Powers Patrick C, Siddiqui Ali, Sharaiha Reem Z, Yang Grace, Dawod Enad, Novikov Aleksey A, Javia Amy, Edirisuriya Cynthia, Noor Arish, Mumtaz Tayebah, Iqbal Usama, Loren David E, Kowalski Thomas E, Cosgrove Natalie, Alicea Yordano, Tyberg Amy, Andalib Iman, Kahaleh Michel, Adler Douglas G
Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Utah, Salt Lake City, UT, USA.
Department of Internal Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA, USA.
Endosc Ultrasound. 2019 May-Jun;8(3):194-198. doi: 10.4103/eus.eus_59_18.
Endoscopic drainage/debridement of symptomatic walled off necrosis (WON) using lumen-apposing metal stents (LAMS) is both safe and effective. While endoscopic management of WON is the standard approach to treatment, the ideal concomitant medical therapy remains unclear. The purpose of this study was to further elucidate the effect of proton pump inhibitor (PPIs) therapy on the technical and clinical success of endoscopic treatment of WON.
Two hundred and seventy-two patients in 8 centers with WON managed by endoscopic drainage using LAMS were evaluated. Patients were followed for at least 6 months following treatment. The patients were divided into two groups: Those that used PPIs continuously during the therapy and those not on PPIs continuously during the interval of therapy. Outcomes included but were not limited to technical success, clinical success, number of procedures performed, and adverse events.
From 2013 to 2016, 272 patients underwent WON drainage with successful transmural LAMS placement. The two groups were split evenly into PPI users and non-PPI users, and matched in regards to demographics, etiology of pancreatitis, WON size, and location. There was no difference in the technical success between the two groups (100% vs. 98.8%, P = 1), or in clinical success rates (78.7% vs. 77.9%). There was a significant difference in the required number of direct endoscopic necrosectomies to achieve clinical success in the PPI vs. non-PPI group (3.2 vs. 4.6 respectively, P < 0.01). There were significantly more cases of stent occlusion in the non-PPI group vs. PPI group (9.5% vs. 20.1% P = 0.012), but all other documented adverse events were not significantly different.
Discontinuing PPIs during endoscopic drainage and necrosectomy of symptomatic WON appears to reduce the number of endoscopic procedures required to achieve resolution. Continuous PPI results in higher rates of early stent occlusion.
使用管腔对合金属支架（LAMS）对有症状的包裹性坏死（WON）进行内镜引流/清创术既安全又有效。虽然WON的内镜治疗是标准的治疗方法，但理想的辅助药物治疗仍不明确。本研究的目的是进一步阐明质子泵抑制剂（PPI）治疗对WON内镜治疗技术和临床成功的影响。
对8个中心的272例采用LAMS内镜引流治疗WON的患者进行评估。治疗后对患者进行至少6个月的随访。患者分为两组：治疗期间持续使用PPI的患者和治疗期间未持续使用PPI的患者。结果包括但不限于技术成功、临床成功、进行的操作次数和不良事件。
2013年至2016年，272例患者接受了WON引流术，成功置入了经壁LAMS。两组患者平均分为PPI使用者和非PPI使用者，在人口统计学、胰腺炎病因、WON大小和位置方面相匹配。两组之间的技术成功率（100%对98.8%，P = 1）或临床成功率（78.7%对77.9%）没有差异。在PPI组和非PPI组中，为实现临床成功所需的直接内镜坏死组织清除术次数存在显著差异（分别为3.2次对4.6次，P < 0.01）。非PPI组的支架闭塞病例明显多于PPI组（9.5%对20.1%，P = 0.012），但所有其他记录的不良事件没有显著差异。
在有症状的WON内镜引流和坏死组织清除术中停用PPI似乎可以减少达到缓解所需的内镜操作次数。持续使用PPI会导致早期支架闭塞率更高。
