scholarly journals GRUPUGE Perspective: Endoscopic Ultrasound-Guided Drainage of Peripancreatic Collections

2020 ◽  
Vol 28 (1) ◽  
pp. 39-51
Author(s):  
Flávio Pereira ◽  
Ana Caldeira ◽  
Sílvia Leite ◽  
Susana Marques ◽  
Teresa Moreira ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Clinical Success ◽  
Fluid Collection ◽  
Surgical Approaches ◽  
Ultrasound Guided ◽  
Technical Issues ◽  
Transmural Drainage ◽  
Walled Off Necrosis

Pancreatic and peripancreatic collections (PPC) are a known complication of acute pancreatitis. They are categorized into four types of collection: (1) acute peripancreatic fluid collection, (2) pseudocyst, (3) acute necrotic collection and (4) walled-off necrosis. Most PPC resolve spontaneously or are persistent but asymptomatic. Intervention is needed in a minority of patients with infected or symptomatic collection. Endoscopic ultrasound-guided transmural drainage is currently the first-line treatment option for PPC management. It has shown great technical and clinical success, similar to percutaneous or surgical approaches, but with lower morbidity and costs and better quality of life. In this review article, the GRUPUGE presents an updated perspective on the potential role of endoscopic ultrasound-guided drainage of peripancreatic collections, addressing the selection criteria and the technical issues of different techniques and analysing emerging data on their efficacy and safety.

Endoscopic ultrasound-guided entero-enterostomy for the treatment of afferent loop syndrome: a multicenter experience

Endoscopy ◽  
2018 ◽  
Vol 50 (09) ◽  
pp. 891-895 ◽  
Author(s):  
Olaya Brewer Gutierrez ◽  
Shayan Irani ◽  
Saowanee Ngamruengphong ◽  
Hanaa Aridi ◽  
Rastislav Kunda ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Clinical Success ◽  
Indirect Comparison ◽  
Procedure Time ◽  
Technical Success ◽  
Ultrasound Guided ◽  
Common Procedure ◽  
Afferent Loop ◽  
Afferent Loop Syndrome

Abstract Background Afferent loop syndrome (ALS) is traditionally managed surgically and, more recently, endoscopically. The role of endoscopic ultrasound-guided entero-enterostomy (EUS-EE) has not been well described. The aim of this study was to assess the technical and clinical success and safety of EUS-EE. Methods This was a multicenter, retrospective series at six centers in patients with ALS treated by EUS-EE. Data on patients treated with enteroscopy-assisted luminal stenting (EALS) at a single center were also collected. Results 18 patients (mean age 64.2 years, 72 % post-pancreaticoduodenectomy, 10 female) underwent EUS-EE. The most common symptoms were vomiting (27.8 %) and jaundice (33.3 %). Clinical success included resolution of symptoms in 88.9 % and improvement to allow hospital discharge in 11.1 %. Technical success was achieved in 100 % of cases, with a mean procedure time of 29.7 minutes. The most common procedure was a gastro-jejunostomy (72.2 %). Three adverse events (16.7 %) occurred (two mild, one moderate). When compared with data on EALS, patients treated with EUS-EE needed fewer re-interventions (16.6 % vs. 76.5 %; P < 0.001). Conclusion EUS-EE seems to be safe and effective in the treatment of ALS. Indirect comparison with EALS suggested that EUS-EE is associated with a reduced need for re-intervention.

scholarly journals Efficacy and safety of endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD): A systematic review and meta-analysis of 714 patients

2020 ◽  
Vol 08 (11) ◽  
pp. E1664-E1672
Author(s):  
Saurabh Chandan ◽  
Babu P. Mohan ◽  
Shahab R. Khan ◽  
Lena L. Kassab ◽  
Suresh Ponnada ◽  
...  
Keyword(s):  
Adverse Events ◽  
Pancreatic Duct ◽  
Endoscopic Ultrasound ◽  
Clinical Success ◽  
Meta Analysis ◽  
Fluid Collection ◽  
Technical Success ◽  
Ultrasound Guided ◽  
Anastomotic Strictures ◽  
Pancreatic Duct Drainage

Abstract Background and study aims Endoscopic ultrasound guided pancreatic duct drainage (EUS-PDD) is a minimal-invasive therapeutic option to surgery and in patients with failed endoscopic retrograde pancreatography (ERP). The aim of this review was to quantitatively appraise the clinical outcomes of EUS-PDD by meta-analysis methods. Methods We searched multiple databases from inception through March 2020 to identify studies that reported on EUS-PDD. Pooled rates of technical success, successful drainage of pancreatic duct, clinical success, and adverse events were calculated. Study heterogeneity was assessed using I2% and 95 % prediction interval. Results A total of 22 studies (714 patients) were included. The pooled rate of technical success in EUS-PDD was 84.8 % (95 % CI 79.1–89.2). The pooled rate of successful PD drained by EUS-PDD was 77.5 % (95 % CI 63.1–87.4). The pooled rate of clinical success of EUS-PDD was 89.2 % (95 % CI 82.1–93.7). The pooled rate of all adverse events was 18.1 % (95 % CI 14.2–22.9). On sub-group analysis, the pooled technical success and clinical success of EUS-PDD from Japanese data were considerably superior (91.2 %, 83–95.6 & 92.5 %, 83.9–96.7, respectively). The pooled rate of post EUS-PDD acute pancreatitis was 6.6 % (95 % CI 4.5–9.4), bleeding was 4.1 % (95 % CI 2.7–6.2), perforation and/or pneumoperitoneum was 3.1 % (95 % CI 1.9–5), pancreatic leak and/or pancreatic fluid collection was 2.3 % (95 % CI 1.4–4), and infection was 2.8 % (95 % CI 1.7–4.6). Conclusion EUS-PDD demonstrates high technical success and clinical success rates with acceptable adverse events. Technical success was especially high for anastomotic strictures.

The role of solid debris in endoscopic ultrasound‐guided drainage of walled‐off necrosis: A large cohort study

2020 ◽  
Vol 35 (12) ◽  
pp. 2103-2108 ◽  
Author(s):  
Huiyun Zhu ◽  
Pei Xie ◽  
Yuxin Wang ◽  
Zhendong Jin ◽  
Zhaoshen Li ◽  
...  
Keyword(s):  
Cohort Study ◽  
Endoscopic Ultrasound ◽  
Large Cohort ◽  
Ultrasound Guided ◽  
Large Cohort Study ◽  
Walled Off Necrosis

scholarly journals Endoscopic ultrasound-guided placement of plastic pigtail stents for the drainage of refractory malignant ascites

2017 ◽  
Vol 05 (11) ◽  
pp. E1096-E1099 ◽  
Author(s):  
Rafael Romero-Castro ◽  
Victoria Jimenez-Garcia ◽  
Jaime Boceta-Osuna ◽  
Luis Castilla-Guerra ◽  
Francisco Pellicer-Bautista ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Poor Prognosis ◽  
Malignant Ascites ◽  
Refractory Ascites ◽  
Plastic Stents ◽  
Pancreatic Pseudocysts ◽  
Metal Stents ◽  
Ultrasound Guided ◽  
Walled Off Necrosis

AbstractEndoscopic ultrasound (EUS)-guided drainage is now the treatment of choice in cases of pancreatic pseudocysts and walled-off necrosis, especially in the absence of luminal bulging and in patients with portal hypertension. Malignant refractory ascites usually heralds a poor prognosis and substantially impairs the quality of life of patients because of the symptoms experienced and the need for repeated paracentesis. EUS-guided placement of lumen-apposing, fully covered, self-expandable metal stents (FCSEMS) has been reported for the drainage of malignant ascites. Herein, we present the results of EUS-guided placement of plastic pigtails stents for the drainage of refractory malignant ascites in three patients. The aim was to improve symptoms and minimize the possible drawbacks of large-caliber FCSEMS. In this preliminary experience, EUS-guided placement of plastic stents was feasible and avoided further paracentesis.

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 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

scholarly journals New Stents for Endoscopic Ultrasound-Guided Procedures

2021 ◽  
Vol 26 (4) ◽  
pp. 248-253
Author(s):  
Gunn Huh ◽  
Tae Jun Song
Keyword(s):  
Bile Duct ◽  
Endoscopic Ultrasound ◽  
Therapeutic Option ◽  
Fluid Collection ◽  
Metal Stents ◽  
Efficacy And Safety ◽  
Ultrasound Guided ◽  
Therapeutic Outcomes ◽  
Transmural Drainage ◽  
Self Expanding Metal Stents

Endoscopic ultrasound (EUS)-guided transmural drainage of peripancreatic fluid collection, gallbladder, bile duct, or pancreatic duct has emerged as a therapeutic option in patients with pancreatobiliary diseases. Recently, dedicated stents for EUS-guided interventions, which include lumen-apposing metal stents and modified tubular self-expanding metal stents, have been developed to improve efficacy and safety of these procedures. This article has reviewed newly developed stents for EUSguided interventions and their therapeutic outcomes.

Comparative Outcomes of EUS-Guided Lumen-Apposing Mental Stents Drainage for Pancreatic Pseudocysts and Walled-off Necrosis: Case Series and Meta-Analysis

2020 ◽  
Author(s):  
Jing Li ◽  
Qian Zhang ◽  
Anni Zhou ◽  
Guiping Zhao ◽  
Wenhai Wang ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Clinical Success ◽  
Medical Center ◽  
Meta Analysis ◽  
Case Series ◽  
Pancreatic Pseudocysts ◽  
Ultrasound Guided ◽  
Technical Success Rate ◽  
Significant Difference ◽  
Walled Off Necrosis

Abstract Background and Aims: Endoscopic ultrasound-guided transmural drainage for pancreatic fluid collections (PFCs) has become the first-line treatment with quicker recovery and less injury compared with surgery and percutaneous drainage. The efficacy of stents implantation and drainage for different types of PFCs remains controversial, especially lumen-apposing mental stents (LAMS). This study aims to compare efficacy and safety of LAMS drainage for pancreatic pseudocysts (PPC) and walled-off necrosis (WON).Methods: A meta-analysis was performed for LAMS drainage for WON and PPC by systematically searching PubMed, Cochrane, and Embase databases from January 2010 to January 2020. From 2017 to 2019, 12 patients who were treated with LAMS drainage for PFCs in our medical center were also reviewed and included in this study.Results: Combining 11 searched literatures with the data from our medical center, a total of 585 patients with PFCs were enrolled in this meta-analysis, including 343 patients with WON and 242 with PPC. The technical success rate in WON is not significant different from that of PPC (P = 0.08 > 0.05). The clinical success of LAMS placement was achieved in 99% versus 89% in PPC and WON, respectively (RR = 0.92, 95% CI: 0.86–0.98, P = 0.01 < 0.05). Further intervention of direct endoscopic necrosectomy was required in 60% of patients in WON group. There was no significant difference in the incidence of adverse events after LAMS placement between WON and PPC, including infection, bleeding, stent migration and stent occlusion.Conclusions: Endoscopic ultrasound-guided LAMS for PFCs is feasible, effective with preferable technical and clinical success rates. The clinical effect of LAMS on PPC is better than that of WON, but its adverse reactions still need to be verified in a large-sample prospective study.

scholarly journals Outcomes of Endoscopic-Ultrasound-Guided Cholangiopancreatography: A Literature Review

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Shahzad Iqbal ◽  
David M. Friedel ◽  
James H. Grendell ◽  
Stavros N. Stavropoulos
Keyword(s):  
Endoscopic Ultrasound ◽  
Clinical Success ◽  
Percutaneous Transhepatic Cholangiography ◽  
Pancreatic Ducts ◽  
Efficacy And Safety ◽  
Success Rates ◽  
Ultrasound Guided ◽  
Endoscopic Retrograde ◽  
Pancreatic Duct Drainage

Endoscopic retrograde cholangiopancreatography (ERCP) can fail in 3–10% of the cases even in experienced hands. Although percutaneous transhepatic cholangiography (PTC) and surgery are the traditional alternatives, there are morbidity and mortality associated with both. In this paper, we have discussed the efficacy and safety of endoscopic-ultrasound-guided cholangiopancreatography (EUS-CP) in decompression of biliary and pancreatic ducts. The overall technical and clinical success rates are around 90% for biliary and 70% for pancreatic duct drainage. The overall EUS-CP complication rate is around 15%. EUS-CP is, however, a technically challenging procedure and should be performed by an experienced endoscopist skilled in both EUS and ERCP. Same session EUS-CP as failed initial ERCP is practical and may result in avoidance of additional procedures. With increasing availability of endoscopists trained in both ERCP and EUS, the role of EUS-CP is likely to grow in clinical practice.

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