scholarly journals The Role of Lumen-Apposing Metal Stents in Transmural Endoscopic Drainage of Postinflammatory Pancreatic and Peripancreatic Fluid Collections

2021 ◽  
Vol 2021 ◽  
pp. 1-18
Author(s):  
Mateusz Jagielski ◽  
Marek Jackowski
Keyword(s):  
Rapid Development ◽  
Metal Stents ◽  
Endoscopic Drainage ◽  
High Efficacy ◽  
Endoscopic Techniques ◽  
Biomedical Technologies ◽  
Transmural Drainage ◽  
Fluid Collections ◽  
Invasive Techniques

Rapid development of advanced gastrointestinal endoscopic techniques contributed to the appearance of new biomedical materials including polymers, which are used for the production of different types of endoprostheses. Endotherapy (ET) of postinflammatory pancreatic and peripancreatic fluid collections (PPFCs) with the use of lumen-apposing metal stent (LAMS) is an effective method of treatment. This paper describes the high efficacy of ET and its potential complications, which are mostly related to the design of the LAMS used. The high efficacy of LAMS in the transmural drainage of PPFCs is associated with lower safety of treatment. Complications of ET presented in the manuscript are mainly related to endoprosthesis’ construction. This paper presents possible directions of development in the field of transmural LAMSs, which in the future may contribute to the invention of an innovative type of LAMS based on new biomedical technologies. Possibly, subsequent novel endoprosthesis projects, based on the above results, will be able to meet the current needs and requirements associated with endoscopic transmural drainage procedures in cases of postinflammatory PPFCs. The ultimate goal is to improve safety of minimally invasive techniques for treatment of the local consequences of pancreatitis.

scholarly journals Endoscopic Management of Pancreatic Fluid Collections

2021 ◽  
Vol 10 (2) ◽  
pp. 284
Author(s):  
Robert Dorrell ◽  
Swati Pawa ◽  
Rishi Pawa
Keyword(s):  
Patient Outcomes ◽  
Endoscopic Management ◽  
Metal Stents ◽  
Ultrasound Guided ◽  
Endoscopic Intervention ◽  
Endoscopic Necrosectomy ◽  
Pancreatic Fluid Collections ◽  
Pancreatic Fluid ◽  
Transmural Drainage ◽  
Fluid Collections

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.

Management of Pancreatic Fluid Collections: A Changing of the Guard from Surgery to Endoscopy

2011 ◽  
Vol 77 (12) ◽  
pp. 1650-1655 ◽  
Author(s):  
Shyam Varadarajulu ◽  
C. Mel Wilcox ◽  
Sahibzada Latif ◽  
Milind Phadnis ◽  
John D. Christein
Keyword(s):  
Practice Patterns ◽  
Treated Group ◽  
Pancreatic Fluid Collections ◽  
Pancreatic Fluid ◽  
Group I ◽  
Impacting Factors ◽  
Transmural Drainage ◽  
Group Ii ◽  
Fluid Collections

The aim of this study was to assess for any trend in management of pancreatic fluid collections (PFCs) and identify impacting factors. The endoscopy and surgical databases were queried for PFC patients. PFCs were categorized as pseudocysts (PP) or complex collections (CC) that included abscess/necrosis. The outcome measures were to compare the utilization of surgery and endoscopy from 2004 to 2007 (group I) and from 2008 to 2010 (group II) and identify factors impacting practice patterns. A total of 285 patients were treated: group I included 119 and group II 166. Of 119 group I patients, 29 per cent were treated by surgery and 71 per cent by endoscopy. Of 85 endoscopy patients, 42 per cent were drained by conventional transmural drainage and 58 per cent by endoscopic ultrasound (EUS). Of 166 group II patients, 31 per cent were treated surgically and 69 per cent endoscopically. Of the 115 endoscopy patients, 17 per cent were drained by conventional transmural drainage and 83 per cent by EUS. Compared with group I, all pseudocysts in group II were treated by endoscopy (84% vs 100%, P = 0.001). There was no difference in the rate of CC treated by endoscopy between both groups (57.7% vs 56.8%, P = 0.9). PFCs not causing luminal compression ( P < 0.0001) or measuring <9 cm in size ( P < 0.0001) were more likely to require EUS. There was a significant trend at our institution in the management of PFCs with all pseudocysts presently being treated only by endoscopy. The ability of EUS to access smaller size PFCs and those not causing luminal compression has significantly expanded the role of endoscopy in PFC management.

Role of EUS in drainage of peripancreatic fluid collections not amenable for endoscopic transmural drainage

2007 ◽  
Vol 66 (6) ◽  
pp. 1107-1119 ◽  
Author(s):  
Shyam Varadarajulu ◽  
C. Mel Wilcox ◽  
Ashutosh Tamhane ◽  
Mohamad A. Eloubeidi ◽  
Jeanetta Blakely ◽  
...  
Keyword(s):  
Transmural Drainage ◽  
Fluid Collections

scholarly journals The Role of EUS-Guided Drainage in the Management of Postoperative Fluid Collections after Pancreatobiliary Surgery

2021 ◽  
Vol 12 (4) ◽  
pp. 433-442
Author(s):  
Lester Wei Lin Ong ◽  
Charing Ching Ning Chong
Keyword(s):  
Fluid Collection ◽  
Plastic Stents ◽  
Pancreatic Pseudocysts ◽  
Metal Stents ◽  
Type Size ◽  
Promising Solution ◽  
Fluid Collections ◽  
Endoscopic Debridement ◽  
Walled Off Necrosis

Postoperative fluid collection (POFC) is a challenging complication following pancreatobiliary surgery. Traditional treatment with surgical drainage is associated with significant morbidity, while percutaneous drainage is associated with a higher rate of recurrence and the need for repeated interventions. Studies have shown that endoscopic ultrasound (EUS)-guided drainage may offer a promising solution to this problem. There are limited data on the ideal therapeutic protocol for EUS-guided drainage of POFC including the timing for drainage; type, size, and number of stents to use; and the need for endoscopic debridement and irrigation. Current practices extrapolated from the treatment of pancreatic pseudocysts and walled-off necrosis may not be applicable to POFC. There are increasing data to suggest that drainage procedures may be performed within two weeks after surgery. While most authors advocate the use of double pigtail plastic stents (DPPSs), there have been a number of reports on the use of novel lumen-apposing metal stents (LAMSs), although no direct comparisons have been made between the two.

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