Surgical Endoscopy

, Volume 32, Issue 5, pp 2448–2453 | Cite as

Comparison of clinical efficacies and safeties of lumen-apposing metal stent and conventional-type metal stent-assisted EUS-guided pancreatic wall-off necrosis drainage: a real-life experience in a tertiary hospital

  • Siu Tong Law
  • Carlos De La SernaHiguera
  • Paula Gil Simón
  • Manuel Pérez-MirandaCastillo
Article

Abstract

Background

Endoscopic ultrasound (EUS)-guided drainage of pancreatic wall-off necrosis (WON) with transmural stent is regarded as firstline therapy. We aimed at comparing its efficacy and safety with using fully covered self-expandable metal stent (FCSEMS) and lumen-apposing metal stent (LAMS).

Methods

A retrospective review was performed on all consecutive patients with pancreatic WONs who underwent EUS-guided drainage by either FCSEMS or LAMS.

Results

From 2011 to 2016, 68 patients (66.2% male, median age, 66.5 years) underwent WON drainage (22/68 (32.4%) using FCSEMSs of size 10 × 60 mm (14/22, Hanarostent; 8/22 Wallflex); 46/68 (67.6%) using LAMSs (38/46 and 8/46 with AXIOS of size 15 × 10 mm and 10 × 10 mm, respectively). These two groups were matched for age (66 vs. 70 years, p 0.514), APACHE II (11.5 vs. 10, p 0.693), causes [72.7 vs. 80.4% by gallstone pancreatitis (p 0.472); 9.1 vs. 10.9% by alcoholism (p 0.818)], WON size (8.5 vs. 9 cm, p 0.322), location (36.4 vs. 26.1% at pancreatic head, p 0.384; 54.5 vs. 65.2% at body/tail, p 0.395), and enterostomy site [63.6 vs. 76.1% via transgastric (p 0.285); 31.8 vs. 19.6% via transduodenal (p 0.267)] and their number of necrosectomy (p 0.978). The technical (100 vs. 93.5%, p 0.219) and clinical (95.5 vs. 93.5%, p 0.749) success and adverse event (22.7 vs. 39.1%, p 0.180; 9.1 vs. 19.6% with bleeding, p 0.271; 4.5 vs. 13% with spontaneous stent migration, p 0.28; 9.1 vs. 6.5% with dislodgement during necrosectomy, p 0.704) of the two groups were comparable without significant different. However, the LAMS group associated with early stent revision compared with FCSEMS group (log rank p 0.048).

Conclusions

EUS-guided drainage of WON using FCSEMSs and LAMSs are comparable in efficacy and safety; however, the latter is associated with early stent revision.

Keywords

Pancreatic wall-off necrosis EUS-guided drainage LAMS FCSEMS 

Notes

Compliance with ethical standards

Disclosure

Law Siu Tong, Carlos De La Serna Higuera, Paula Gil Simón, and Manuel Pérez-Miranda Castillo have no conflict of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Siu Tong Law
    • 1
  • Carlos De La SernaHiguera
    • 2
  • Paula Gil Simón
    • 2
  • Manuel Pérez-MirandaCastillo
    • 2
  1. 1.Department of Medicine and GeriatricsTuen Mun HospitalTuen MunHong Kong
  2. 2.Department of Gastroenterology and HepatologyHospital Universitario Rio HortegaValladolidSpain

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