Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
Division of Gastroenterology, University of North Carolina, Chapel Hill, North Carolina, USA.
Gastrointest Endosc. 2018 Jan;87(1):141-149. doi: 10.1016/j.gie.2017.04.032. Epub 2017 May 3.
Symptomatic pancreatic walled-off necrosis (WON) may be managed by endoscopic transmural drainage and endoscopic transmural necrosectomy, with stent placement at endoscopic drainage sites. The optimal stent choice is yet to be determined. We compared outcomes after endoscopic management of WON using either large-caliber fully covered self-expandable metal stents (LC-SEMSs) or double-pigtail plastic stents (DPPSs).
We performed a retrospective comparison of outcomes among patients who received LC-SEMSs or DPPSs before endoscopic transmural necrosectomy for WON.
Among 94 patients included, WON resolution rates did not differ between the DPPS (36 patients) and LC-SEMS (58 patients) groups, whether concomitant percutaneous drainage was considered a failure (75% vs 82.8%; P = .36) or not (91.7% vs 94.8%; P = .55). Of 75 patients (80%) successfully treated without percutaneous drainage, 37 (49%) underwent endoscopic transmural drainage without subsequent endoscopic transmural necrosectomy. WON was more likely to resolve without subsequent endoscopic transmural necrosectomy in the LC-SEMS group than the DPPS group (60.4% vs 30.8%; P = .01). WON resolution without subsequent endoscopic transmural necrosectomy remained more likely with LC-SEMSs (odds ratio, 4.5 [95% confidence interval, 1.5-15.5]) after adjusting for patient age and size and location of WON. Rates of adverse events were similar except for clinically significant bleeding requiring endoscopic intervention, which was higher with DPPSs than LC-SEMSs (14% vs 2%; P = .02).
Management of pancreatic WON with LC-SEMSs appears to decrease both the need for repeated necrosectomy procedures and the risk of intervention-related hemorrhage.
有症状的胰腺包裹性坏死（WON）可通过内镜经壁引流和内镜经壁坏死组织清除术进行治疗，同时在内镜引流部位放置支架。目前尚未确定最佳的支架选择。我们比较了使用大口径全覆膜自膨式金属支架（LC-SEMS）或双猪尾塑料支架（DPPS）进行内镜治疗 WON 的结果。
我们对接受内镜经壁坏死组织清除术治疗 WON 前使用 LC-SEMS 或 DPPS 的患者进行了回顾性比较。
在纳入的 94 例患者中，无论是否同时行经皮引流，DPPS（36 例）和 LC-SEMS（58 例）组的 WON 缓解率均无差异（失败率分别为 75%和 82.8%，P=.36；成功率分别为 91.7%和 94.8%，P=.55）。在无需经皮引流而成功治疗的 75 例患者（80%）中，37 例（49%）未行内镜经壁坏死组织清除术而行内镜经壁引流。与 DPPS 组相比，LC-SEMS 组更有可能无需行内镜经壁坏死组织清除术而使 WON 得到缓解（60.4% vs 30.8%，P=.01）。在调整患者年龄、WON 大小和位置后，LC-SEMS 组无需行后续内镜经壁坏死组织清除术使 WON 得到缓解的可能性仍然更高（比值比，4.5[95%置信区间，1.5-15.5]）。除了 DPPS 组比 LC-SEMS 组更易发生需要内镜干预的临床显著出血（14% vs 2%，P=.02）外，两组不良事件发生率相似。
LC-SEMS 治疗胰腺 WON 似乎可以减少重复坏死组织清除术的需要，并降低与干预相关的出血风险。
