Safety and Efficacy of Endoscopic Ultrasound-Guided Drainage of Pancreatic Fluid Collections With Lumen-Apposing Covered Self-Expanding Metal Stents
Safety and Efficacy of Endoscopic Ultrasound-Guided Drainage of Pancreatic Fluid Collections With Lumen-Apposing Covered Self-Expanding Metal Stents
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DOI：
10.1016/j.cgh.2014.09.047
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发表时间：
2015-04-01
影响因子：
12.6
通讯作者：
Kahaleh, Michel
中科院分区：
文献类型：
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作者：
Shah, Raj J.;Shah, Janak N.;Kahaleh, Michel
背景与目的：通过内窥镜放置塑料支架以排出胰腺积液（pfc），需要重复使用。有盖金属支架直径较大，可以一步插入，但可以迁移。我们评估了一种贴腔、覆盖、自膨胀金属支架（LACSEMS）用于PFC引流的安全性和有效性。方法：我们对33例伴有症状性胰腺假性囊肿和壁闭塞性坏死（>= 6 cm, >= 70%液体含量）的患者（18例男性，年龄53 +/- 14岁，28例慢性胰腺炎）的支架置入结果进行了前瞻性研究。受试者于2011年10月至2013年8月在7个三级保健中心（6个在美国，1个在欧洲）登记入组。膀胱肠造口术是根据内镜医师的偏好而创建的。安全性指标包括感染、出血、穿孔、组织损伤和支架移位。疗效终点包括LACSEMS的放置、通畅和移除，以及pfc减少50%或更多。结果：患者PFCs的平均大小为9 +/- 3.3 cm。30例患者（91%）在超声内镜引导下成功放置LACSEMSs；其余3例患者接受2个双尾纤支架。一名受试者因假性动脉瘤而无法评估。在接受LACSEMS的患者中，29名患者中有27名（93%）PFCs消退。总体而言，33例患者中有30例（91%）PFCs消退。通过LACSEMS进行内镜清创11例。并发症（15%）包括腹痛（n = 3）、支架自发移动、背部疼痛（n[1）、通路部位感染和支架脱位（n = 1）。结论：91%的pfc患者成功植入了LACSEMS。总体而言，93%的患者有PFC分辨率。与其他支架相比，LACSEMSs的优点包括单步部署和能够进行内镜清创，支架移动最少。
BACKGROUND & AIMS: Plastic stents, placed via endoscopy to drain pancreatic fluid collections (PFCs), require repeat access. Covered metal stents are larger in diameter and can be inserted in a single step, but can migrate. We evaluated the safety and efficacy of a lumen-apposing, covered, self-expanding metal stent (LACSEMS) for PFC drainage.METHODS: We performed a prospective study of the outcomes of stent placement in 33 patients (18 men; age, 53 +/- 14 y; 28 with chronic pancreatitis) with symptomatic pancreatic pseudocysts and walled-off necrosis (>= 6 cm with >= 70% fluid content). Subjects were enrolled at 7 tertiary care centers (6 in the United States and 1 in Europe) from October 2011 through August 2013. Cystenterostomies were created based on endoscopist preference. Safety outcomes included infection, bleeding, perforation, tissue injury, and stent migration. Efficacy end points included LACSEMS placement, patency, and removal, as well as 50% or more reduction in PFCs.RESULTS: The mean size of the patients' PFCs was 9 +/- 3.3 cm. LACSEMSs were placed successfully via endoscopic ultrasound guidance in 30 patients (91%); the remaining 3 patients received 2 double-pigtail stents. One subject could not be evaluated because of a pseudoaneurysm. In the patients receiving LACSEMS, PFCs resolved in 27 of 29 (93%). Overall, PFCs resolved in 30 of 33 patients (91%). Endoscopic debridement through the LACSEMS was conducted in 11 subjects. Complications (15%) included abdominal pain (n = 3), spontaneous stent migration, back pain (n [1), access-site infection, and stent dislodgement (n = 1).CONCLUSIONS: LACSEMS were placed successfully in 91% of subjects with PFCs. Overall, 93% had PFC resolution. Advantages of LACSEMSs over other stents include single-step deployment and the ability to perform endoscopic debridement with minimal stent migration.