scholarly journals Which Are the Most Suitable Stents for Interventional Endoscopic Ultrasound?

2020 ◽  
Vol 9 (11) ◽  
pp. 3595
Author(s):  
Se Woo Park ◽  
Sang Soo Lee
Keyword(s):  
Clinical Outcomes ◽  
Endoscopic Ultrasound ◽  
Outlet Obstruction ◽  
Current Status ◽  
Easy Access ◽  
Metal Stents ◽  
Interventional Eus ◽  
Pancreatic Fluid ◽  
Surgically Altered Anatomy ◽  
Walled Off Necrosis

Endoscopic ultrasound (EUS)-guided interventions provide easy access to structures adjacent to the gastrointestinal tract, effectively targeting them for therapeutic purposes. They play an important role in the management of pancreatic fluid collections (PFC) and bile duct (BD) and pancreatic duct (PD) drainage in cases of failed endoscopic retrograde cholangiopancreatography (ERCP) or gallbladder (GB) drainage. Specially designed stents and delivery systems for EUS-guided transluminal interventions allow various new applications and improve the efficacy and safety of these procedures. In fact, EUS-guided drainage has emerged as the treatment of choice for the management of PFC, and recent innovations such as fully covered metal stents (including lumen-apposing metal stents) have improved outcomes in patients with walled-off necrosis. Similarly, EUS-guided BD and PD drainage with specially designed stents can be beneficial for patients with failed ERCP due to an inaccessible papilla, gastric outlet obstruction, or surgically altered anatomy. EUS-guided GB drainage is also performed using dedicated stents in patients with acute cholecystitis who are not fit for surgery. Although the field of dedicated stents for interventional EUS is rapidly advancing with increasing innovations, the debate on the most appropriate stent for EUS-guided drainage has resurfaced. Furthermore, some important questions remain unaddressed, such as which stent improves clinical outcomes and safety in EUS-guided drainage. Herein, the current status and problems of the available stents are reviewed, including the applicable indications, long-term clinical outcomes, comparison between each stent, and their future prospects.

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

Novel 15-mm-long lumen-apposing metal stent for endoscopic ultrasound-guided drainage of pancreatic fluid collections located ≥10 mm from the luminal wall

Endoscopy ◽  
2021 ◽  
Author(s):  
Linda Y. Zhang ◽  
Rastislav Kunda ◽  
Maridi Aerts ◽  
Nouredin Messaoudi ◽  
Rishi Pawa ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Clinical Symptoms ◽  
Clinical Success ◽  
Duodenal Wall ◽  
Metal Stents ◽  
Pancreatic Fluid Collections ◽  
Pancreatic Fluid ◽  
Maximal Diameter ◽  
International Multicenter Study ◽  
Fluid Collections

Abstract Background Endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collections (PFCs) by cautery-enhanced lumen-apposing metal stents (LAMS) has largely been limited to collections located < 10 mm from the luminal wall. We present outcomes of the use of a novel 15-mm-long cautery-enhanced LAMS for drainage of PFCs located ≥ 10 mm away. Methods This international, multicenter study analyzed all adults with PFCs located ≥ 10 mm from the luminal wall who were treated by EUS-guided drainage using the 15-mm-long cautery-enhanced LAMS. The primary outcome was technical success. Secondary outcomes included clinical success (decrease in PFC size by ≥ 50 % at 30 days and resolution of clinical symptoms without surgical intervention), complications, and recurrence. Results 35 patients (median age 57 years; interquartile range [IQR] 47–64 years; 49 % male) underwent novel LAMS placement for drainage of PFCs (26 walled-off necrosis, 9 pseudocysts), measuring 85 mm (IQR 64–117) maximal diameter and located 11.8 mm (IQR 10–12.3; range 10–14) from the gastric/duodenal wall. Technical and clinical success were high (both 97 %), with recurrence in one patient (3 %) at a median follow-up of 123 days (58–236). Three complications occurred (9 %; one mild, two moderate). Conclusions The 15-mm-long cautery-enhanced LAMS was feasible and safe for drainage of PFCs located 10–14 mm from the luminal wall.

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 Endoscopic Ultrasound-guided Gastroenterostomy: A Promising Alternative to Surgery

2019 ◽  
Vol 7 (3) ◽  
pp. 93-99 ◽  
Author(s):  
Guoxin Wang ◽  
Xiang Liu ◽  
Sheng Wang ◽  
Nan Ge ◽  
Jintao Guo ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Outlet Obstruction ◽  
Metal Stents ◽  
Success Rates ◽  
Ultrasound Guided ◽  
Traditional Treatment ◽  
Promising Alternative ◽  
Prolonged Hospital ◽  
Surgical Adverse Events ◽  
Guided Therapy

Abstract Recently, with the advancement of techniques, endoscopic ultrasound-guided therapies have shown distinct advantages, especially in relieving benign and malignant gastric outlet obstruction (GOO), as well as in postoperative pancreaticobiliary diseases. Herein, we present five currently used approaches in endoscopic ultrasound-guided gastroenterostomy (EUS-GE) using lumenapposing biflanged metal stents (LAMS), along with several examples of LAMS-based EUS treatment of pancreaticobiliary diseases. Compared with traditional treatment methods, EUS-guided procedures have – to some degree – shown higher success rates, both technical and clinical. Moreover, EUS-guided therapies reduce the risk of multiple surgical adverse events, including delayed gastric emptying, prolonged hospital stay, increased costs, and delay in cancer treatment. Particularly in terms of postoperative pancreaticobiliary diseases, EUS-guided therapy has assumed an essential role as a treatment option in cases where traditional methods are difficult to perform. Nevertheless, EUS-guided gastrointestinal procedures are still relatively new, with some clinical failures, and additional prospective clinical trials are warranted.

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