Takahashi Koji, Ohyama Hiroshi, Ohno Izumi, Kato Naoya
Gastroenterology, Chiba University, Chiba, JPN.
Cureus. 2024 Oct 15;16(10):e71561. doi: 10.7759/cureus.71561. eCollection 2024 Oct.
Pancreatic fluid collections (PFCs) are common local complications of pancreatitis that may require interventional therapy. Endoscopic ultrasound (EUS)-guided transluminal drainage from the digestive tract, particularly with lumen-apposing metal stents (LAMS), is the first-line therapy due to its safety and efficacy. However, adverse events and post-removal courses remain uncertain. This study aimed to clarify the characteristics of LAMS placement and its removal, comparing pancreatic pseudocysts (PPC) and walled-off necrosis (WON).
This single-center retrospective study included 23 patients who underwent transgastric LAMS placement for PFCs under EUS guidance. The patients were categorized into the PPC group (n = 14) and the WON group (n = 9). Backgrounds and clinical outcomes were analyzed and compared.
The mean procedure time was 19 minutes in the PPC group and 25 minutes in the WON group, with no significant difference (p = 0.11). The overall incidence of adverse events during LAMS placement was 14.3% in the PPC group and 33.3% in the WON group, with no significant difference (p = 0.28), but the incidence of infection of noninfected fluid collections was 0% in the PPC group and 55.5% in the WON group, significantly higher in the WON group (p = 0.0016). At the time of LAMS removal, a double-pigtail plastic stent (DPS) was replaced in 53.8% of the PPC group and 57.1% of the WON group. Within one year, 57.1% of the replaced DPS in the PPC group and 25.0% in the WON group became dislocated. There were no adverse events due to the dislocation of the replaced DPS. Adverse events occurred in one patient in each group after LAMS removal: 7.7% in the PPC group and 14.3% in the WON group (p = 0.64), which consisted of peritonitis in the PPC group and recurrent infection of fluid collection in the WON group, and both of these events occurred when the replaced DPS was still in place after LAMS removal.
Although there was no significant difference in the overall incidence of adverse events between PPC and WON, the incidence of infection after LAMS placement was significantly higher in WON. Regarding the replaced DPS, there were some cases of dislocation within one year, but there were no related adverse events. Adverse events occurred even after the removal of LAMS and replacement with DPS, so careful follow-up is required.
胰液积聚（PFCs）是胰腺炎常见的局部并发症，可能需要介入治疗。内镜超声（EUS）引导下经消化道腔内引流，尤其是使用管腔贴附金属支架（LAMS），因其安全性和有效性而成为一线治疗方法。然而，不良事件和支架取出后的病程仍不明确。本研究旨在阐明LAMS置入及其取出的特点，比较胰腺假性囊肿（PPC）和包裹性坏死（WON）。
本单中心回顾性研究纳入了23例在EUS引导下经胃置入LAMS治疗PFCs的患者。患者分为PPC组（n = 14）和WON组（n = 9）。分析并比较两组患者的背景和临床结局。
PPC组平均手术时间为19分钟，WON组为25分钟，差异无统计学意义（p = 0.11）。LAMS置入期间不良事件的总发生率在PPC组为14.3%，在WON组为33.3%，差异无统计学意义（p = 0.28），但未感染性液体积聚的感染发生率在PPC组为0%，在WON组为55.5%，WON组显著更高（p = 0.0016）。在LAMS取出时，PPC组53.8%的患者和WON组57.1%的患者更换了双猪尾塑料支架（DPS）。在1年内，PPC组更换的DPS中有57.1%发生移位，WON组为25.0%。更换的DPS移位未导致不良事件。LAMS取出后，每组各有1例患者发生不良事件：PPC组为7.7%，WON组为14.3%（p = 0.64），PPC组为腹膜炎，WON组为液体积聚复发感染，这两起事件均发生在LAMS取出后更换的DPS仍在位时。
虽然PPC和WON之间不良事件的总发生率无显著差异，但WON组LAMS置入后感染发生率显著更高。关于更换的DPS，1年内有一些移位病例，但无相关不良事件。即使在LAMS取出并更换为DPS后仍会发生不良事件，因此需要仔细随访。
