Elsevier

Gastrointestinal Endoscopy

Volume 84, Issue 3, September 2016, Pages 450-457.e2
Gastrointestinal Endoscopy

Original article
Clinical endoscopy
Evaluation of the short- and long-term effectiveness and safety of fully covered self-expandable metal stents for drainage of pancreatic fluid collections: results of a Spanish nationwide registry

https://doi.org/10.1016/j.gie.2016.02.044Get rights and content

Background and Aims

Initial reports suggest that fully covered self-expandable metal stents (FCSEMSs) may be better suited for drainage of dense pancreatic fluid collections (PFCs), such as walled-off pancreatic necrosis. The primary aim was to analyze the effectiveness and safety of FCSEMSs for drainage of different types of PFCs in a large cohort. The secondary aim was to investigate which type of FCSEMS is superior.

Methods

This was a retrospective, noncomparative review of a nationwide database involving all hospitals in Spain performing EUS-guided PFC drainage. From April 2008 to August 2013, all patients undergoing PFC drainage with an FCSEMS were included in a database. The main outcome measurements were technical success, short-term (2 weeks) and long-term (6 months) effectiveness, adverse events, and need for surgery.

Results

The study included 211 patients (pseudocyst/walled-off pancreatic necrosis, 53%/47%). The FCSEMSs used were straight biliary (66%) or lumen-apposing (34%). Technical success was achieved in 97% of patients (95% confidence interval [CI], 93%-99%). Short-term- and long-term clinical success was obtained in 94% (95% CI, 89%-97%) and 85% (95% CI, 79%-89%) of patients, respectively. Adverse events occurred in 21% of patients (95% CI, 16%-27%): infection (11%), bleeding (7%), and stent migration and/or perforation (3%). By multivariate analysis, patient age (>58 years) and previous failed drainage were the most important factors associated with negative outcome.

Conclusions

An FCSEMS is effective and safe for PFC drainage. Older patients with a history of unsuccessful drainage are more likely to fail EUS-guided drainage. The type of FCSEMS does not seem to influence patient outcome.

Section snippets

Patients

All hospitals performing EUS-guided PFC drainage with FCSEMSs in Spain between April 2008 and August 2013 were identified through the national EUS and endoscopy societies and were invited to participate in this nationwide retrospective registry. Institutional review board approval was obtained for medical record and database review and analysis of included patients.

Results

From this retrospective national registry, data from 211 patients from 26 hospitals who had undergone EUS-guided PFC drainage with an FCSEMS in Spain were included. All hospitals with experience in this technique in the country participated in the study, and we included all patients treated at those institutions. Each hospital provided a median of 9 patients for the registry (range, 1-57).

Patient characteristics and endoscopic treatments performed are shown in Table 1. Most patients included in

Discussion

The results of the present study, representing the accumulated experience of 1 country over an 8-year period, showed an 85% clinical success rate at 6 months and a 25% AE rate after drainage of PFCs and support the use of FCSEMSs for the treatment of any PFC type. This study represents a large experience on this topic and supports its use in clinical practice.

However, many questions remain regarding PFC drainage, and answers are anxiously awaited by the scientific community. Efforts have been

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    DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.

    If you would like to chat with an author of this study, you may contact Dr Vazquez-Sequeiros at [email protected].

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