Drainage of pancreatic fluid collections using a lumen-apposing metal stent with an electrocautery-enhanced delivery system.

Abstract

Our aim was to evaluate the efficacy and safety of a lumen-apposing metal stent with an electrocautery-enhanced delivery system (EDS-LAMS) for EUS-guided drainage of pancreatic fluid collections (PFCs) in regular clinical practice. A retrospective and subsequent prospective analysis was undertaken of all patients who underwent EUS-guided drainage of their PFCs using the EDS-LAMS at 17 tertiary therapeutic endoscopy centers. 208 cases of EDS-LAMS deployment were attempted in 202 patients (mean age 52.9 yr) at time of evaluation. 97 patients had pancreatic pseudocysts (PP), 75 walled-off pancreatic necrosis (WOPN), 10 acute peripancreatic fluid collections (APFC), 6 acute necrotic collections (ANC) and 14 post-operative collections (POC). Procedural technical success was achieved in 202/208 cases (97.1%). Maldeployment occurred in 7/208 cases (3.4%). Clinical success was achieved in 142/160 (88.8%) patients (PP 90%, WOPN 85.2%, APFC 100%, ANC 75%, POC 100%). Delayed adverse events included stent migration in 15/202 (7.4%), stent occlusion and infection in 16/202 (7.9%), major bleeding in 4/202 (2%) and buried EDS-LAMS in 2/202 (1%). PFC recurrence occurred in 13/142 (9.2%) patients. 9/202 (4.5%) required surgical or radiological intervention for PFC management after EDS-LAMS insertion. This large international multi-center study evaluating the EDS-LAMS for drainage of PFCs in routine clinical practice suggests that the EDS-LAMS are safe and effective for drainage of all types of PFCs; however, further endoscopic therapy is often required for WOPN. Major bleeding was a rare complication in our cohort.