Fasullo Matthew, Al-Azzawi Yasir, Kheder Joan, Abergel Jeffrey, Wassef Wahid
Department of Gastroenterology, UMass Memorial Medical Center, Worcester, MA, USA,
Department of Gastroenterology, Staten Island University Hospital, Staten Island, NY, USA.
Clin Exp Gastroenterol. 2018 Jun 27;11:249-254. doi: 10.2147/CEG.S167736. eCollection 2018.
Mature peripancreatic fluid collection (MPFC) is a known and often challenging consequence of acute pancreatitis and often requires intervention. The most common method accepted is the "step-up approach," which consists of percutaneous drainage followed, if necessary, by minimally invasive retroperitoneal necrosectomy. Our paper aims to distinguish between plastic stents and lumen-apposing stents in the endoscopic management of MPFC in terms of morbidity, mortality, and haste of fluid collection resolution.
A retrospective analysis was performed at UMass Memorial Medical Center in patients with a diagnosis of MPFC. Utilizing medical records, clinical data, radiology, as well as endoscopic evidence, patients were differentiated by stent type used (plastic versus lumen-apposing) for the management of the MPFC. The primary outcome of the study was to assess the time to MPFC resolution following the placement of either plastic or lumen-apposing stents (on endoscopic ultrasound or computerized tomography scan) using a multivariate analysis with a logistic regression model.
A total of 54 patients were included in this study from UMass Memorial Medical Center between 2012 and 2015. Twelve (22%) of these patients received lumen-apposing stents and 42 (78%) of these patients received plastic pigtail stents. For the lumen-apposing stent group, the mean interval between stent placement and resolution of MPFC was 57 days as compared to 102 days for plastic pigtail stents (=0.02). The mean interval for placement/removal of lumen-apposing stents was 48 days as compared to 81 days for plastic pigtail stents (=0.01). Stent migration was seen in 5 patients (11%) who received a plastic pigtail stent compared to 0 (0%) patients who received a lumen-apposing stent.
Our study demonstrates that lumen-apposing stents result in a significant reduction in the interval between stent placement and MPFC resolution as well as the time from stent placement to removal, when compared to plastic pigtail stents, the prior standard-of-care. Our study reached similar conclusions regarding the number of stents placed. However, we did not find a significant difference between the complication rates, specifically peri- and postprocedural bleeding or perforation, between the 2 study groups, as demonstrated in prior papers.
成熟的胰周液体积聚（MPFC）是急性胰腺炎常见且颇具挑战的后果，常需干预。目前公认的最常用方法是“递进式方法”，即先经皮引流，必要时再行微创腹膜后坏死组织清除术。本文旨在在内镜治疗MPFC时，从发病率、死亡率及液体积聚消散速度方面区分塑料支架和管腔贴附型支架。
在马萨诸塞大学纪念医疗中心对诊断为MPFC的患者进行回顾性分析。利用病历、临床数据、影像学及内镜证据，根据治疗MPFC所使用的支架类型（塑料支架与管腔贴附型支架）对患者进行区分。本研究的主要结局是采用逻辑回归模型进行多变量分析，评估置入塑料或管腔贴附型支架（经内镜超声或计算机断层扫描）后MPFC消散的时间。
2012年至2015年期间，马萨诸塞大学纪念医疗中心共有54例患者纳入本研究。其中12例（22%）患者接受了管腔贴附型支架，42例（78%）患者接受了塑料猪尾支架。管腔贴附型支架组中，从支架置入到MPFC消散的平均间隔时间为57天，而塑料猪尾支架组为102天（P=0.02）。管腔贴附型支架置入/取出的平均间隔时间为48天，塑料猪尾支架组为81天（P=0.01）。接受塑料猪尾支架的5例患者（11%）出现支架移位，而接受管腔贴附型支架的患者中无此情况（0%）。
我们的研究表明，与先前的标准治疗方法塑料猪尾支架相比，管腔贴附型支架可显著缩短支架置入至MPFC消散的间隔时间以及从支架置入到取出的时间。我们的研究在置入支架数量方面得出了类似结论。然而，正如先前论文所示，我们并未发现两个研究组在并发症发生率，尤其是围手术期和术后出血或穿孔方面存在显著差异。
