski is a consultant for Boston Scientific and Medtronic. Dr. Jose Nieto is a consultant for Boston Scientific. Dr. Sachin Wani is a consultant for and received grant support from Boston Scientific and Medtronic, and grant support from Cook. Dr. Mihir S. Wagh has served as a consultant for Boston Scientific and Medtronic. Dr. Ali Mir Ahmed is a consultant for Boston Scientific and Cook Medical. Dr. Andrea Anderloni is a consultant for Boston Scientific. Dr. Douglas G. Adler is a consultant for Boston Scientific. Dr. Nikhil A. Kumta is a consultant for Apollo Endosurgery, Boston Scientific and Olympus. Dr. Frank P. Vleggaar is a consultant for Boston Scientific Dr. Isaac Raijman is a consultant for Boston Scientific. Dr. Shayan Irani is a consultant for Boston Scientific. Dr. Vivek Kumbhari is a consultant for ReShape Lifesciences, Apollo Endosurgery, Boston Scientific and Medtronic. Dr. Vikesh Singh is consultant for Abbvie, Novo Nordisk, and Ariel and advisory board participant for Nordmark. Dr. Douglas Pleskow is a consultant for Boston Scientific, Olympus, Nine Point and CSA. Dr. Mouen A. Khashab is a consultant for Boston Scientific, Olympus and Medtronic and is on the medical advisory board for Boston Scientific and Olympus

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