TY - JOUR
T1 - The safety and efficacy of a new 20-mm lumen apposing metal stent (lams) for the endoscopic treatment of pancreatic and peripancreatic fluid collections
T2 - a large international, multicenter study
AU - Anderloni, Andrea
AU - Fabbri, Carlo
AU - Nieto, Jose
AU - Uwe, Will
AU - Dollhopf, Markus
AU - Aparicio, José Ramón
AU - Perez-Miranda, Manuel
AU - Tarantino, Ilaria
AU - Arlt, Alexander
AU - Vleggaar, Frank
AU - Vanbiervliet, Geoffrey
AU - Hampe, Jochen
AU - Kahaleh, Michel
AU - Vila, Juan J
AU - Dayyeh, Barham K Abu
AU - Storm, Andrew C
AU - Fugazza, Alessandro
AU - Binda, Cecilia
AU - Charachon, Antoine
AU - Sevilla-Ribota, Sergio
AU - Tyberg, Amy
AU - Robert, Moran
AU - Wani, Sachin
AU - Repici, Alessandro
AU - Sethi, Amrita
AU - Khashab, Mouen A
AU - Kunda, Rastislav
N1 - Publisher Copyright:
© 2020, Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2021/4
Y1 - 2021/4
N2 - BACKGROUND: Lumen apposing metal stent (LAMS) allows an easy access to peripancreatic fluid collections (PPFCs) and the possibility of performing direct endoscopic necrosectomy (DEN). The aim of our study was to evaluate the safety and efficacy of a new 20-mm LAMS in the management of PPFCs. This novel stent represents the largest diameter LAMS available on the market to date.METHODS: This is an international, multicenter retrospective study involving 20 centers. Consecutive patients who underwent EUS-guided PPFC drainage using a 20-mm LAMS were included. Primary outcomes were technical and clinical success. Secondary outcomes were rate and the severity of adverse events.RESULTS: A total 105 patients underwent PPFC drainage using the new 20-mm LAMS and 106 LAMS were placed. Technical success was 100% (106/106). 7/105 patients died due to causes not related to the stent. Clinical success was achieved in 92/98 patients (93.9%). Significant adverse events occurred in 8/98 patients (8.16%): 4 cases (4.08%) of bleeding, 3 cases (3.06%) of suprainfection, 1 case of gastric outlet obstruction.CONCLUSIONS: This multicenter study demonstrated acceptable rates of technical and clinical success using a new 20-mm LAMS for PPFC, including walled-off pancreatic necrosis (WOPN). The results of our study suggest that a new 20-mm LAMS is non-inferior in terms of safety, efficacy, and adverse events as compared to smaller diameter LAMS in the management of PPFCs, including pancreatic psuedocysts (PP) and WOPN. Randomized controlled studies will be needed to determine the ideal size of LAMS need to achieve the greatest clinical benefit with the minimized risk exposure for this high-risk patient population.
AB - BACKGROUND: Lumen apposing metal stent (LAMS) allows an easy access to peripancreatic fluid collections (PPFCs) and the possibility of performing direct endoscopic necrosectomy (DEN). The aim of our study was to evaluate the safety and efficacy of a new 20-mm LAMS in the management of PPFCs. This novel stent represents the largest diameter LAMS available on the market to date.METHODS: This is an international, multicenter retrospective study involving 20 centers. Consecutive patients who underwent EUS-guided PPFC drainage using a 20-mm LAMS were included. Primary outcomes were technical and clinical success. Secondary outcomes were rate and the severity of adverse events.RESULTS: A total 105 patients underwent PPFC drainage using the new 20-mm LAMS and 106 LAMS were placed. Technical success was 100% (106/106). 7/105 patients died due to causes not related to the stent. Clinical success was achieved in 92/98 patients (93.9%). Significant adverse events occurred in 8/98 patients (8.16%): 4 cases (4.08%) of bleeding, 3 cases (3.06%) of suprainfection, 1 case of gastric outlet obstruction.CONCLUSIONS: This multicenter study demonstrated acceptable rates of technical and clinical success using a new 20-mm LAMS for PPFC, including walled-off pancreatic necrosis (WOPN). The results of our study suggest that a new 20-mm LAMS is non-inferior in terms of safety, efficacy, and adverse events as compared to smaller diameter LAMS in the management of PPFCs, including pancreatic psuedocysts (PP) and WOPN. Randomized controlled studies will be needed to determine the ideal size of LAMS need to achieve the greatest clinical benefit with the minimized risk exposure for this high-risk patient population.
KW - EUS-guided drainage
KW - Lumen apposing metal stent
KW - Pancreatic fluid collection
KW - Walled-off pancreatic necrosis
UR - http://www.scopus.com/inward/record.url?scp=85083796526&partnerID=8YFLogxK
U2 - 10.1007/s00464-020-07567-8
DO - 10.1007/s00464-020-07567-8
M3 - Article
C2 - 32323015
SN - 0930-2794
VL - 35
SP - 1741
EP - 1748
JO - Surgical endoscopy
JF - Surgical endoscopy
IS - 4
ER -