Background: The use of lumen-apposing metal stents (LAMS) for the management of pancreatic fluid collections (PFCs) has recently increased significantly. Recent studies reported high clinical success rate. However, there has been a concern with occurrence of adverse events (AEs) related to this relatively new practice. There is scarce literature on AEs related to the use of LAMS in the management of PFCs. Aims: To evaluate the incidence, severity, and management of AEs related to the use of LAMS for the drainage of PFCs. Methods: This is a multicenter, international, retrospective study at 15 multinational centers. All patients who underwent LAMS (Axios or Electrocautery enhanced (EC)-AXIOS, BSCI) placement for the management of pancreatic pseudocysts (PP) or walled off necrosis (WON) between 03/2013 and 10/2017 were included. Intraprocedural and post-procedural AE’s were recorded, classified and graded according to the ASGE lexicon. Results: During the study period, a total of 333 patients (female 35.1%, mean age 56yr  15.84yr) were identified table 1. The mean diameter of PFCs was 113.11 58.98 mm and were most commonly located in the pancreatic body (54.95%). LAMS were placed for the the treatment of PP in 166 patients and WON in 167 patients. A total of 335 LAMS were used, with 2(0.6%) patients being treated with 2 LAMS. A 15mm diameter stent was placed in 225/335(67.2%). EC-LAMS was used in 303/335(90.4%). Technical success was achieved in 324 (96.7 %) cases with a mean procedural time of 32.4min  22.95. Clinical success (resolution of PFC) was achieved in 286 (85.9%) patients and LAMS were removed after a mean of 59 days (95% CI: 52.9-65.2). AE’s associated with the use of LAMS occurred in 89/333(26.6%, 95% CI: 18.9-36.1%) of cases. A total of 98 AEs occurred with 2 AEs occurring in 9 (2.7%) patients. Characteristics and management of AE’s are listed in table 2. Death occurred in 9 cases. The mean time between stent placement and occurrence of AEs was 22.8 (95% CI:16.6-29.9; range 0- 146) days. Conclusion: Data from this large international study confirm that the use of LAMS stent for management of PFCs has excellent technical and clinical success rates. The rate of complications including fatal events, however, is not negligible and should be carefully considered before using the stent in this clinical setting. Further studies are needed to determine the optimal algorithm for follow-up of LAMS placement to attempt to minimize AEs
Fugazza, A., Sethi, A., Packey, C.d., Trindade, A.j., Benias, P.c., Devlin, J., et al. (2018). COMPREHENSIVE ANALYSIS OF ADVERSE EVENTS ASSOCIATED WITH ENDOSCOPIC ULTRASOUND DRAINAGE OF PANCREATIC FLUID COLLECTION: AN INTERNATIONAL MULTICENTER STUDY. GASTROINTESTINAL ENDOSCOPY, 87(6), AB325-AB325.
COMPREHENSIVE ANALYSIS OF ADVERSE EVENTS ASSOCIATED WITH ENDOSCOPIC ULTRASOUND DRAINAGE OF PANCREATIC FLUID COLLECTION: AN INTERNATIONAL MULTICENTER STUDY
Fugazza, A;Tarantino, I;Fabbri, C;Binda, C;
2018
Abstract
Background: The use of lumen-apposing metal stents (LAMS) for the management of pancreatic fluid collections (PFCs) has recently increased significantly. Recent studies reported high clinical success rate. However, there has been a concern with occurrence of adverse events (AEs) related to this relatively new practice. There is scarce literature on AEs related to the use of LAMS in the management of PFCs. Aims: To evaluate the incidence, severity, and management of AEs related to the use of LAMS for the drainage of PFCs. Methods: This is a multicenter, international, retrospective study at 15 multinational centers. All patients who underwent LAMS (Axios or Electrocautery enhanced (EC)-AXIOS, BSCI) placement for the management of pancreatic pseudocysts (PP) or walled off necrosis (WON) between 03/2013 and 10/2017 were included. Intraprocedural and post-procedural AE’s were recorded, classified and graded according to the ASGE lexicon. Results: During the study period, a total of 333 patients (female 35.1%, mean age 56yr 15.84yr) were identified table 1. The mean diameter of PFCs was 113.11 58.98 mm and were most commonly located in the pancreatic body (54.95%). LAMS were placed for the the treatment of PP in 166 patients and WON in 167 patients. A total of 335 LAMS were used, with 2(0.6%) patients being treated with 2 LAMS. A 15mm diameter stent was placed in 225/335(67.2%). EC-LAMS was used in 303/335(90.4%). Technical success was achieved in 324 (96.7 %) cases with a mean procedural time of 32.4min 22.95. Clinical success (resolution of PFC) was achieved in 286 (85.9%) patients and LAMS were removed after a mean of 59 days (95% CI: 52.9-65.2). AE’s associated with the use of LAMS occurred in 89/333(26.6%, 95% CI: 18.9-36.1%) of cases. A total of 98 AEs occurred with 2 AEs occurring in 9 (2.7%) patients. Characteristics and management of AE’s are listed in table 2. Death occurred in 9 cases. The mean time between stent placement and occurrence of AEs was 22.8 (95% CI:16.6-29.9; range 0- 146) days. Conclusion: Data from this large international study confirm that the use of LAMS stent for management of PFCs has excellent technical and clinical success rates. The rate of complications including fatal events, however, is not negligible and should be carefully considered before using the stent in this clinical setting. Further studies are needed to determine the optimal algorithm for follow-up of LAMS placement to attempt to minimize AEsI documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
