Department of Gastroenterology and Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia.
Saudi J Gastroenterol. 2021 Mar-Apr;27(2):85-90. doi: 10.4103/sjg.SJG_244_20.
Peripancreatic fluid collections (PFCs) are a frequent complication of acute pancreatitis. Symptomatic PFCs may need to be drained, and there are multiple endoscopic accessories that can facilitate the procedure. This paper aims to compare the success rate, number of procedures required for resolution and adverse events rate for PFCs EUS-guided drainage with plastic stents and lumen-apposing metal stents (LAMS).
This is a retrospective analysis of a consecutive sample of patients that was collected from 2013 - 2019. The medical records of these patients were reviewed, and the outcomes for each type of stent (plastic vs LAMS, and different subtypes of LAMS) were compared in terms of clinical success, number of re-interventions needed, and adverse events.
A total of 33 patients (23 males) were treated for PFCs with EUS-guided drainage and stenting. The patients' ages ranged between 14 and 85 years (mean ± SD: 43.5 ± 19 years). Overall, there was no difference between plastic stents and LAMS in terms of symptomatic recovery (P = 0. 24), but metal stents had better results with regards to radiological resolution (P = 0.03), and were associated with a higher number of necrosectomies (P = 0.029). Adverse events occurred more frequently in patients who had plastic stents, but direct comparison between the two groups showed that the difference was not statistically significant (P = 0.2). Stratification for different LAMS subtypes showed no difference in terms of symptomatic or radiological resolution (P =0.49), number of rescue procedures (P = 0.41), and adverse events (P = 0.81).
Our study, along with the current available evidence, suggests a slight advantage of metal stents over plastic stents in terms of clinical success, need for rescue procedures, and incidence of adverse events. Furthermore, it provides empirical evidence that the different sub-types of LAMS perform similarly when compared against each other.
胰周液体积聚（PFCs）是急性胰腺炎的常见并发症。有症状的 PFCs 可能需要引流，有多种内镜附件可以辅助该操作。本文旨在比较超声内镜引导下引流时使用塑料支架和 lumen-apposing 金属支架（LAMS）治疗 PFC 的成功率、需要解决问题的次数和不良事件发生率。
这是一项回顾性分析，样本来自 2013 年至 2019 年连续收集的患者。回顾这些患者的病历，比较每种支架（塑料支架与 LAMS，以及不同类型的 LAMS）的临床成功率、需要再次干预的次数和不良事件。
共 33 例（23 名男性）接受超声内镜引导下引流和支架治疗 PFCs。患者年龄 14-85 岁（平均 ± 标准差：43.5 ± 19 岁）。总体而言，在症状缓解方面，塑料支架和 LAMS 之间无差异（P = 0.24），但金属支架在影像学缓解方面效果更好（P = 0.03），且与更多的坏死组织清除术相关（P = 0.029）。塑料支架组不良事件更常见，但两组直接比较差异无统计学意义（P = 0.2）。不同 LAMS 亚型分层显示，在症状或影像学缓解（P = 0.49）、需要抢救程序（P = 0.41）和不良事件（P = 0.81）方面无差异。
本研究以及现有的证据表明，在临床成功率、需要抢救程序和不良事件发生率方面，金属支架略优于塑料支架。此外，本研究提供了经验证据，表明不同类型的 LAMS 彼此之间的性能相似。
