Xu Ning, Li Longsong, Su Song, Zhao Danqi, Xiang Jingyuan, Wang Pengju, Cheng Yaxuan, Linghu Enqiang, Chai Ningli
Senior Department of Gastroenterology, the First Medical Center of PLA General Hospital, Beijing 100853, China.
Endosc Ultrasound. 2024 Jan-Feb;13(1):40-45. doi: 10.1097/eus.0000000000000039. Epub 2023 Dec 29.
Previous studies showed that lumen-apposing metal stent (LAMS) provides a feasible route to perform direct endoscopic necrosectomy. However, the high risk of bleeding and migration induced by the placement of LAMS attracted attention. The aim of this study was to evaluate the safety and effectiveness of a novel LAMS.
In this retrospective study, we enrolled patients with symptomatic pancreatic fluid collections (PFCs) to perform EUS-guided drainage with a LAMS in our hospital. Evaluation variables included technical success rate, clinical success rate, and adverse events.
Thirty-two patients with a mean age of 41.38 ± 10.72 years (53.1% males) were included in our study, and the mean size of PFC was 10.06 ± 3.03 cm. Technical success rate and clinical success rate reached 96.9% and 93.8%, respectively. Stent migration occurred in 1 patient (3.1%), and no stent-induced bleeding occurred. The outcomes of using LAMS in 10 patients with pancreatic pseudocyst and 22 patients with walled-off necrosis were comparable. Compared with pancreatic pseudocyst, walled-off necrosis needed more direct endoscopic necrosectomy times to achieve resolution ( = 0.024).
Our study showed that the novel LAMS is effective and safe for endoscopic drainage of PFCs with a relatively low rate of adverse events. Further large-scale multicenter studies are needed to confirm the present findings.
既往研究表明,管腔贴壁金属支架(LAMS)为直接内镜坏死组织清除术提供了一条可行途径。然而,LAMS置入所引发的出血和移位高风险受到关注。本研究旨在评估一种新型LAMS的安全性和有效性。
在这项回顾性研究中,我们纳入了有症状的胰腺液体积聚(PFC)患者,在我院行超声内镜引导下LAMS引流。评估变量包括技术成功率、临床成功率和不良事件。
我们的研究纳入了32例患者,平均年龄41.38±10.72岁(男性占53.1%),PFC平均大小为10.06±3.03cm。技术成功率和临床成功率分别达到96.9%和93.8%。1例患者(3.1%)发生支架移位,未发生支架引起的出血。10例胰腺假性囊肿患者和22例包裹性坏死患者使用LAMS的结果相当。与胰腺假性囊肿相比,包裹性坏死需要更多的直接内镜坏死组织清除术次数才能实现消退(P = 0.024)。
我们的研究表明,新型LAMS用于PFC内镜引流有效且安全,不良事件发生率相对较低。需要进一步的大规模多中心研究来证实目前的发现。