Department of Gastroenterology, Washington University in Saint Louis, St. Louis, Missouri, USA.
Department of Medicine, Washington University in Saint Louis, St. Louis, Missouri, USA.
Gastrointest Endosc. 2018 Jan;87(1):150-157. doi: 10.1016/j.gie.2017.06.029. Epub 2017 Jul 14.
Transmural drainage with double-pigtail plastic stents (DPPSs) was the mainstay of endoscopic therapy for symptomatic peripancreatic fluid collections (PPFCs) until the introduction of lumen-apposing covered self-expanding metal stents (LAMSs). Currently, there are limited data regarding the efficacy and adverse event rate of LAMSs compared with DPPSs.
A retrospective analysis of EUS-guided PPFC drainage at a single tertiary care center between 2008 and 2015 was performed. Patients were classified based on drainage method: DPPSs and LAMSs. Adverse event rates, unplanned endoscopic procedures/necrosectomies, and PPFC resolution within 6 months were recorded. Significant bleeding was defined as necessitating transfusion or requiring endoscopic treatment/radiographic embolization. Subsequent endoscopic procedures were defined as unplanned procedures; stent removals were excluded.
A total of 103 patients met inclusion criteria (84 DPPSs, 19 LAMSs). PPFCs were classified as walled-off necrosis (WON) in 23 (14 DPPSs, 9 LAMSs). There were significantly more bleeding episodes in the LAMS group (4 [19%]: 2 splenic artery pseudo-aneurysms, 1 collateral vessel bleed, 1 intracavitary variceal bleed; P = .0003) than in the DPPS group (1 (1%]: stent erosion into the gastric wall). One perforation occurred in the DPPS group. Unplanned repeat endoscopy was more frequent in the LAMS group (10% vs 26%, P = .07). Among retreated LAMS patients in with WON, 5 (56%) had obstruction by necrotic debris. In patients for whom follow-up was available, 67 of 70 (96%) with DPPSs and 16 of 17 (94%) with LAMSs had resolution of PPFCs within 6 months (P = .78).
DPPSs and LAMSs are effective methods for treatment of PPFCs. In our cohort, use of LAMSs was associated with significantly higher rates of procedure-related bleeding and greater need for repeat endoscopic intervention.
在引入管腔贴合覆盖自膨式金属支架（LAMS）之前，经内镜透壁引流双猪尾塑料支架（DPPS）是治疗症状性胰周液体积聚（PPFC）的主要方法。目前，与 DPPS 相比，关于 LAMS 的疗效和不良事件发生率的数据有限。
对 2008 年至 2015 年期间在一家三级保健中心进行的超声内镜引导下的 PPFC 引流进行回顾性分析。根据引流方法对患者进行分类：DPPS 和 LAMS。记录不良事件发生率、计划外内镜手术/坏死切除术和 6 个月内 PPFC 消退情况。显著出血定义为需要输血或需要内镜治疗/放射栓塞。随后的内镜手术定义为计划外手术；不包括支架取出。
共纳入 103 例符合纳入标准的患者（84 例 DPPS，19 例 LAMS）。PPFC 被分类为包裹性坏死（WON）23 例（14 例 DPPS，9 例 LAMS）。LAMS 组出血事件明显多于 DPPS 组（4 [19%]：2 例脾动脉假性动脉瘤，1 例侧支血管出血，1 例腔内静脉曲张出血；P =.0003）。DPPS 组发生 1 例穿孔。LAMS 组计划外重复内镜检查更为频繁（10%比 26%，P =.07）。在 WON 接受再治疗的 LAMS 患者中，5 例（56%）因坏死碎片阻塞。在有随访资料的患者中，70 例 DPPS 中有 67 例（96%）和 17 例 LAMS 中有 16 例（94%）在 6 个月内 PPFC 消退（P =.78）。
DPPS 和 LAMS 是治疗 PPFC 的有效方法。在我们的队列中，LAMS 的使用与明显更高的与手术相关的出血率和更需要重复内镜干预相关。
