Drainage of pancreatic fluid collections using a lumen-apposing metal stent with an electrocautery-enhanced delivery system

Saad Khan; Sujievvan Chandran; Jerry Chin; Shwan Karim; Dileep Mangira; Mohamad Nasr; Goktug Ermerak; Andrew Trinh; Christopher Y H Kia; Thomas Mules; Mohammadali Zad; Tiing Leong Ang; Estella Johns; Derrick Tee; Abha Kaul; Thawee Ratanachu-Ek; Jirat Jirathan-Opas; Leon Fisher; Rees Cameron; Christine Welch; Gary Lim; Andrew J Metz; Alan Moss; Milan Bassan; Payal Saxena; Arthur Kaffes; Andrew St John; Luke F Hourigan; Peter Tagkalidis; Frank Weilert; Rhys Vaughan; Benedict Devereaux

doi:10.1111/jgh.15658

Drainage of pancreatic fluid collections using a lumen-apposing metal stent with an electrocautery-enhanced delivery system

J Gastroenterol Hepatol. 2021 Dec;36(12):3395-3401. doi: 10.1111/jgh.15658. Epub 2021 Aug 19.

Authors

Saad Khan^{1

2}, Sujievvan Chandran², Jerry Chin³, Shwan Karim⁴, Dileep Mangira⁵, Mohamad Nasr⁶, Goktug Ermerak⁷, Andrew Trinh⁸, Christopher Y H Kia¹, Thomas Mules⁹, Mohammadali Zad¹⁰, Tiing Leong Ang¹¹, Estella Johns¹², Derrick Tee¹³, Abha Kaul¹⁴, Thawee Ratanachu-Ek¹⁵, Jirat Jirathan-Opas¹⁶, Leon Fisher¹⁴, Rees Cameron¹², Christine Welch¹⁰, Gary Lim⁹, Andrew J Metz⁸, Alan Moss⁵, Milan Bassan^{7

17}, Payal Saxena^{6

18}, Arthur Kaffes^{6

18}, Andrew St John^{4

19

20}, Luke F Hourigan^{4

20

21}, Peter Tagkalidis^{5

8}, Frank Weilert³, Rhys Vaughan^{2

22}, Benedict Devereaux^{1

20}

Affiliations

¹ Department of Gastroenterology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
² Department of Gastroenterology, Austin Health, Melbourne, Victoria, Australia.
³ Department of Gastroenterology, Waikato Hospital, Waikato District Health Board, Hamilton, New Zealand.
⁴ Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
⁵ Department of Gastroenterology, Western Health, Melbourne, Victoria, Australia.
⁶ Department of Gastroenterology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
⁷ Department of Gastroenterology and Hepatology, Liverpool Hospital, Sydney, New South Wales, Australia.
⁸ Department of Gastroenterology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
⁹ Department of Gastroenterology, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand.
¹⁰ Department of Gastroenterology, Townsville Hospital, Townsville, Queensland, Australia.
¹¹ Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore.
¹² Department of Gastroenterology, Wellington Hospital, Capital and Coast District Health Board, Wellington, New Zealand.
¹³ Department of Gastroenterology, Lyell McEwin Hospital, Adelaide, South Australia, Australia.
¹⁴ Department of Gastroenterology, Peninsula Health, Melbourne, Victoria, Australia.
¹⁵ Department of Gastroenterology, Rajavithi Hospital, Bangkok, Thailand.
¹⁶ Department of Gastroenterology, Hatyai Hospital, Hat Yai, Songkhla Province, Thailand.
¹⁷ South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
¹⁸ Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia.
¹⁹ Department of Medicine, Toowoomba Hospital, Toowoomba, Queensland, Australia.
²⁰ School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
²¹ Gallipoli Medical Research Institute, School of Medicine, University of Queensland, Greenslopes Private Hospital, Brisbane, Queensland, Australia.
²² Department of Medicine, University of Melbourne, Austin Health, Melbourne, Victoria, Australia.

PMID: 34370869
DOI: 10.1111/jgh.15658

Abstract

Background and aim: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: endoscopic ultrasound; lumen-apposing metal stents; pancreatic fluid collections; pancreatitis.

Publication types

Multicenter Study

MeSH terms

Drainage* / instrumentation
Electrocoagulation
Humans
Middle Aged
Pancreatic Diseases* / surgery
Retrospective Studies
Stents