超声内镜引导下应用附有电凝增强输送系统的新型覆膜金属支架引流胰腺周围液体积聚:一项大规模的回顾性研究

Emanuele Rinninella, MD, Rastislav Kunda, MD, Markus Dollhopf, MD, Andres Sanchez-Yague, MD, Uwe Will, MD, Ilaria Tarantino, MD, Joan Gornals Soler, MD, Sebastian Ullrich, MD, Alexander Meining, MD, Josè Miguel Esteban, MD, Thomas Enz, MD, Geoffroy Vanbiervliet, MD, Frank Vleggaar, MD, Fabia Attili, MD, Alberto Larghi, MD, PhD

Background and Aims: A lumen-apposing, self-expanding metal stent incorporated in an electrocauteryenhanced delivery system for EUS-guided drainage of pancreatic fluid collections (PFCs) recently has become available. The aim of this study was to analyze the safety and clinical effectiveness of this newly developed device in this clinical setting.

Methods: This was a retrospective analysis of all consecutive patients with PFCs who underwent EUS-guided drainage using the study device in 13 European centers.

Results: Ninety-three patients with PFCs (80% with complex collections) underwent drainage using the study device. Penetration of the PFC was accomplished directly with the study device in 74.2% of patients, and successful stent placement was accomplished in all but 1 patient, mostly without fluoroscopic assistance. Direct endoscopic necrosectomy (DEN) was carried out in 31 of 52 cases (59.6%) of walled-off necrosis and in 2 of 4 cases (50%) of acute peripancreatic fluid collection. Complete resolution of the PFC was obtained in 86 cases (92.5%), with no recurrence during follow-up. Treatment failure occurred in 6 patients because of persistent infection requiring surgery (n = 3), perforation and massive bleeding caused by the nasocystic drainage catheter (NCDC) (n = 2), and the need for a larger opening to extract large necrotic tissue pieces (n = 1). Major adverse events occurred in 5 patients (perforation and massive bleeding caused by the NCDC in 2 patients, 1 pneumoperitoneum and 1 stent dislodgement during DEN, and 1 postdrainage infection) and were mostly not related to the drainage procedure.

Conclusions: EUS-guided drainage with the electrocautery-enhanced delivery system is a safe, easy to perform, and a highly effective minimally invasive treatment modality for PFCs. (Gastrointest Endosc 2015;82:1039-46.)


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