Clinical impact of EUS treatment of walled-off pancreatic necrosis with dedicated devices

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Abstract

BACKGROUND AND STUDY AIMS:  Walled-off pancreatic necrosis (WOPN) represents the major risk factor for sepsis-related multiple organ failure. Surgical debridement is an invasive approach associated with high rates of adverse events (AEs) and death. As an alternative, endoscopic ultrasound-guided cysto-gastro-anastomosis has emerged as an effective treatment for WOPNs. Recently a new dedicated-lumen apposing metal stent (LAMS) has been used with satisfactory results in treating peri-pancreatic fluid collections, including WOPNs. The primary outcomes of this study were to evaluate survival and clinical success. Secondary outcomes included: technical success, adverse events and recurrence rate.

PATIENTS AND METHODS:  All consecutive patients with infected WOPN between February 2014 and June 2016 were retrospectively reviewed. Patients underwent placement of a new LAMS incorporated in an electrocautery-enhanced delivery system and direct endoscopic necrosectomy (DEN). DEN was performed immediately after stent deployment and repeated every 3 to 7 days until complete resolution.

RESULTS:  In the study period we treated 20 consecutive patients with infected WOPN using the new LAMS. Technical success was achieved in 95 % of patients. Clinical success was achieved in 73 % and 84.2 % of patients at 1 and 3 months, respectively. Survival rate was 84.2 % and 79 %. Mean length of hospital stay was 19 days (range 3 - 43). No AEs occurred. Patients were followed up after stent retrieval for a mean time of 554,7 days (range 70 - 986) and no recurrence was observed.

CONCLUSIONS:  DEN following "1-step, exchange-free" LAMS positioning recorded excellent results. We believe that simplicity of procedure plays a key role in terms of safety.

Original languageEnglish
Pages (from-to)E784-E791
JournalEndoscopy International Open
Volume5
Issue number8
DOIs
Publication statusPublished - Aug 2017

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Stents
Necrosis
Equipment and Supplies
Metals
Length of Stay
Therapeutics
Recurrence
Electrocoagulation
Multiple Organ Failure
Debridement
Sepsis
Survival Rate
Outcome Assessment (Health Care)
Safety
Survival

Keywords

  • Journal Article

Cite this

@article{b2ac6e321bf64cb28ae4f4d276a78a09,
title = "Clinical impact of EUS treatment of walled-off pancreatic necrosis with dedicated devices",
abstract = "BACKGROUND AND STUDY AIMS:  Walled-off pancreatic necrosis (WOPN) represents the major risk factor for sepsis-related multiple organ failure. Surgical debridement is an invasive approach associated with high rates of adverse events (AEs) and death. As an alternative, endoscopic ultrasound-guided cysto-gastro-anastomosis has emerged as an effective treatment for WOPNs. Recently a new dedicated-lumen apposing metal stent (LAMS) has been used with satisfactory results in treating peri-pancreatic fluid collections, including WOPNs. The primary outcomes of this study were to evaluate survival and clinical success. Secondary outcomes included: technical success, adverse events and recurrence rate.PATIENTS AND METHODS:  All consecutive patients with infected WOPN between February 2014 and June 2016 were retrospectively reviewed. Patients underwent placement of a new LAMS incorporated in an electrocautery-enhanced delivery system and direct endoscopic necrosectomy (DEN). DEN was performed immediately after stent deployment and repeated every 3 to 7 days until complete resolution.RESULTS:  In the study period we treated 20 consecutive patients with infected WOPN using the new LAMS. Technical success was achieved in 95 {\%} of patients. Clinical success was achieved in 73 {\%} and 84.2 {\%} of patients at 1 and 3 months, respectively. Survival rate was 84.2 {\%} and 79 {\%}. Mean length of hospital stay was 19 days (range 3 - 43). No AEs occurred. Patients were followed up after stent retrieval for a mean time of 554,7 days (range 70 - 986) and no recurrence was observed.CONCLUSIONS:  DEN following {"}1-step, exchange-free{"} LAMS positioning recorded excellent results. We believe that simplicity of procedure plays a key role in terms of safety.",
keywords = "Journal Article",
author = "Ilaria Tarantino and Dario Ligresti and Fabio Tuzzolino and Luca Barresi and Gabriele Curcio and Antonino Granata and Mario Traina",
year = "2017",
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doi = "10.1055/s-0043-112494",
language = "English",
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T1 - Clinical impact of EUS treatment of walled-off pancreatic necrosis with dedicated devices

AU - Tarantino, Ilaria

AU - Ligresti, Dario

AU - Tuzzolino, Fabio

AU - Barresi, Luca

AU - Curcio, Gabriele

AU - Granata, Antonino

AU - Traina, Mario

PY - 2017/8

Y1 - 2017/8

N2 - BACKGROUND AND STUDY AIMS:  Walled-off pancreatic necrosis (WOPN) represents the major risk factor for sepsis-related multiple organ failure. Surgical debridement is an invasive approach associated with high rates of adverse events (AEs) and death. As an alternative, endoscopic ultrasound-guided cysto-gastro-anastomosis has emerged as an effective treatment for WOPNs. Recently a new dedicated-lumen apposing metal stent (LAMS) has been used with satisfactory results in treating peri-pancreatic fluid collections, including WOPNs. The primary outcomes of this study were to evaluate survival and clinical success. Secondary outcomes included: technical success, adverse events and recurrence rate.PATIENTS AND METHODS:  All consecutive patients with infected WOPN between February 2014 and June 2016 were retrospectively reviewed. Patients underwent placement of a new LAMS incorporated in an electrocautery-enhanced delivery system and direct endoscopic necrosectomy (DEN). DEN was performed immediately after stent deployment and repeated every 3 to 7 days until complete resolution.RESULTS:  In the study period we treated 20 consecutive patients with infected WOPN using the new LAMS. Technical success was achieved in 95 % of patients. Clinical success was achieved in 73 % and 84.2 % of patients at 1 and 3 months, respectively. Survival rate was 84.2 % and 79 %. Mean length of hospital stay was 19 days (range 3 - 43). No AEs occurred. Patients were followed up after stent retrieval for a mean time of 554,7 days (range 70 - 986) and no recurrence was observed.CONCLUSIONS:  DEN following "1-step, exchange-free" LAMS positioning recorded excellent results. We believe that simplicity of procedure plays a key role in terms of safety.

AB - BACKGROUND AND STUDY AIMS:  Walled-off pancreatic necrosis (WOPN) represents the major risk factor for sepsis-related multiple organ failure. Surgical debridement is an invasive approach associated with high rates of adverse events (AEs) and death. As an alternative, endoscopic ultrasound-guided cysto-gastro-anastomosis has emerged as an effective treatment for WOPNs. Recently a new dedicated-lumen apposing metal stent (LAMS) has been used with satisfactory results in treating peri-pancreatic fluid collections, including WOPNs. The primary outcomes of this study were to evaluate survival and clinical success. Secondary outcomes included: technical success, adverse events and recurrence rate.PATIENTS AND METHODS:  All consecutive patients with infected WOPN between February 2014 and June 2016 were retrospectively reviewed. Patients underwent placement of a new LAMS incorporated in an electrocautery-enhanced delivery system and direct endoscopic necrosectomy (DEN). DEN was performed immediately after stent deployment and repeated every 3 to 7 days until complete resolution.RESULTS:  In the study period we treated 20 consecutive patients with infected WOPN using the new LAMS. Technical success was achieved in 95 % of patients. Clinical success was achieved in 73 % and 84.2 % of patients at 1 and 3 months, respectively. Survival rate was 84.2 % and 79 %. Mean length of hospital stay was 19 days (range 3 - 43). No AEs occurred. Patients were followed up after stent retrieval for a mean time of 554,7 days (range 70 - 986) and no recurrence was observed.CONCLUSIONS:  DEN following "1-step, exchange-free" LAMS positioning recorded excellent results. We believe that simplicity of procedure plays a key role in terms of safety.

KW - Journal Article

U2 - 10.1055/s-0043-112494

DO - 10.1055/s-0043-112494

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SP - E784-E791

JO - Endoscopy International Open

JF - Endoscopy International Open

SN - 2196-9736

IS - 8

ER -