versus plastic stents in the management of pancreatic pseudocysts a large comparative international multicenter study Dr Federico Cravero Tutor Dr Mauro Bruno Yang ID: 1033012
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1. Lumen-apposing stents versus plastic stents in the management of pancreatic pseudocysts: a large, comparative, international, multicenter study Dr. Federico CraveroTutor: Dr. Mauro BrunoYang J. et al. Endoscopy. 2019 Nov;51(11):1035-1043.
2. Acute pancreatitis subtypesFluid collection80-90%10-20%10-40 %
3. Atlanta classification
4. When drainage is indicated?4 weeks
5. Drainage techniques70-80 % resolution10-15% morbidity30 % resolutionHospital stay 4-10% mortalitySevere disease only
6. Endoscopic drainage
7. Choosing stentPseudocystsPlastic stent are a valid solution:Multiple stents for optimal drainageLow priceComplex insertion procedure Infectious and occlusion riskLAMS role??WONData on LAMS are lacking, but in recent studies they show excellent results:Greater clinical successLower insertion timeLower occlusion rateAccess to cavity (e.g. necrosectomy)Greater costGreater bleeding risk
8. Today topic
9. Background
10. Background e scopo dello studioLAMS are mostly studied for WON drainage or in mixed WON/pseudocyst cohortLarge direct comparative studies of LAMSs with DPPSs in pancreatic pseudocyst management are lacking Objective: to compare the clinical outcomes of transmural guided EUS drainage of pancreatic pseudocysts performed with DPPSs vs LAMS
11. MethodsRetrospective international multicentric study. 14 tertiary hospitals: 12 USA, 2 UEInclusion criteria:Patients who underwent EUS-guided pancreatic pseudocyts drainageUsed stent: LAMS or DPPSsEnrolling time: January 2012 – August 2016Exclusion criteria:WONLess than 30 days follow-up inferiore ai 30 giorniAtlanta classification
12. End points
13. End points
14. Patients - demographics
15. Patients – PC characteristics
16. Procedure techniqueLAMSLinear array echoendoscopesPC size and position evaluation Probe – PC distance < 1cmColor-doppler to exclude vessel interpositionCautery assisted LAMS insertion (60%)Non cautery assisted: needle, wire, tract dilation, insertionDPPSLinear array echoendoscopesAccess to cavity with 19 gauge needle from stomach or duodenum0.025 or 0.035 guidewire insertion in cyst cavity under fluoroscopic guidanceTract dilation with baloon or cystotomeDPPS insertion over guidewire under fluoroscopic guidance
17. Procedure characteristics
18. Clinical outcomes
19. Adverse events
20. Predictors of clinical successPOSITIVENEGATIVE
21. Conclusions
22. BibliographyArvanitakis M, et al . Endoscopic management of acute necrotizing pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) evidence-based multidisciplinary guidelines. Endoscopy. 2018 May;50(5):524-546.Banks PA et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102. ASGE Standards of Practice Committee, The role of endoscopy in the diagnosis and treatment of inflammatory pancreatic fluid collections. Gastrointest Endosc. 2016;83(3):481.Hookey LC et al. Endoscopic drainage of pancreatic-fluid collections in 116 patients: a comparison of etiologies, drainage techniques, and outcomes. Gastrointest Endosc. 2006;63(4):635.Antillon MR et al. Single-step EUS-guided transmural drainage of simple and complicated pancreatic pseudocysts. Gastrointest Endosc. 2006;63(6):797B. Joseph Elmunzer . Endoscopic Drainage of Pancreatic Fluid Collections. Clinical Gastroenterology and Hepatology 2018;16:1851–1863