Khan Saad, Chandran Sujievvan, Chin Jerry, Karim Shwan, Mangira Dileep, Nasr Mohamad, Ermerak Goktug, Trinh Andrew, Kia Christopher Y H, Mules Thomas, Zad Mohammadali, Ang Tiing Leong, Johns Estella, Tee Derrick, Kaul Abha, Ratanachu-Ek Thawee, Jirathan-Opas Jirat, Fisher Leon, Cameron Rees, Welch Christine, Lim Gary, Metz Andrew J, Moss Alan, Bassan Milan, Saxena Payal, Kaffes Arthur, St John Andrew, Hourigan Luke F, Tagkalidis Peter, Weilert Frank, Vaughan Rhys, Devereaux Benedict
Department of Gastroenterology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
Department of Gastroenterology, Austin Health, Melbourne, Victoria, Australia.
J Gastroenterol Hepatol. 2021 Dec;36(12):3395-3401. doi: 10.1111/jgh.15658. Epub 2021 Aug 19.
Our aim was to evaluate the efficacy and safety of a lumen-apposing metal stent with an electrocautery-enhanced delivery system (EDS-LAMS) for endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collections (PFCs) in regular clinical practice.
A retrospective and subsequent prospective analysis was undertaken of all patients who underwent EUS-guided drainage of their PFCs using the EDS-LAMS at 17 tertiary therapeutic endoscopy centers.
Two hundred eight cases of EDS-LAMS deployment were attempted in 202 patients (mean age 52.9 years) at time of evaluation. Ninety-seven patients had pancreatic pseudocysts (PPs), 75 walled-off pancreatic necrosis (WOPN), 10 acute peripancreatic fluid collections (APFCs), 6 acute necrotic collections (ANCs), and 14 postoperative collections (POCs). Procedural technical success was achieved in 202/208 cases (97.1%). Maldeployment occurred in 7/208 cases (3.4%). Clinical success was achieved in 142/160 (88.8%) patients (PP 90%, WOPN 85.2%, APFC 100%, ANC 75%, POC 100%). Delayed adverse events included stent migration in 15/202 (7.4%), stent occlusion and infection in 16/202 (7.9%), major bleeding in 4/202 (2%), and buried EDS-LAMS in 2/202 (1%). PFC recurrence occurred in 13/142 (9.2%) patients; 9/202 (4.5%) required surgical or radiological intervention for PFC management after EDS-LAMS insertion.
This large international multicenter study evaluating the EDS-LAMS for drainage of PFCs in routine clinical practice suggests that the EDS-LAMS are safe and effective for drainage of all types of PFCs; however, further endoscopic therapy is often required for WOPN. Major bleeding was a rare complication in our cohort.
我们的目的是在常规临床实践中评估一种带有电灼增强输送系统的管腔贴附金属支架（EDS-LAMS）用于内镜超声（EUS）引导下胰液积聚（PFC）引流的有效性和安全性。
对17家三级治疗内镜中心所有使用EDS-LAMS进行EUS引导下PFC引流的患者进行回顾性及后续前瞻性分析。
在评估时，202例患者（平均年龄52.9岁）尝试进行了208例EDS-LAMS置入术。97例患者为胰腺假性囊肿（PP），75例为包裹性胰腺坏死（WOPN），10例为急性胰周液体积聚（APFC），6例为急性坏死性积聚（ANC），14例为术后积液（POC）。202/208例（97.1%）手术技术成功。208例中有7例（3.4%）发生置入不当。142/160例（88.8%）患者获得临床成功（PP为90%，WOPN为85.2%，APFC为100%，ANC为75%，POC为100%）。延迟不良事件包括15/202例（7.4%）支架移位，16/202例（7.9%）支架阻塞和感染，4/202例（2%）大出血，以及2/202例（1%）EDS-LAMS埋入。13/142例（9.2%）患者出现PFC复发；9/202例（4.5%）在插入EDS-LAMS后需要手术或放射介入治疗PFC。
这项评估EDS-LAMS在常规临床实践中用于PFC引流的大型国际多中心研究表明，EDS-LAMS对所有类型的PFC引流安全有效；然而，WOPN通常需要进一步的内镜治疗。大出血在我们的队列中是一种罕见的并发症。
