Definition of a hospital volume threshold to optimize outcomes after drainage of pancreatic fluid collections with lumen-apposing metal stents: a nationwide cohort study

Pancreatic fluid collections (PFCs) are a common sequela of pancreatitis. Most PFCs can be managed conservatively, but symptomatic PFCs require either surgical, percutaneous, or endoscopic intervention. Recent advances in the therapeutics of PFCs, including the step-up approach, endoscopic ultrasound-guided transmural drainage with lumen apposing metal stents, and direct endoscopic necrosectomy, have ushered endoscopy to the forefront of PFCs management and have allowed for improved patient outcomes and decreased morbidity. In this review, we explore the progress and future of endoscopic management of PFCs.

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Safety and Efficacy of Endoscopic Ultrasound-Guided Drainage of Pancreatic Fluid Collections With Lumen-Apposing Covered Self-Expanding Metal Stents

Clinical Gastroenterology and Hepatology ◽

10.1016/j.cgh.2014.09.047 ◽

2015 ◽

Vol 13 (4) ◽

pp. 747-752 ◽

Cited By ~ 133

Author(s):

Raj J. Shah ◽

Janak N. Shah ◽

Irving Waxman ◽

Thomas E. Kowalski ◽

Andres Sanchez-Yague ◽

...

Keyword(s):

Endoscopic Ultrasound ◽

Metal Stents ◽

Ultrasound Guided ◽

Safety And Efficacy ◽

Pancreatic Fluid Collections ◽

Pancreatic Fluid ◽

Self Expanding Metal Stents ◽

Fluid Collections

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Predicting the Need for Step-Up Therapy After EUS-Guided Drainage of Pancreatic Fluid Collections With Lumen-Apposing Metal Stents

Clinical Gastroenterology and Hepatology ◽

10.1016/j.cgh.2021.05.005 ◽

2021 ◽

Author(s):

Vinay Chandrasekhara ◽

Sherif Elhanafi ◽

Andrew C. Storm ◽

Naoki Takahashi ◽

Nam Ju Lee ◽

...

Keyword(s):

Metal Stents ◽

Pancreatic Fluid Collections ◽

Pancreatic Fluid ◽

Fluid Collections

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A systematic review and meta-analysis of metal versus plastic stents for drainage of pancreatic fluid collections: metal stents are advantageous

Surgical Endoscopy ◽

10.1007/s00464-018-6416-5 ◽

2018 ◽

Vol 33 (5) ◽

pp. 1412-1425 ◽

Cited By ~ 12

Author(s):

Rebecca Saunders ◽

Jayapal Ramesh ◽

Silvia Cicconi ◽

Jonathan Evans ◽

Vincent S. Yip ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Plastic Stents ◽

Metal Stents ◽

Pancreatic Fluid Collections ◽

Pancreatic Fluid ◽

Fluid Collections

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Novel 15-mm-long lumen-apposing metal stent for endoscopic ultrasound-guided drainage of pancreatic fluid collections located ≥10 mm from the luminal wall

Endoscopy ◽

10.1055/a-1682-7095 ◽

2021 ◽

Author(s):

Linda Y. Zhang ◽

Rastislav Kunda ◽

Maridi Aerts ◽

Nouredin Messaoudi ◽

Rishi Pawa ◽

...

Keyword(s):

Endoscopic Ultrasound ◽

Clinical Symptoms ◽

Clinical Success ◽

Duodenal Wall ◽

Metal Stents ◽

Pancreatic Fluid Collections ◽

Pancreatic Fluid ◽

Maximal Diameter ◽

International Multicenter Study ◽

Fluid Collections

Abstract Background Endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collections (PFCs) by cautery-enhanced lumen-apposing metal stents (LAMS) has largely been limited to collections located < 10 mm from the luminal wall. We present outcomes of the use of a novel 15-mm-long cautery-enhanced LAMS for drainage of PFCs located ≥ 10 mm away. Methods This international, multicenter study analyzed all adults with PFCs located ≥ 10 mm from the luminal wall who were treated by EUS-guided drainage using the 15-mm-long cautery-enhanced LAMS. The primary outcome was technical success. Secondary outcomes included clinical success (decrease in PFC size by ≥ 50 % at 30 days and resolution of clinical symptoms without surgical intervention), complications, and recurrence. Results 35 patients (median age 57 years; interquartile range [IQR] 47–64 years; 49 % male) underwent novel LAMS placement for drainage of PFCs (26 walled-off necrosis, 9 pseudocysts), measuring 85 mm (IQR 64–117) maximal diameter and located 11.8 mm (IQR 10–12.3; range 10–14) from the gastric/duodenal wall. Technical and clinical success were high (both 97 %), with recurrence in one patient (3 %) at a median follow-up of 123 days (58–236). Three complications occurred (9 %; one mild, two moderate). Conclusions The 15-mm-long cautery-enhanced LAMS was feasible and safe for drainage of PFCs located 10–14 mm from the luminal wall.

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