Dhillon Amit, Li Suqing, Sandha Simrat, D'Souza Pernilla, Sandha Gurpal
Division of Gastroenterology, University of Alberta Hospital, Edmonton, Alberta, Canada.
J Can Assoc Gastroenterol. 2020 Jul 28;4(4):158-164. doi: 10.1093/jcag/gwaa023. eCollection 2021 Aug.
Endoscopic ultrasound-guided transmural drainage is the preferred management of pancreatic fluid collections (PFCs). Optimizing drainage is important and there remains debate as to the choice of stent. A recent trend towards the use of lumen-apposing metal stents (LAMS) has emerged.
To evaluate the performance characteristics of a LAMS based on a prospective protocol (CT scan 1 week after placement to assess for resolution and need for necrosectomy followed by stent removal within 3 weeks).
This is a descriptive prospective cohort study performed at a single centre. The primary outcome was clinical success. Secondary outcomes were technical success, procedure time, total number of endoscopic procedures with or without necrosectomy, stent indwell time, stent functionality and adverse events.
Thirty-seven patients (21 males, mean age 46.5 years) underwent placement of LAMS for 41 PFCs (median size 12 cm). There were 18 pseudocysts and 23 walled-off necrosis. Clinical success was seen in 33 of 41 (80%) PFCs. Of the remaining eight patients, six underwent surgery and two patients died from underlying malignant disease (although their PFC had completely resolved). Technical success and stent functionality were 100%. The median procedure time was 14 min (interquartile range 11 min to 20 min). Of the 23 walled-off necrosis, 9 (39%) required necrosectomy. The median stent indwell time was 19 days (interquartile range 14 to 22 days). There were no serious adverse events.
Our protocol demonstrates excellent performance characteristics of LAMS. Their clinical efficacy and favourable safety profile suggest that they may be the preferred modality for endoscopic ultrasound-guided management of PFCs.
内镜超声引导下经壁引流是胰腺液体积聚（PFCs）的首选治疗方法。优化引流很重要，关于支架的选择仍存在争议。最近出现了使用管腔贴附金属支架（LAMS）的趋势。
根据前瞻性方案（放置后1周进行CT扫描以评估消退情况及是否需要坏死组织清除术，随后在3周内取出支架）评估一种LAMS的性能特征。
这是一项在单一中心进行的描述性前瞻性队列研究。主要结局是临床成功。次要结局包括技术成功、手术时间、有无坏死组织清除术的内镜手术总数、支架留置时间、支架功能及不良事件。
37例患者（21例男性，平均年龄46.5岁）因41个PFCs接受了LAMS置入（中位大小12 cm）。其中有18个假性囊肿和23个包裹性坏死。41个PFCs中有33个（80%）获得临床成功。其余8例患者中，6例接受了手术，2例患者死于基础恶性疾病（尽管其PFC已完全消退）。技术成功率和支架功能均为100%。中位手术时间为14分钟（四分位间距11分钟至20分钟）。23个包裹性坏死中，9个（39%）需要进行坏死组织清除术。中位支架留置时间为19天（四分位间距14至22天）。无严重不良事件。
我们的方案显示LAMS具有出色的性能特征。其临床疗效和良好的安全性表明，它们可能是内镜超声引导下治疗PFCs的首选方式。
