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Outcomes of a single-step endoscopic ultrasound-guided drainage of pancreatic-fluid collections using an electrocautery-enhanced coaxial lumen-apposing, self-expanding metal stent with and without fluoroscopy.
Olaiya, Babatunde; Mekaroonkamol, Parit; Li, Bai-Wen; Massaad, Julia; Vachaparambil, Cicily T; Xu, Jennifer; Lamm, Vladamir; Luo, Hui; Shen, Shan-Shan; Chen, Hui-Min; Keilin, Steve; Willingham, Field F; Cai, Qiang.
Afiliación
  • Olaiya B; Department of Internal Medicine, Marshfield Clinic, Marshfield, WI, USA.
  • Mekaroonkamol P; Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA, USA.
  • Li BW; Division of Gastroenterology, King Chulalongkorn Memorial Hospital, Chulalongkorn University and Thai Red Cross, Bangkok, Thailand.
  • Massaad J; Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA, USA.
  • Vachaparambil CT; Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, P. R. China.
  • Xu J; Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA, USA.
  • Lamm V; Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA, USA.
  • Luo H; Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA, USA.
  • Shen SS; Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA, USA.
  • Chen HM; Department of Gastroenterology, Xijing Hospital, Xi'an, Shaanxi, P. R. China.
  • Keilin S; Department of Gastroenterology, Nanjing Drum Tower Hospital, Nanjing, Jiangshu, P. R. China.
  • Willingham FF; Department of Gastroenterology, Renji Hospital, Shanghai Jiaotong University, Shanghai, P. R. China.
  • Cai Q; Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA, USA.
Gastroenterol Rep (Oxf) ; 8(6): 425-430, 2020 Dec.
Article en En | MEDLINE | ID: mdl-33442474
ABSTRACT

BACKGROUND:

Fluoroscopy is often used during the endoscopic drainage of pancreatic-fluid collections (PFCs). An electrocautery-enhanced coaxial lumen-apposing, self-expanding metal stent (ELAMS) facilitates a single-step procedure and may avoid the need for fluoroscopy. This study compares the treatment outcomes using ELAMS with and without fluoroscopy.

METHODS:

Patients with PFCs who had cystogastrostomy from January 2014 to February 2017 were enrolled. Two groups were studied based on fluoroscopy use. Technical success was defined as uneventful insertion of ELAMS at time of procedure. Clinical success was defined as (i) clinical resolution of symptoms after the procedure and (ii) >75% reduction in cyst size on computed tomography 8 weeks after stent placement. Adverse events including bleeding, stent migration, and infection were recorded.

RESULTS:

A total of 21 patients (13 males) had PFCs drainage with ELAMS in the study period. The mean age was 51.6 ± 14.2 years. Thirteen patients had walled-off necrosis while eight had a pancreatic pseudocyst. The mean size of the PFCs was 11.3 ± 3.3 cm. Fluoroscopy was used in seven cases (33%) and was associated with a longer procedure time compared to non-fluoroscopy (43.1 ± 10.4 vs 33.3 ± 10.5 min, P = 0.025). This association was independent of the size, location, or type of PFCs. Fluoroscopy had no effect on the technical success rates. In fluoroless procedures, the clinical resolution was 91% as compared to 71% in fluoroscopy procedures (P = 0.52) and the radiologic resolution was 57% as compared to 71% in fluoroscopy procedures (P = 0. 65). Three cases of stent migration/displacement occurred in the fluoroless procedures.

CONCLUSIONS:

ELAMS may avoid the need for fluoroscopy during cystogastrostomy. Procedures without fluoroscopy were significantly shorter and fluoroscopy use had no impact on the technical or clinical success rates.
Palabras clave

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Gastroenterol Rep (Oxf) Año: 2020 Tipo del documento: Article País de afiliación: Estados Unidos

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Gastroenterol Rep (Oxf) Año: 2020 Tipo del documento: Article País de afiliación: Estados Unidos