Bekkali Noor L H, Nayar Manu K, Leeds John S, Charnley Richard M, Huggett Matthew T, Oppong Kofi W
HPB Unit, Freeman Hospital, Newcastle upon Tyne, United Kingdom.
Department of Gastroenterology, Freeman Hospital, Newcastle upon Tyne, United Kingdom.
Endosc Int Open. 2017 Dec;5(12):E1189-E1196. doi: 10.1055/s-0043-120831. Epub 2017 Nov 21.
Bi-flanged metal stents (BFMS) have shown promise in the drainage of walled-off pancreatic necrosis (WON), but their placement requires multiple steps and the use of other devices. More recently, a novel device consisting of a combined lumen-apposing metal stent (LAMS) and electrocautery-enhanced delivery system has been introduced. The aim of this study was to compare the placement and outcomes of the two devices.
This was a retrospective review of consecutive patients undergoing endoscopic ultrasound-guided placement of BFMS or LAMS for drainage of symptomatic WON. Data from procedures between October 2012 and December 2016 were taken from a prospectively maintained database. We compared technical and clinical success, procedure time, costs, and composite end point of significant events (adverse events, stent migration, additional percutaneous drainage) between BFMS and LAMS.
72 consecutive patients underwent placement of BFMS (40 patients, 44 stents) or LAMS (32 patients, 33 stents). Technical success was 91 % for BFMS and 97 % for LAMS. Clinical success was 65 % vs. 78 %, respectively. Median in-room procedure time was significantly shorter in the LAMS group (45 minutes [range 30 - 80]) than in the BFMS group (62.5 minutes [range 35 - 135]; < 0.001) and fewer direct endoscopic necrosectomies (DEN) were performed (median 1 [0 - 2.0] vs. 2 [0 - 3.7], respectively; = 0.005). If only inpatients were considered (35 BFMS and 19 LAMS), there was no significant difference in DEN 2 (range 0 - 11) and 2 (range 0 - 8), respectively. The composite end point of 32 % vs. 24 % was not significantly different. Median procedural costs for all patients with successful stent placement for WON treatment was €4427 (range 1630 - 12 926) for BFMS vs. €3500 (range 2509 - 13 393) for LAMS ( = 0.10).
LAMS was superior to BFMS in terms of procedure time, with comparable adverse events, success, and costs.
双凸缘金属支架（BFMS）在有包裹性坏死的胰腺坏死（WON）引流方面已显示出前景，但放置过程需要多个步骤并使用其他设备。最近，一种由管腔贴壁金属支架（LAMS）和电灼增强输送系统组成的新型设备已被引入。本研究的目的是比较这两种设备的放置情况和结果。
这是一项对连续接受内镜超声引导下放置BFMS或LAMS以引流有症状WON患者的回顾性研究。2012年10月至2016年12月手术的数据来自一个前瞻性维护的数据库。我们比较了BFMS和LAMS在技术和临床成功率、手术时间、成本以及重大事件（不良事件、支架移位、额外的经皮引流）的复合终点方面的差异。
72例连续患者接受了BFMS（40例患者，44个支架）或LAMS（32例患者，33个支架）的放置。BFMS的技术成功率为91%，LAMS为97%。临床成功率分别为65%和78%。LAMS组的室内手术中位时间（45分钟[范围30 - 80]）明显短于BFMS组（62.5分钟[范围35 - 135]；P<0.001），且进行的直接内镜坏死组织清除术（DEN）更少（中位值分别为1[0 - 2.0]和2[0 - 3.7]；P = 0.005）。如果仅考虑住院患者（35例BFMS和19例LAMS），DEN分别为2（范围0 - 11）和2（范围0 - 8），无显著差异。复合终点分别为32%和24%，无显著差异。所有成功放置支架进行WON治疗患者的中位手术成本，BFMS为4427欧元（范围1630 - 12926），LAMS为3500欧元（范围2509 - 13393）（P = 0.10）。
在手术时间方面，LAMS优于BFMS，不良事件、成功率和成本相当。
