scholarly journals Use of Lumen-Apposing Stents for the Treatment of Postsurgical Fluid Collections: A Case Series and a Review of Literature

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Priyanka Priyanka ◽  
William Hsueh ◽  
John Nasr
Keyword(s):  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Fluid Collection ◽  
Case Series ◽  
Plastic Stents ◽  
Metal Stents ◽  
Pancreatic Fluid Collection ◽  
Pancreatic Fluid ◽  
Whipple’S Procedure ◽  
Fluid Collections

Lumen-apposing metal stents (LAMS) use in gastrointestinal endoscopy has been on the rise for various indications for the last few years. Currently, LAMS is a well-established treatment for post-pancreatitis peri-pancreatic fluid collections and walled-off necrosis (WON), but it is still not a standard of care in the treatment of post-surgical fluid collections (PSFC). Most of the earlier studies for treatment of PSFC utilized double pigtail plastic stents (DPS). We present a series of 3 cases where LAMS was successfully used for PSFC drainage. The cases include a patient with perigastric abscess after Whipple’s procedure, a case of peri-pancreatic collection after distal pancreatectomy, and a patient with peri-pancreatic fluid collection after right partial hepatectomy and splenectomy due to lacerations from a motor vehicle accident.

scholarly journals Comparative Randomized Multicenter Study Of Plastic Vs. Self-expanding Metal Stents In The Endoscopic Ultrasound-guided Drainage Of Walled-off Pancreatic Necrosis

2019 ◽  
Author(s):  
joan b gornals ◽  
Manuel Perez-Miranda ◽  
Enrique Vazquez-Sequeiros ◽  
Juan Vila ◽  
Jose M Esteban ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Clinical Success ◽  
Fluid Collection ◽  
Plastic Stents ◽  
Metal Stents ◽  
Controlled Clinical Trial ◽  
Pancreatic Fluid Collection ◽  
Pancreatic Fluid ◽  
Tertiary Hospitals ◽  
Walled Off Necrosis

Abstract Background: It seems that the appearance of lumen-apposing metal stents (LAMS), are displacing the role of plastic stents in the therapy of pancreatic fluid collection as walled-off necrosis (WON). To date there is no quality of evidence to recommend LAMS as the standard treatment in management of WON. The theoretical benefit of LAMS over PLASTIC stents, need to be proved.Methods/design: This is a multicenter prospective study, superiority, randomized controlled clinical trial by parallel groups, without masking. One hundred fourteen patients with WON will be Endoscopic ultrasound (EUS)-guided transmural drained in 9 tertiary hospitals in Spain and will be randomized to the LAMS or PLASTIC stent group. The primary endpoint is to assess the short-term (4 weeks) clinical success determined by the reduction of the collection (to <50% or < 5cm in size), along with clinical improvement. Secondary endpoints: the long-term (4 months) clinical success (total resolution or 5cm); the procedure’s duration, the level of difficulty, safety and recurrences.Discussion: The PROMETHEUS trial has been designed to response if LAMS are superior over PLASTIC stents in the EUS-guided transmural drainage of WON. Trial registration: ClinicalTrials.gov, NCT03100578. Registered on April 4, 2017. https://clinicaltrials.gov/ct2/home

scholarly journals Perivesicular Abscess Drainage with Lumen-Apposing SelfExpanding Metal Stents

2020 ◽  
Vol 12 (3) ◽  
pp. 206-210
Author(s):  
Gabriel Melki ◽  
Abdalla Mohamed ◽  
Yana Cavanagh ◽  
Walid Baddoura ◽  
Matthew Grossman
Keyword(s):  
Large Diameter ◽  
Fluid Collection ◽  
Plastic Stents ◽  
Metal Stents ◽  
Abscess Drainage ◽  
Pancreatic Fluid Collection ◽  
Therapeutic Modalities ◽  
Abdominal Abscesses ◽  
Pancreatic Fluid ◽  
Self Expanding Metal Stents

Abdominal and pelvic abscesses can occur due to a number of reasons, the most common being surgery. They are associated with significant morbidity and mortality. The treatment approach for these types of collections is often the initiation of broad-spectrum antibiotics, accompanied by drainage. Multiple diagnostic and therapeutic modalities have been described, including; percutaneous, transvaginal, endoscopic, and surgicaldrainage. Due to the complexity of pelvic anatomy, minimally invasive approaches such as percutaneous drainage are usually difficult. Pelvic abscesses have been historically drained through surgery. Endoscopic ultrasound (EUS)-guided interventions have emerged as an alternative for the management of difficult abdominal and pelvic abscesses. Endoscopic interventions have classically included diagnostic and therapeutic aspiration, utilizing drainage catheters with or without placement of plastic stents. More recently, the use of lumen apposing self-expanding metal stents has become a treatment option for deep pelvic abscesses. Lumen opposing metal stents (LAMS) have a saddle-shaped design with two large-diameter flanges on both ends of the stent to anchor the stent edges within the respective lumens as well asa central waist that allows for communication between the two lumens. LAMS were originally designed for transmural pancreatic fluid collection drainage; however,they have been successfully implemented for numerous other off-label uses, including the drainage of pelvic and abdominal abscesses. We present the case of a 34-year-old womanwho presented with a septated abscess located between the urinary bladder and the rectum, which was successfully and definitively drained with LAMS.

scholarly journals Comparison of early and delayed EUS-guided drainage of pancreatic fluid collection

2018 ◽  
Vol 06 (12) ◽  
pp. E1398-E1405 ◽  
Author(s):  
Tanyaporn Chantarojanasiri ◽  
Natsuyo Yamamoto ◽  
Yousuke Nakai ◽  
Tomotaka Saito ◽  
Kei Saito ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Gastrointestinal Tract ◽  
Fluid Collection ◽  
Adverse Event Rate ◽  
Plastic Stents ◽  
Endoscopic Drainage ◽  
Metallic Stent ◽  
Pancreatic Fluid Collection ◽  
Pancreatic Fluid ◽  
Covered Metallic Stent

Abstract Background and study aims While endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collection (PFC) is recommended to be performed ≥ 4 weeks after onset of acute pancreatitis (AP), early (< 4 weeks) interventions are needed in some symptomatic cases. Despite feasibility of early percutaneous drainage, there have been few studies about early EUS-guided drainage of PFC. Patients and methods Consecutive patients who received EUS-guided drainage (EUS-PCD) of infected or symptomatic PFC at the University of Tokyo were retrospectively studied. Contraindications for EUS-PCD are lack of encapsulation or adhesion to the gastrointestinal tract. Safety and effectiveness of early vs delayed (≥ 4 weeks) EUS-PCD were compared. Results A total of 35 patients underwent EUS-PCD (12 early and 23 delayed) using 19 large-bore fully-covered metallic stent and 16 plastic stents. The median diameter of PFC was 110 mm (40 – 180) and 122 mm (17 – 250) in the early and delayed drainage groups, respectively. Median time from onset of AP to drainage was 23 and 85 days for early and delayed drainage, respectively. The technical success rate of EUS-guided drainage was 100 %. Endoscopic necrosectomy was performed in six early and 16 cases of delayed drainage. The adverse event rate was 25 % (3 bleeding) and 13 % (2 perforations and 1 CO2 retention) in the early and delayed drainage groups, respectively. Two patients died (1 early and 1 delayed) due to multiorgan failure. Conclusion Endoscopic drainage and subsequent necrosectomy of symptomatic PFC within 4 weeks after onset of acute pancreatitis was feasible, given that the collection was encapsulated and attached to the gastrointestinal tract.

scholarly journals A systematic review and meta-analysis of metal versus plastic stents for drainage of pancreatic fluid collections: metal stents are advantageous

2018 ◽  
Vol 33 (5) ◽  
pp. 1412-1425 ◽  
Author(s):  
Rebecca Saunders ◽  
Jayapal Ramesh ◽  
Silvia Cicconi ◽  
Jonathan Evans ◽  
Vincent S. Yip ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Plastic Stents ◽  
Metal Stents ◽  
Pancreatic Fluid Collections ◽  
Pancreatic Fluid ◽  
Fluid Collections

Lumen-apposing metal stents for pancreatic fluid collection drainage: may not be business as usual?

Gut ◽  
2016 ◽  
Vol 66 (8) ◽  
pp. 1530.1-1530 ◽  
Author(s):  
John S Leeds ◽  
Manu K Nayar ◽  
Richard M Charnley ◽  
Kofi W Oppong
Keyword(s):  
Fluid Collection ◽  
Metal Stents ◽  
Pancreatic Fluid Collection ◽  
Pancreatic Fluid ◽  
Business As Usual

scholarly journals Multicenter study of plastic vs. self-expanding metal stents in endoscopic ultrasound-guided drainage of walled-off pancreatic necrosis – PROMETHEUS: a randomized controlled trial protocol

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Joan B. Gornals ◽  
◽  
Manuel Perez-Miranda ◽  
Enrique Vazquez-Sequeiros ◽  
Juan Vila ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Clinical Success ◽  
Controlled Trial ◽  
Fluid Collection ◽  
Plastic Stents ◽  
Metal Stents ◽  
Pancreatic Fluid Collection ◽  
Randomized Controlled ◽  
Link Type ◽  
Walled Off Necrosis

Abstract Background It seems that lumen-apposing metal stents (LAMS) are displacing plastic stents in the therapy of pancreatic-fluid collection in walled-off necrosis (WON). To date, there is no quality of evidence to recommend LAMS as the standard treatment in the management of WON. The theoretical benefit of LAMS over plastic stents needs to be proven. Methods/design This is a randomized controlled, multicenter, prospective clinical trial with two parallel groups, without masking. One-hundred and fourteen patients with WON will undergo endoscopic ultrasound (EUS)-guided transmural draining in nine tertiary hospitals in Spain and will be randomized to the LAMS or plastic-stent group. The primary endpoint is the short-term (4 weeks) clinical success determined by the reduction of the collection (to < 50% or < 5 cm in size), along with clinical improvement. Secondary endpoints: long-term (4 months) clinical success (total resolution or 5 cm), procedure duration, level of difficulty, safety, and recurrences. Discussion The PROMETHEUS trial has been designed to determine whether LAMS are superior to plastic stents in EUS-guided transmural drainage of WON. Trial registration ClinicalTrials.gov, ID: NCT03100578. Registered on 4 April 2017. https://clinicaltrials.gov/ct2/home

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