Yang Dennis, Perbtani Yaseen B, Mramba Lazarus K, Kerdsirichairat Tossapol, Prabhu Anoop, Manvar Amar, Ho Sammy, Pannu Davindebir, Keswani Rajesh N, Strand Daniel S, Wang Andrew Y, Quintero Eduardo, Buscaglia Jonathan M, Muniraj Thiruvengadam, Aslanian Harry R, Draganov Peter V, Siddiqui Ali S
Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, United States.
Department of Biostatistics, University of Florida, Gainesville, Florida, United States.
Endosc Int Open. 2018 Oct;6(10):E1267-E1275. doi: 10.1055/a-0732-502. Epub 2018 Oct 8.
Endoscopic drainage with dedicated lumen-apposing metal stents (LAMS) is routinely performed for symptomatic pancreatic fluid collections (PFCs), walled-off necrosis (WON) and pseudocyst (PP). There has been increasing concern regarding delayed adverse events associated with the indwelling LAMS. Multicenter retrospective analysis of consecutive patients who underwent endoscopic ultrasound (EUS)-guided LAMS placement for PFC from January 2010 to May 2017. Main outcomes included: (1) resolution of the PFC, (2) rate of delayed adverse events at follow-up, and (3) predictors of treatment failure and delayed adverse events on logistic regression. A total of 122 patients (mean age 50.9 years, 68 % male) underwent LAMS insertion for 64 WON (98.4 %) and 58 PP (98.3 %). PFC mean size was 10.6 cm. PFC resolution was significantly lower for WON (62.3 %) vs. PP (96.5 %) ( < 0.001) on imaging at a median of 4 weeks. Stent occlusion was identified in 18 (29.5 %) and 10 (17.5 %) patients with WON and PP, respectively ( = 0.13). There were no cases of delayed bleeding or buried stent on follow-up endoscopy. Use of electrocautery-enhanced LAMS was the only factor associated with treatment failure of WON (OR = 13.2; 95 % ci: 3.33 - 51.82, = 0.02) on logistic regression. There were no patient, operator, or procedure-related factors predictive of stent occlusion. EUS-guided LAMS for PFC is associated with a low incidence of delayed adverse events. While nearly all PPs resolve at 4 weeks permitting LAMS removal shortly thereafter, many WON persist, with use of electrocautery-enhanced LAMS being the sole predictor of treatment failure.
对于有症状的胰腺液体积聚（PFC）、包裹性坏死（WON）和假性囊肿（PP），常规采用专用的管腔贴壁金属支架（LAMS）进行内镜引流。与留置LAMS相关的延迟不良事件越来越受到关注。对2010年1月至2017年5月期间因PFC接受内镜超声（EUS）引导下LAMS置入术的连续患者进行多中心回顾性分析。主要结局包括：（1）PFC的消退，（2）随访时延迟不良事件的发生率，以及（3）逻辑回归分析中治疗失败和延迟不良事件的预测因素。共有122例患者（平均年龄50.9岁，68%为男性）因64例WON（98.4%）和58例PP（98.3%）接受了LAMS置入。PFC平均大小为10.6cm。在中位4周的影像学检查中，WON的PFC消退率（62.%）显著低于PP（96.5%）（<0.001）。分别在18例（29.5%）WON患者和10例（17.5%）PP患者中发现支架闭塞（=0.13）。随访内镜检查未发现延迟出血或埋藏支架的病例。逻辑回归分析显示，使用电灼增强型LAMS是WON治疗失败的唯一相关因素（OR=13.2；95%可信区间：3.33-51.82，=0.02）。没有患者、操作者或与手术相关的因素可预测支架闭塞。EUS引导下的LAMS治疗PFC延迟不良事件发生率较低。虽然几乎所有PP在4周时消退，随后不久即可取出LAMS，但许多WON仍然存在，使用电灼增强型LAMS是治疗失败的唯一预测因素。
