Chen Yen-I, Yang Juliana, Friedland Shai, Holmes Ian, Law Ryan, Hosmer Amy, Stevens Tyler, Franco Matheus C, Jang Sunguk, Pawa Rishi, Mathur Nihar, Sejpal Divyesh V, Inamdar Sumant, Trindade Arvind J, Nieto Jose, Berzin Tyler M, Sawhney Mandeep, DeSimone Michael L, DiMaio Christopher, Kumta Nikhil A, Gupta Sanchit, Yachimski Patrick, Anderloni Andrea, Baron Todd H, James Theodore W, Jamil Laith H, Ona Mel A, Lo Simon K, Gaddam Srinivas, Dollhopf Markus, Bukhari Majidah A, Moran Robert, Gutierrez Olaya Brewer, Sanaei Omid, Fayad Lea, Ngamruengphong Saowanee, Kumbhari Vivek, Singh Vikesh, Repici Alessandro, Khashab Mouen A
Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Division of Gastroenterology and Hepatology, McGill University Health Center, McGill University, Montreal, QC, Canada.
Endosc Int Open. 2019 Mar;7(3):E347-E354. doi: 10.1055/a-0828-7630. Epub 2019 Feb 28.
The use of lumen apposing metal stents (LAMS) during EUS-guided transmural drainage (EUS-TD) of pancreatic walled-off necrosis (WON) has gained popularity. Data supporting their use in WON over plastic stents (PS), however, remain scarce. The aim of this study was to compare the clinical efficacy of LAMS (Axios, Boston Scientific) with PS in WON. This was a multicenter, retrospective study involving 14 centers. Consecutive patients who underwent EUS-TD of WON (2012 - 2016) were included. The primary end point was clinical success defined as WON size ≤ 3 cm within a 6-month period without need for percutaneous drainage (PCD) or surgery. A total of 189 patients (mean age 55.2 ± 15.6 years, 34.9 % female) were included (102 LAMS and 87 PS). Technical success rates were similar: 100 % in LAMS and 98.9 % in PS ( = 0.28). Clinical success was attained in 80.4 % of LAMS and 57.5 % of PS ( = 0.001). Rate of PCD was similar (13.7 % LAMS vs. 16.3 % PS, = 0.62), while PS was associated with a greater need for surgery (16.1 % PS vs. 5.6 % LAMS, = 0.02). Adverse events (AEs) were observed in 9.8 % of LAMS and 10.3 % of PS ( = 0.90) and were rated as severe in 2.0 % and 6.9 %, respectively ( = 0.93). After excluding patients with < 6 months follow-up, the rate of WON recurrence following initial clinical success was greater with PS (22.9 % PS vs. 5.6 % LAMS, = 0.04). When compared to PS, LAMS in WON is associated with higher clinical success, shorter procedure time, lower need for surgery, and lower rate of recurrence.
在超声内镜引导下经壁引流（EUS-TD）治疗胰腺壁内坏死（WON）过程中，使用管腔对合金属支架（LAMS）越来越普遍。然而，支持其在WON治疗中优于塑料支架（PS）的数据仍然很少。本研究的目的是比较LAMS（Axios，波士顿科学公司）与PS在WON治疗中的临床疗效。 这是一项涉及14个中心的多中心回顾性研究。纳入2012年至2016年期间接受WON的EUS-TD的连续患者。主要终点是临床成功，定义为在6个月内WON大小≤3 cm，无需经皮引流（PCD）或手术。 共纳入189例患者（平均年龄55.2±15.6岁，女性占34.9%）（102例使用LAMS，87例使用PS）。技术成功率相似：LAMS为100%，PS为98.9%（P = 0.28）。LAMS组的临床成功率为80.4%，PS组为57.5%（P = 0.001）。PCD率相似（LAMS组为13.7%，PS组为16.3%，P = 0.62），而PS组手术需求更高（PS组为16.1%，LAMS组为5.6%，P = 0.02）。LAMS组不良事件（AE）发生率为9.8%，PS组为10.3%（P = 0.90），严重不良事件发生率分别为2.0%和6.9%（P = 0.93）。排除随访时间<6个月的患者后，初始临床成功后PS组WON复发率更高（PS组为22.9%，LAMS组为5.6%，P = 0.04）。 与PS相比，LAMS治疗WON的临床成功率更高、手术时间更短、手术需求更低且复发率更低。
