Clinical evaluation of a novel lumen-apposing metal stent for endosonography-guided pancreatic pseudocyst and gallbladder drainage (with videos)
Clinical evaluation of a novel lumen-apposing metal stent for endosonography-guided pancreatic pseudocyst and gallbladder drainage (with videos)
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DOI：
10.1016/j.gie.2011.10.020
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发表时间：
2012-04-01
影响因子：
7.7
通讯作者：
Moriyasu, Fuminori
中科院分区：
文献类型：
--
作者：
Itoi, Takao;Binmoeller, Kenneth F.;Moriyasu, Fuminori
背景：管状塑料和金属支架在用于经肠液体收集引流时存在固有的缺点。目的：探讨一种新型的顺腔、自膨胀金属支架在eus引导下用于胰腺假性囊肿及胆囊的引流。设计：回顾性病例系列。环境：三级保健学术医疗中心。患者：本研究涉及15例有症状的胰腺假性囊肿患者（中位年龄54岁），他们接受了12次经胃和3次经十二指肠假性囊肿引流术。5例急性胆囊炎患者（中位年龄69.5岁）行4例胆囊十二指肠造口术和1例胆囊胃造口术。干预措施：在EUS指导下放置支架，内窥镜通过支架腔进行假性膀胱镜或胆囊镜检查，经肠内窥镜引导的干预措施包括活检、坏死切除术和结石取出。主要结果测量：技术和临床成功。结果：所有支架均成功放置，无并发症，中位取出时间为35天。所有假性囊肿在一次引流手术后消失。一个支架迁移到胃中，其余14个在移除时被发现是专利的。中位随访11.4个月，无假性囊肿复发。1例胆囊支架留置12个月后完全通畅。急性胆囊炎在支架置入术后立即消退。中位随访9个月无症状复发。局限性：回顾性研究，样本量小，缺乏对照患者。结论：在这项初步观察研究中，使用一种新型的、腔旁置的金属支架经肠引流胰腺假性囊肿和胆囊，取得了高技术和临床成功。进一步的研究是必要的。
Background: Tubular plastic and metal stents have inherent shortcomings when used for transenteric drainage of fluid collections.Objective: To evaluate a novel lumen-apposing, self-expandable metal stent for EUS-guided drainage of pancreatic pseudocysts and the gallbladder.Design: Retrospective case series.Setting: Tertiary-care academic medical center.Patients: This study involved 15 patients (median age 54 years) with symptomatic pancreatic pseudocysts who underwent 12 transgastric and 3 transduodenal pseudocyst drainage procedures. Five patients (median age 69.5 years) with acute cholecystitis underwent 4 cholecystoduodenostomies and 1 cholecystogastostomy.Intervention: Stent deployment under EUS guidance, passage of an endoscope through the stent lumen for pseudocystoscopy or cholecystoscopy, transenteric endoscopy-guided interventions including biopsy, necrosectomy, and stone removal.Main Outcome Measurements: Technical and clinical success.Results: All stents were successfully deployed without complication, with a median time to removal of 35 days. All pseudocysts resolved after a single drainage procedure. One stent migrated into the stomach, and the remaining 14 were found to be patent at the time of removal. There was no pseudocyst recurrence during the 11.4-month median follow-up period. One gallbladder stent remains indwelling and fully patent at 12 months. Resolution of acute cholecystitis was observed immediately after stent implantation. No recurrence of symptoms was observed during a median follow-up period of 9 months.Limitations: Retrospective study, small sample size, lack of control patients.Conclusion: Transenteric drainage of pancreatic pseudocysts and the gallbladder by using a novel, lumen-apposing, metal stent was accomplished with high technical and clinical success in this pilot observational study. Further studies are warranted.