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Real-life multicentre study of lumen-apposing metal stent for EUS-guided drainage of pancreatic fluid collections
  1. Arnaldo Amato1,
  2. Ilaria Tarantino2,
  3. Antonio Facciorusso3,4,
  4. Cecilia Binda5,
  5. Stefano Francesco Crinò4,
  6. Alessandro Fugazza6,
  7. Edoardo Forti7,
  8. Maria Chiara Petrone8,
  9. Roberto Di Mitri9,
  10. Raffaele Macchiarelli10,
  11. Emanuele Sinagra11,
  12. Marcello Maida12,
  13. Alessandro Repici6,13,
  14. Andrea Anderloni6,
  15. Carlo Fabbri5
  16. On behalf of i-EUS Group
    1. 1 Gastroenterology Unit, Valduce Hospital, Como, Italy
    2. 2 Endoscopy Service, Department of Diagnostic and Therapeutic Services, ISMETT, Palermo, Italy
    3. 3 Department of Surgical and Medical Sciences, Section of Gastroenterology University of Foggia, Foggia, Italy
    4. 4 Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy
    5. 5 Gastroenterology and Endoscopy Unit, Forlì-Cesena Hospitals, AUSL della Romagna, Forlì, Italy
    6. 6 Digestive Endoscopy Unit, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Italy
    7. 7 Operative Endoscopy Unit, Niguarda Ca’ Granda Hospital, Milano, Italy
    8. 8 Gastroenterology and Gastrointestinal Endoscopy, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, Milano, Italy
    9. 9 Gastroenterology and Endoscopy Unit, Arnas Civico Hospital, Palermo, Italy
    10. 10 Gastroenterology Unit, A.O.U.S. Policlinico S.Maria alle Scotte, Policlinico Santa Maria alle Scotte, Siena, Italy
    11. 11 Gastroenterology and Endoscopy Unit, Fondazione Istituto San Raffaele G. Giglio di Cefalù, Cefalu, Italy
    12. 12 Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, Caltanisetta, Italy
    13. 13 Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
    1. Correspondence to Dr Arnaldo Amato, Division of Digestive Endoscopy and Gastroenterology, Valduce Hospital, Como, Italy; arnamato{at}gmail.com

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    Significance of this study

    What is already known about this topic?

    • The use of lumen apposing metal stents (LAMS) is currently the most common choice for endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collections (PFCs). Early removal of LAMS from PFCs is considered key factor in reducing adverse events.

    What this study adds?

    • The efficacy and safety of EUS-guided drainage of PFCs are confirmed in a real-life setting.

    • The timing for LAMS removal has not been confirmed to impact safety and efficacy of EUS-guided PFCs drainage, probably being less crucial than currently considered.

    How this study might affect research, practice or policy?

    • The good outcomes of EUS-guided drainage also in a real-life setting and the possibility of leaving the LAMS longer in the PFCs, without incurring a greater risk of adverse events, might enable to better planning their management.

    Message

    In a retrospective analysis involving 30 secondary and tertiary centres during a 5-year period (until July 2020), 516 pancreatic fluid collections (PFCs) (47.9% pseudocysts, 52.1% walled-off necroses) were drained by endoscopists with different levels of experience. High technical and clinical success rates (96.9% and 91.7%, respectively) and a good safety profile (adverse events (AEs) 14.7%, of which bleeding 5.6%) were confirmed also in a real-life setting. The timing for luminal apposing metal stents (LAMS) removal might be less relevant than currently considered.

    In more detail

    Management of PFCs has moved from a surgical method to a ‘step-up’ endoscopic approach with reduction of negative outcomes1 and improved efficacy.2 The improvement of endosonographic procedures and the introduction of dedicated LAMS have made endoscopic drainage relatively easier,3 making the treatment accessible not only to experienced endoscopists from third-level centres (figure 1). Having already proven its efficacy, safety, mainly the risk of delayed bleeding,4–6 represents the main area for improvement.

    Figure 1

    EUS-guided drainage of a pancreatic collection (walled-off necrosis, WON). EUS, endoscopic ultrasound; LAMS, lumen apposing metal stents.

    To confirm the good safety and efficacy profile in a real-life …

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    Supplementary materials

    Footnotes

    • Collaborators i-EUS Group: Daryl Ramai, 14 Francesca D’Errico 15, Debora Berretti 16, Germana De Nucci 17, Mauro Lovera18, Fabia Attili19, Mario Luciano Brancaccio20, Alessandro Radaelli21, Enrico Tasini22, Marco Ballarè23, Franco Coppola24, Nicola Leone25, Luigi Cugia26, Roberto Grassia27, Monica Sbrancia28, Thomas Togliani29, Pietro Fusaroli 30, Claudio De Angelis31, Fabio Cipolletta32, Mauro Manno33, Roberta Badas34, Valeria Pollino35, Lorenzo Camellini36, Laura Bernardoni 4, Elisabetta Conte 9, Andrea Lisotti 30, Massimiliano Mutignani7, Mario Traina2, Paolo Giorgio Arcidiacono8.14 Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, Utah, USA; 15 Gastroenterology and Endoscopy Unit, General Regional Hospital "F. Miulli", Acquaviva delle Fonti, Bari, Italy; 16 Department for Gastroenterology and Digestive Endoscopy, Academic Center of Udine, Italy; 17 Department of Gastroenterology, Salvini Hospital, Garbagnate, Italy; 18 Digestive Endoscopy Unit, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy; 19 Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy; 20 Division of Gastroenterology, S. Maria delle Croci Hospital, Ravenna, Italy; 21 Gastroenterology and Endoscopy Unit, San Gerardo Hospital, Monza, Italy; 22 Gastroenterology and Digestive Endoscopy Unit; Santa Chiara; Hospital, Trento, Italy; 23 Department of Gastroenterology, Maggiore della Carità; Hospital, Novara, Italy; 24 Digestive Endoscopy Unit, Division of Gastroenterology, ASL TO4, Turin, Italy; 25 Digestive Endoscopy Unit, Humanitas Gradenigo, Turin, Italy; 26 Gastroenterology and Digestive Endoscopy Department, Azienda Ospedaliero Universitaria Sassari, Sassari, Italy; 27 Gastroenterology and Digestive Endoscopy Unit, ASST Cremona, Cremona, Italy; 28 Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Cesena, Italy; 29 Gastroenterology and Endoscopy Unit, ASST Carlo Poma, Mantua, Italy; 30 Department of Medical and Surgical Sciences, Gastroenterology Unit, University of Bologna/Hospital of Imola, Imola, Italy; 31 Gastroenterology and Endoscopy Unit, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy; 32 Division of Gastroenterology, Ospedale del Mare, Naples, Italy; 33 Digestive Endoscopy Unit, USL Modena, Carpi Hospital, Italy; 34 Digestive Endoscopy Unit, University Hospital, Cagliari, Italy; 35 Department of Endoscopic Surgery, Brotzu Hospital, Cagliari, Italy; 36 Unit of Gastroenterology, ASL 5 Spezzino, La Spezia, Italy

    • Contributors Study concept and design: AA, AF and CF. Acquisition of data: AA and AF. Analysis and interpretation of data: AF, ES and MM. Drafting of the manuscript: AA and AF. Revision of the manuscript for important intellectual content: IT, AA and CF. Approval of the final manuscript: all the authors. Guarantor of the article: AA.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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