Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
Gastrointest Endosc. 2012 Apr;75(4):870-6. doi: 10.1016/j.gie.2011.10.020. Epub 2012 Jan 31.
Tubular plastic and metal stents have inherent shortcomings when used for transenteric drainage of fluid collections.
To evaluate a novel lumen-apposing, self-expandable metal stent for EUS-guided drainage of pancreatic pseudocysts and the gallbladder.
Retrospective case series.
Tertiary-care academic medical center.
This study involved 15 patients (median age 54 years) with symptomatic pancreatic pseudocysts who underwent 12 transgastric and 3 transduodenal pseudocyst drainage procedures. Five patients (median age 69.5 years) with acute cholecystitis underwent 4 cholecystoduodenostomies and 1 cholecystogastostomy.
Stent deployment under EUS guidance, passage of an endoscope through the stent lumen for pseudocystoscopy or cholecystoscopy, transenteric endoscopy-guided interventions including biopsy, necrosectomy, and stone removal.
Technical and clinical success.
All stents were successfully deployed without complication, with a median time to removal of 35 days. All pseudocysts resolved after a single drainage procedure. One stent migrated into the stomach, and the remaining 14 were found to be patent at the time of removal. There was no pseudocyst recurrence during the 11.4-month median follow-up period. One gallbladder stent remains indwelling and fully patent at 12 months. Resolution of acute cholecystitis was observed immediately after stent implantation. No recurrence of symptoms was observed during a median follow-up period of 9 months.
Retrospective study, small sample size, lack of control patients.
Transenteric drainage of pancreatic pseudocysts and the gallbladder by using a novel, lumen-apposing, metal stent was accomplished with high technical and clinical success in this pilot observational study. Further studies are warranted.
管状塑料和金属支架在用于肠内引流积液时存在固有缺陷。
评估一种新型的腔内置入、自膨式金属支架，用于超声内镜引导下引流胰腺假性囊肿和胆囊。
回顾性病例系列研究。
三级保健学术医疗中心。
这项研究涉及 15 名（中位年龄 54 岁）有症状的胰腺假性囊肿患者，他们接受了 12 例经胃和 3 例经十二指肠假性囊肿引流术。5 名（中位年龄 69.5 岁）急性胆囊炎患者接受了 4 例胆囊十二指肠吻合术和 1 例胆囊胃吻合术。
在超声内镜引导下放置支架，通过支架腔内置入内镜进行假性囊肿镜检或胆囊镜检，进行经内镜肠道内干预，包括活检、坏死组织清除和取石。
技术和临床成功率。
所有支架均成功放置，无并发症，中位取出时间为 35 天。所有假性囊肿在单次引流后均得到解决。1 枚支架迁移至胃内，其余 14 枚支架在取出时发现通畅。在中位随访 11.4 个月期间，假性囊肿无复发。1 枚胆囊支架仍留置，12 个月时完全通畅。支架植入后即刻观察到急性胆囊炎得到缓解。在中位随访 9 个月期间，无症状复发。
回顾性研究，样本量小，缺乏对照患者。
在这项初步观察性研究中，使用新型腔内置入、自膨式金属支架进行胰腺假性囊肿和胆囊的经肠引流取得了很高的技术和临床成功率。需要进一步研究。
