Feasibility and safety of a fully covered self-expandable metal stent with antimigration properties for EUS-guided pancreatic duct drainage: early and midterm outcomes (with video)
Feasibility and safety of a fully covered self-expandable metal stent with antimigration properties for EUS-guided pancreatic duct drainage: early and midterm outcomes (with video)
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DOI：
10.1016/j.gie.2015.07.015
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发表时间：
2016-02-01
影响因子：
7.7
通讯作者：
Kim, Myung-Hwan
中科院分区：
文献类型：
--
作者：
Oh, Dongwook;Park, Do Hyun;Kim, Myung-Hwan
背景和目标：最近，EUS引导的胰管引流（EUS-PD）已用于内镜逆行胰管造影（ERP）失败的患者。支架相关不良事件，如支架移位、支架置入失败或胰腺液泄漏，一直是透壁塑料支架植入术的关注点。本研究的目的是评估EUS-PD的可行性和安全性与一个完全覆盖的自膨式金属支架（FCSEMS）的梗阻性胰腺炎患者失败ERP.Methods：25例疼痛性梗阻性胰腺炎患者进行EUS-PD与一个FCSEMS失败后ERP。技术和临床成功，不良事件，支架通畅率进行了assessed.Results：EUS-PD是成功的所有25例（技术成功率，100%），所有患者的症状改善（临床成功率，100%）。行EUS引导下胰胃吻合术（n = 23）、胰十二指肠吻合术（n = 1）和胰肠吻合术（n = 1）。放置FCSEMS后疼痛评分显著改善（P = .001）。5例患者（20%）发生早期轻度不良事件，4例为自限性腹痛，1例为轻微出血。随访期间未观察到与FCEMS相关的其他不良事件，包括支架移位、支架堵塞、胰腺脓毒症和支架诱导的导管狭窄。平均支架通畅持续时间为126.9天，平均随访期间（221.1天）。结论：EUS-PD与FCSEMS可能是技术上可行的，相对安全的患者谁失败的传统ERP。应鼓励开展更多的随机试验，比较EUS-PD与长期FCSEMS和塑料支架治疗ERCP失败后疼痛性梗阻性胰腺炎患者的效果。
Background and Aims: Recently, EUS-guided pancreatic duct drainage (EUS-PD) has been used for patients in whom endoscopic retrograde pancreatography (ERP) has failed. Stent-related adverse events such as stent migrations, failures in stent placement, or pancreatic fluid leakages have been of concern in transmural plastic stenting procedures. The aim of this study is to evaluate the feasibility and safety of EUS-PD with a fully covered selfexpandable metal stent (FCSEMS) for patients with obstructive pancreatitis who failed ERP.Methods: Twenty-five consecutive patients with painful obstructive pancreatitis underwent EUS-PD with a FCSEMS after failed ERP. Technical and clinical success, adverse events, and stent patency were assessed.Results: EUS-PD was successful in all 25 patients (technical success rate, 100%), and symptoms improved in all patients (clinical success rate, 100%). EUS-guided pancreaticogastrostomy (n = 23), pancreaticoduodenostomy (n = 1), and pancreaticojejunostomy (n = 1) were performed. Pain scores improved significantly after FCSEMS placement (P = .001). Early mild grade adverse events occurred in 5 patients (20%), 4 with self-limited abdominal pain and 1 with minor bleeding. No other adverse events related to FCSEMS, including stent migration, stent clogging, pancreatic sepsis, and stent-induced ductal stricture, were observed during follow-up periods. Mean stent patency duration was 126.9 days during mean follow-up periods (221.1 days).Conclusions: EUS-PD with an FCSEMS may be technically feasible and relatively safe for patients who fail conventional ERP. Further randomized trials comparing EUS-PD with long-term FCSEMS and plastic stents for patients with painful obstructive pancreatitis after failed ERCP should be encouraged.