EUS-guided drainage of pancreatic fluid collections using a novel lumen-apposing metal stent on an electrocautery-enhanced delivery system: a large retrospective study (with video)

Emanuele Rinninella; Rastislav Kunda; Markus Dollhopf; Andres Sanchez-Yague; Uwe Will; Ilaria Tarantino; Joan Gornals Soler; Sebastian Ullrich; Alexander Meining; Josè Miguel Esteban; Thomas Enz; Geoffroy Vanbiervliet; FP Vleggaar; Fabia Attili; Alberto Larghi

doi:10.1016/j.gie.2015.04.006

EUS-guided drainage of pancreatic fluid collections using a novel lumen-apposing metal stent on an electrocautery-enhanced delivery system: a large retrospective study (with video)

Emanuele Rinninella, Rastislav Kunda, Markus Dollhopf, Andres Sanchez-Yague, Uwe Will, Ilaria Tarantino, Joan Gornals Soler, Sebastian Ullrich, Alexander Meining, Josè Miguel Esteban, Thomas Enz, Geoffroy Vanbiervliet, FP Vleggaar, Fabia Attili, Alberto Larghi

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND AND AIMS: A lumen-apposing, self-expanding metal stent incorporated in an electrocautery-enhanced delivery system for EUS-guided drainage of pancreatic fluid collections (PFCs) recently has become available. The aim of this study was to analyze the safety and clinical effectiveness of this newly developed device in this clinical setting.

METHODS: This was a retrospective analysis of all consecutive patients with PFCs who underwent EUS-guided drainage using the study device in 13 European centers.

RESULTS: Ninety-three patients with PFCs (80% with complex collections) underwent drainage using the study device. Penetration of the PFC was accomplished directly with the study device in 74.2% of patients, and successful stent placement was accomplished in all but 1 patient, mostly without fluoroscopic assistance. Direct endoscopic necrosectomy (DEN) was carried out in 31 of 52 cases (59.6%) of walled-off necrosis and in 2 of 4 cases (50%) of acute peripancreatic fluid collection. Complete resolution of the PFC was obtained in 86 cases (92.5%), with no recurrence during follow-up. Treatment failure occurred in 6 patients because of persistent infection requiring surgery (n = 3), perforation and massive bleeding caused by the nasocystic drainage catheter (NCDC) (n = 2), and the need for a larger opening to extract large necrotic tissue pieces (n = 1). Major adverse events occurred in 5 patients (perforation and massive bleeding caused by the NCDC in 2 patients, 1 pneumoperitoneum and 1 stent dislodgement during DEN, and 1 postdrainage infection) and were mostly not related to the drainage procedure.

CONCLUSIONS: EUS-guided drainage with the electrocautery-enhanced delivery system is a safe, easy to perform, and a highly effective minimally invasive treatment modality for PFCs.

Original language	English
Pages (from-to)	1039-46
Number of pages	8
Journal	Gastrointestinal Endoscopy
Volume	82
Issue number	6
DOIs	https://doi.org/10.1016/j.gie.2015.04.006
Publication status	Published - Dec 2015

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Rinninella, E., Kunda, R., Dollhopf, M., Sanchez-Yague, A., Will, U., Tarantino, I., Gornals Soler, J., Ullrich, S., Meining, A., Esteban, J. M., Enz, T., Vanbiervliet, G., Vleggaar, FP., Attili, F., & Larghi, A. (2015). EUS-guided drainage of pancreatic fluid collections using a novel lumen-apposing metal stent on an electrocautery-enhanced delivery system: a large retrospective study (with video). Gastrointestinal Endoscopy, 82(6), 1039-46. https://doi.org/10.1016/j.gie.2015.04.006

@article{c4001a59a87a4f6086ff2a2b5e4a7423,

title = "EUS-guided drainage of pancreatic fluid collections using a novel lumen-apposing metal stent on an electrocautery-enhanced delivery system: a large retrospective study (with video)",

abstract = "BACKGROUND AND AIMS: A lumen-apposing, self-expanding metal stent incorporated in an electrocautery-enhanced delivery system for EUS-guided drainage of pancreatic fluid collections (PFCs) recently has become available. The aim of this study was to analyze the safety and clinical effectiveness of this newly developed device in this clinical setting.METHODS: This was a retrospective analysis of all consecutive patients with PFCs who underwent EUS-guided drainage using the study device in 13 European centers.RESULTS: Ninety-three patients with PFCs (80% with complex collections) underwent drainage using the study device. Penetration of the PFC was accomplished directly with the study device in 74.2% of patients, and successful stent placement was accomplished in all but 1 patient, mostly without fluoroscopic assistance. Direct endoscopic necrosectomy (DEN) was carried out in 31 of 52 cases (59.6%) of walled-off necrosis and in 2 of 4 cases (50%) of acute peripancreatic fluid collection. Complete resolution of the PFC was obtained in 86 cases (92.5%), with no recurrence during follow-up. Treatment failure occurred in 6 patients because of persistent infection requiring surgery (n = 3), perforation and massive bleeding caused by the nasocystic drainage catheter (NCDC) (n = 2), and the need for a larger opening to extract large necrotic tissue pieces (n = 1). Major adverse events occurred in 5 patients (perforation and massive bleeding caused by the NCDC in 2 patients, 1 pneumoperitoneum and 1 stent dislodgement during DEN, and 1 postdrainage infection) and were mostly not related to the drainage procedure.CONCLUSIONS: EUS-guided drainage with the electrocautery-enhanced delivery system is a safe, easy to perform, and a highly effective minimally invasive treatment modality for PFCs.",

author = "Emanuele Rinninella and Rastislav Kunda and Markus Dollhopf and Andres Sanchez-Yague and Uwe Will and Ilaria Tarantino and {Gornals Soler}, Joan and Sebastian Ullrich and Alexander Meining and Esteban, {Jos{\`e} Miguel} and Thomas Enz and Geoffroy Vanbiervliet and FP Vleggaar and Fabia Attili and Alberto Larghi",

year = "2015",

month = dec,

doi = "10.1016/j.gie.2015.04.006",

language = "English",

volume = "82",

pages = "1039--46",

journal = "Gastrointestinal Endoscopy",

issn = "0016-5107",

publisher = "Mosby Inc.",

number = "6",

}

Rinninella, E, Kunda, R, Dollhopf, M, Sanchez-Yague, A, Will, U, Tarantino, I, Gornals Soler, J, Ullrich, S, Meining, A, Esteban, JM, Enz, T, Vanbiervliet, G, Vleggaar, FP, Attili, F & Larghi, A 2015, 'EUS-guided drainage of pancreatic fluid collections using a novel lumen-apposing metal stent on an electrocautery-enhanced delivery system: a large retrospective study (with video)', Gastrointestinal Endoscopy, vol. 82, no. 6, pp. 1039-46. https://doi.org/10.1016/j.gie.2015.04.006

EUS-guided drainage of pancreatic fluid collections using a novel lumen-apposing metal stent on an electrocautery-enhanced delivery system: a large retrospective study (with video). / Rinninella, Emanuele; Kunda, Rastislav; Dollhopf, Markus et al.
In: Gastrointestinal Endoscopy, Vol. 82, No. 6, 12.2015, p. 1039-46.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - EUS-guided drainage of pancreatic fluid collections using a novel lumen-apposing metal stent on an electrocautery-enhanced delivery system

T2 - a large retrospective study (with video)

AU - Rinninella, Emanuele

AU - Kunda, Rastislav

AU - Dollhopf, Markus

AU - Sanchez-Yague, Andres

AU - Will, Uwe

AU - Tarantino, Ilaria

AU - Gornals Soler, Joan

AU - Ullrich, Sebastian

AU - Meining, Alexander

AU - Esteban, Josè Miguel

AU - Enz, Thomas

AU - Vanbiervliet, Geoffroy

AU - Vleggaar, FP

AU - Attili, Fabia

AU - Larghi, Alberto

PY - 2015/12

Y1 - 2015/12

N2 - BACKGROUND AND AIMS: A lumen-apposing, self-expanding metal stent incorporated in an electrocautery-enhanced delivery system for EUS-guided drainage of pancreatic fluid collections (PFCs) recently has become available. The aim of this study was to analyze the safety and clinical effectiveness of this newly developed device in this clinical setting.METHODS: This was a retrospective analysis of all consecutive patients with PFCs who underwent EUS-guided drainage using the study device in 13 European centers.RESULTS: Ninety-three patients with PFCs (80% with complex collections) underwent drainage using the study device. Penetration of the PFC was accomplished directly with the study device in 74.2% of patients, and successful stent placement was accomplished in all but 1 patient, mostly without fluoroscopic assistance. Direct endoscopic necrosectomy (DEN) was carried out in 31 of 52 cases (59.6%) of walled-off necrosis and in 2 of 4 cases (50%) of acute peripancreatic fluid collection. Complete resolution of the PFC was obtained in 86 cases (92.5%), with no recurrence during follow-up. Treatment failure occurred in 6 patients because of persistent infection requiring surgery (n = 3), perforation and massive bleeding caused by the nasocystic drainage catheter (NCDC) (n = 2), and the need for a larger opening to extract large necrotic tissue pieces (n = 1). Major adverse events occurred in 5 patients (perforation and massive bleeding caused by the NCDC in 2 patients, 1 pneumoperitoneum and 1 stent dislodgement during DEN, and 1 postdrainage infection) and were mostly not related to the drainage procedure.CONCLUSIONS: EUS-guided drainage with the electrocautery-enhanced delivery system is a safe, easy to perform, and a highly effective minimally invasive treatment modality for PFCs.

AB - BACKGROUND AND AIMS: A lumen-apposing, self-expanding metal stent incorporated in an electrocautery-enhanced delivery system for EUS-guided drainage of pancreatic fluid collections (PFCs) recently has become available. The aim of this study was to analyze the safety and clinical effectiveness of this newly developed device in this clinical setting.METHODS: This was a retrospective analysis of all consecutive patients with PFCs who underwent EUS-guided drainage using the study device in 13 European centers.RESULTS: Ninety-three patients with PFCs (80% with complex collections) underwent drainage using the study device. Penetration of the PFC was accomplished directly with the study device in 74.2% of patients, and successful stent placement was accomplished in all but 1 patient, mostly without fluoroscopic assistance. Direct endoscopic necrosectomy (DEN) was carried out in 31 of 52 cases (59.6%) of walled-off necrosis and in 2 of 4 cases (50%) of acute peripancreatic fluid collection. Complete resolution of the PFC was obtained in 86 cases (92.5%), with no recurrence during follow-up. Treatment failure occurred in 6 patients because of persistent infection requiring surgery (n = 3), perforation and massive bleeding caused by the nasocystic drainage catheter (NCDC) (n = 2), and the need for a larger opening to extract large necrotic tissue pieces (n = 1). Major adverse events occurred in 5 patients (perforation and massive bleeding caused by the NCDC in 2 patients, 1 pneumoperitoneum and 1 stent dislodgement during DEN, and 1 postdrainage infection) and were mostly not related to the drainage procedure.CONCLUSIONS: EUS-guided drainage with the electrocautery-enhanced delivery system is a safe, easy to perform, and a highly effective minimally invasive treatment modality for PFCs.

U2 - 10.1016/j.gie.2015.04.006

DO - 10.1016/j.gie.2015.04.006

M3 - Article

C2 - 26014960

SN - 0016-5107

VL - 82

SP - 1039

EP - 1046

JO - Gastrointestinal Endoscopy

JF - Gastrointestinal Endoscopy

IS - 6

ER -

EUS-guided drainage of pancreatic fluid collections using a novel lumen-apposing metal stent on an electrocautery-enhanced delivery system: a large retrospective study (with video)

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