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Endoscopic Therapy With Lumen-apposing Metal Stents Is Safe and Effective for Patients With Pancreatic Walled-off Necrosis.
Clin Gastroenterol Hepatol 2016; 14(12):1797-1803CG

Abstract

BACKGROUND & AIMS

Endoscopic ultrasound-guided transmural drainage and necrosectomy have become the standard treatment for patients with pancreatic walled-off necrosis (WON). Lumen-apposing metal stents (LAMS) have shown success in the management of pancreatic fluid collections. However, there are few data on their specific roles in management of WON. We investigated the efficacy and safety of LAMS in treatment of WON.

METHODS

We performed a retrospective multicenter case series of 124 patients with WON who underwent endoscopic transmural drainage by using LAMS at 17 tertiary care centers from January 2014 through May 2015. Patients underwent endoscopic ultrasound-guided cystogastrostomy or cystoenterostomy with placement of an LAMS into the WON collection. At the discretion of the endoscopist, we performed direct endoscopic necrosectomy, irrigation with hydrogen peroxide, and/or nasocystic drain placement. We performed endoscopic retrograde cholangiopancreatography with pancreatic duct stent placement when indicated. Concomitant therapies included direct endoscopic debridement (n = 78), pancreatic duct stent placement for leak (n = 19), hydrogen peroxide-assisted necrosectomy (n = 38), and nasocystic irrigation (n = 22). We collected data for a median time of 4 months (range, 1-34 months) after the LAMS placement. The primary outcomes were rates of technical success (successful placement of the LAMS), clinical success (resolution of WON, on the basis of image analysis, without need for further intervention via surgery or interventional radiology), and adverse events.

RESULTS

The median size of the WON was 9.5 cm (range, 4-30 cm). Eight patients had 2 LAMS placed for multiport access, all with technical success (100%). Clinical success was achieved in 107 patients (86.3%) after 3 months of follow-up. Thirteen patients required a percutaneous drain, and 3 required a surgical intervention to manage their WON. The stents remained patent in 94% of patients (117 of 124) and migrated in 5.6% of patients (7 of 124). The median number of endoscopic interventions was 2 (range, 1-9 interventions).

CONCLUSIONS

On the basis of a retrospective analysis of 124 patients, endoscopic therapy of WON by using LAMS is safe and effective. Creation of a large and sustained cystogastrostomy or cystoenterostomy tract is effective in the drainage and treatment of WON.

Authors+Show Affiliations

Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York. Electronic address: rzs9001@med.cornell.edu.Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York.Gastroenterology and Hepatology, Johns Hopkins Medical Institute, Baltimore, Maryland.Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York.Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York.Department of Gastroenterology and Hepatology, Borland Groover Clinic, Jacksonville, Florida.Center for Endoscopic Research and Therapeutics (CERT), University of Chicago Medicine and Biological Sciences, Chicago, Illinois.Center for Endoscopic Research and Therapeutics (CERT), University of Chicago Medicine and Biological Sciences, Chicago, Illinois.Gastroenterology and Hepatology, Ochsner Health System, New Orleans, Louisiana.Gastroenterology and Hepatology, Beth Israel Mt Sinai, New York, New York.Gastroenterology and Hepatology, University of Maryland, Baltimore, Maryland.Gastroenterology and Hepatology, Mount Sinai Medical Center, New York, New York.Gastroenterology and Hepatology, Brooke Army Medical Center, Fort Sam Houston, Texas.Gastroenterology and Hepatology, Stanford Hospital and Clinics, Palo Alto, California.Gastroenterology and Hepatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.Gastroenterology and Hepatology, North Shore-Long Island Jewish Health System, New York, New York.Gastroenterology and Hepatology, Columbia University Medical Center, New York, New York.Gastroenterology and Hepatology, Columbia University Medical Center, New York, New York.Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York.Center for Endoscopic Research and Therapeutics (CERT), University of Chicago Medicine and Biological Sciences, Chicago, Illinois.Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York.Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York.Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York.Gastroenterology and Hepatology, Columbia University Medical Center, New York, New York.Gastroenterology and Hepatology, Columbia University Medical Center, New York, New York.Gastroenterology and Hepatology, Montefiore, New York, New York.Gastroenterology and Hepatology, Johns Hopkins Medical Institute, Baltimore, Maryland.Gastroenterology and Hepatology, Johns Hopkins Medical Institute, Baltimore, Maryland.Gastroenterology and Hepatology, Johns Hopkins Medical Institute, Baltimore, Maryland.Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York.Gastroenterology and Hepatology, University of Missouri Kansas City, Kansas City, Missouri.Gastroenterology and Hepatology, Brooke Army Medical Center, Fort Sam Houston, Texas.Gastroenterology and Hepatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.Gastroenterology and Hepatology, University of Missouri Kansas City, Kansas City, Missouri.Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York.Gastroenterology and Hepatology, Beth Israel Mt Sinai, New York, New York.Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York.Gastroenterology and Hepatology, Jefferson University, Philadelphia, Pennsylvania.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

27189914

Citation

Sharaiha, Reem Z., et al. "Endoscopic Therapy With Lumen-apposing Metal Stents Is Safe and Effective for Patients With Pancreatic Walled-off Necrosis." Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, vol. 14, no. 12, 2016, pp. 1797-1803.
Sharaiha RZ, Tyberg A, Khashab MA, et al. Endoscopic Therapy With Lumen-apposing Metal Stents Is Safe and Effective for Patients With Pancreatic Walled-off Necrosis. Clin Gastroenterol Hepatol. 2016;14(12):1797-1803.
Sharaiha, R. Z., Tyberg, A., Khashab, M. A., Kumta, N. A., Karia, K., Nieto, J., ... Siddiqui, A. A. (2016). Endoscopic Therapy With Lumen-apposing Metal Stents Is Safe and Effective for Patients With Pancreatic Walled-off Necrosis. Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, 14(12), pp. 1797-1803. doi:10.1016/j.cgh.2016.05.011.
Sharaiha RZ, et al. Endoscopic Therapy With Lumen-apposing Metal Stents Is Safe and Effective for Patients With Pancreatic Walled-off Necrosis. Clin Gastroenterol Hepatol. 2016;14(12):1797-1803. PubMed PMID: 27189914.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscopic Therapy With Lumen-apposing Metal Stents Is Safe and Effective for Patients With Pancreatic Walled-off Necrosis. AU - Sharaiha,Reem Z, AU - Tyberg,Amy, AU - Khashab,Mouen A, AU - Kumta,Nikhil A, AU - Karia,Kunal, AU - Nieto,Jose, AU - Siddiqui,Uzma D, AU - Waxman,Irving, AU - Joshi,Virendra, AU - Benias,Petros C, AU - Darwin,Peter, AU - DiMaio,Christopher J, AU - Mulder,Christopher J, AU - Friedland,Shai, AU - Forcione,David G, AU - Sejpal,Divyesh V, AU - Gonda,Tamas A, AU - Gress,Frank G, AU - Gaidhane,Monica, AU - Koons,Ann, AU - DeFilippis,Ersilia M, AU - Salgado,Sanjay, AU - Weaver,Kristen R, AU - Poneros,John M, AU - Sethi,Amrita, AU - Ho,Sammy, AU - Kumbhari,Vivek, AU - Singh,Vikesh K, AU - Tieu,Alan H, AU - Parra,Viviana, AU - Likhitsup,Alisa, AU - Womeldorph,Craig, AU - Casey,Brenna, AU - Jonnalagadda,Sreeni S, AU - Desai,Amit P, AU - Carr-Locke,David L, AU - Kahaleh,Michel, AU - Siddiqui,Ali A, Y1 - 2016/05/14/ PY - 2016/03/02/received PY - 2016/04/29/revised PY - 2016/05/03/accepted PY - 2016/5/18/pubmed PY - 2017/8/10/medline PY - 2016/5/19/entrez KW - ERCP KW - Necrosectomy KW - Pancreatic Necrosis KW - Pancreatitis KW - Stents SP - 1797 EP - 1803 JF - Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association JO - Clin. Gastroenterol. Hepatol. VL - 14 IS - 12 N2 - BACKGROUND & AIMS: Endoscopic ultrasound-guided transmural drainage and necrosectomy have become the standard treatment for patients with pancreatic walled-off necrosis (WON). Lumen-apposing metal stents (LAMS) have shown success in the management of pancreatic fluid collections. However, there are few data on their specific roles in management of WON. We investigated the efficacy and safety of LAMS in treatment of WON. METHODS: We performed a retrospective multicenter case series of 124 patients with WON who underwent endoscopic transmural drainage by using LAMS at 17 tertiary care centers from January 2014 through May 2015. Patients underwent endoscopic ultrasound-guided cystogastrostomy or cystoenterostomy with placement of an LAMS into the WON collection. At the discretion of the endoscopist, we performed direct endoscopic necrosectomy, irrigation with hydrogen peroxide, and/or nasocystic drain placement. We performed endoscopic retrograde cholangiopancreatography with pancreatic duct stent placement when indicated. Concomitant therapies included direct endoscopic debridement (n = 78), pancreatic duct stent placement for leak (n = 19), hydrogen peroxide-assisted necrosectomy (n = 38), and nasocystic irrigation (n = 22). We collected data for a median time of 4 months (range, 1-34 months) after the LAMS placement. The primary outcomes were rates of technical success (successful placement of the LAMS), clinical success (resolution of WON, on the basis of image analysis, without need for further intervention via surgery or interventional radiology), and adverse events. RESULTS: The median size of the WON was 9.5 cm (range, 4-30 cm). Eight patients had 2 LAMS placed for multiport access, all with technical success (100%). Clinical success was achieved in 107 patients (86.3%) after 3 months of follow-up. Thirteen patients required a percutaneous drain, and 3 required a surgical intervention to manage their WON. The stents remained patent in 94% of patients (117 of 124) and migrated in 5.6% of patients (7 of 124). The median number of endoscopic interventions was 2 (range, 1-9 interventions). CONCLUSIONS: On the basis of a retrospective analysis of 124 patients, endoscopic therapy of WON by using LAMS is safe and effective. Creation of a large and sustained cystogastrostomy or cystoenterostomy tract is effective in the drainage and treatment of WON. SN - 1542-7714 UR - https://www.unboundmedicine.com/medline/citation/27189914/Endoscopic_Therapy_With_Lumen_apposing_Metal_Stents_Is_Safe_and_Effective_for_Patients_With_Pancreatic_Walled_off_Necrosis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1542-3565(16)30196-3 DB - PRIME DP - Unbound Medicine ER -