Protocol of early lumen apposing metal stent removal for pseudocysts and walled off necrosis avoids bleeding complications

Abstract Background and study aims Walled-off necrosis (WON) is a known complication of acute necrotizing pancreatitis (ANP). There is no study comparing nasocystic irrigation with hydrogen peroxide (H2O2) versus biflanged metal stent (BMS) in the management of WON. The aim of this study was to compare the clinical efficacy of both the treatment strategies. Patients and methods This study was conducted on patients with symptomatic WON who were randomized to nasocystic irrigation with H2O2 (Group A) and BMS placement (Group B). Primary outcomes were clinical and technical success while secondary outcomes were procedure time, adverse events, need for additional procedures, duration of hospitalization, and mortality. Results Fifty patients were randomized into two groups. Group A (n = 25, age 37.8 ± 17.6 years, 16 men) and Group B (n = 25, age 41.8 ± 15.2 years, 17 men). There were no significant differences in baseline characteristics between the two groups. The most common etiology of pancreatitis was alcohol, observed in 27 (54 %) patients. Technical success (100 % vs 96 %, P = 0.98), clinical success (84 % vs 76 %, P = 0.76), requirement of additional procedures (16 % vs 24 %, P = 0.70) and adverse events (4 vs 7, P = 0.06) were comparable in both the groups. The duration to clinical success (34.4 ± 12 vs 14.8 ± 10.8 days, P = 0.001) and procedure time (36 ± 15 vs 18 ± 12 minutes, P = 0.01) were longer in Group A compared to Group B. Conclusions Nasocystic irrigation with H2O2 and BMS are equally effective in the management of WON but time to clinical success and procedure time is longer with nasocystic irrigation.

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Closure of a duodenal stent-induced perforation by endoscopic stent removal and covered self-expandable metal stent placement (with video)

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2007.03.1082 ◽

2007 ◽

Vol 66 (5) ◽

pp. 1063-1065 ◽

Cited By ~ 6

Author(s):

Aaron J. Small ◽

Bret T. Petersen ◽

Todd H. Baron

Keyword(s):

Stent Placement ◽

Metal Stent ◽

Endoscopic Stent ◽

Stent Removal ◽

Duodenal Stent ◽

Self Expandable Metal Stent

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Double Pigtail Plastic Stents Are Cheaper and As Effective as Lumen Apposing Metal Stent for the Endoscopic Drainage of Walled-Off Necrosis: a Case Control Study

Pancreatology ◽

10.1016/j.pan.2019.05.452 ◽

2019 ◽

Vol 19 ◽

pp. S168-S169

Author(s):

Roberto Valente ◽

Laura Zarantonello ◽

Marco Del Chiaro ◽

Miroslav Vujasinovic ◽

Francisco Baldaque Silva ◽

...

Keyword(s):

Case Control Study ◽

Case Control ◽

Plastic Stents ◽

Endoscopic Drainage ◽

Metal Stent ◽

Walled Off Necrosis ◽

Control Study

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P.04.21 PSEUDOCYSTS' METAL STENT DRAINAGE: STENT REMOVAL IS NOT MANDATORY

Digestive and Liver Disease ◽

10.1016/s1590-8658(18)30489-4 ◽

2018 ◽

Vol 50 (2) ◽

pp. e164

Author(s):

E. Forti ◽

L. Dioscoridi ◽

F. Pugliese ◽

A. Tringali ◽

M. Cintolo ◽

...

Keyword(s):

Metal Stent ◽

Stent Removal

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Side-by-side partially covered self-expandable metal stent placement for malignant hilar biliary obstruction

Endoscopy International Open ◽

10.1055/s-0043-117955 ◽

2017 ◽

Vol 05 (12) ◽

pp. E1211-E1217 ◽

Cited By ~ 11

Author(s):

Katsuya Kitamura ◽

Akira Yamamiya ◽

Yu Ishii ◽

Yuta Mitsui ◽

Tomohiro Nomoto ◽

...

Keyword(s):

Stent Placement ◽

Biliary Obstruction ◽

Success Rates ◽

Metal Stent ◽

Stent Removal ◽

Tumor Ingrowth ◽

Hilar Biliary Obstruction ◽

Malignant Hilar Biliary Obstruction ◽

Self Expandable Metal Stent

Abstract Background and study aims This study investigated the feasibility of side-by-side (SBS) partially covered self-expandable metal stent (PCSEMS) placement for unresectable malignant hilar biliary obstruction (MHBO). Patients and methods We retrospectively analyzed 33 patients from a single center who underwent endoscopic biliary drainage for unresectable MHBO from July 2013 to June 2015. In all patients with bilateral obstruction during complete bilateral intrahepatic cholangiograms, we performed endoscopic SBS placement of a 6-mm diameter PCSEMS using an 8-French delivery system. All patients underwent endoscopic sphincterotomy. Generally, patients with recurrent biliary obstruction (RBO) after stent placement underwent endoscopic reintervention. Our study outcomes included the technical and functional success rates, RBO rate, time to RBO (TRBO), reintervention rate, and incidence of adverse events. Results Seventeen patients with unresectable MHBO during complete bilateral intrahepatic cholangiograms underwent endoscopic SBS PCSEMS placement (median age, 78 years; men, 9). Lesions were Bismuth types II (n = 10), III (n = 1), and IV (n = 6), including 10 cholangiocarcinomas, 3 gallbladder cancers, and 4 metastatic cancers. In all patients, the PCSEMS was placed across the duodenal papilla. The technical and functional success rates were 100 % and 82 %, respectively. The median procedure time was 43 minutes (interquartile range [IQR]: 36 – 52 minutes). Twelve patients had RBO (71 %), including 9 stent occlusions due to sludge and 3 stent migrations. The median TRBO was 79 days (IQR: 58 – 156 days) during the follow-up period (median 192 days [IQR: 88 – 551 days]). The median TRBO of patients with Bismuth type II lesions was significantly longer than that of patients with Bismuth types III and IV lesions (87 days [IQR: 70 – 244 days] vs. 54 days [IQR: 35 – 100 days]; P = 0.030). Thirteen patients (76 %) required endoscopic reintervention. Endoscopic stent removal was possible in 6 patients without tumor ingrowth into the uncovered distal part of the stent. One late adverse event (≥ 31 days) occurred (cholangitis). Conclusions Endoscopic SBS placement of a PCSEMS was feasible in patients with unresectable MHBO. Additionally, reinterventional stent removal was possible in the absence of tumor ingrowth.

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