Comparing efficacy of lumen-apposing stents to plastic stents in the endoscopic management of mature peripancreatic fluid collections: a single-center experience
Matthew Fasullo,1 Yasir Al-Azzawi,1 Joan Kheder,1 Jeffrey Abergel,2 Wahid Wassef1 1Department of Gastroenterology, UMass Memorial Medical Center, Worcester, MA, USA; 2Department of Gastroenterology, Staten Island University Hospital, Staten Island, NY, USA Introduction: Mature peripancreatic fluid c...
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doaj-22a8c69763cb46ffbb78b114c8268e872020-11-24T23:56:12ZengDove Medical PressClinical and Experimental Gastroenterology1178-70232018-06-01Volume 1124925439048Comparing efficacy of lumen-apposing stents to plastic stents in the endoscopic management of mature peripancreatic fluid collections: a single-center experienceFasullo MAl-Azzawi YKheder JAbergel JWassef WMatthew Fasullo,1 Yasir Al-Azzawi,1 Joan Kheder,1 Jeffrey Abergel,2 Wahid Wassef1 1Department of Gastroenterology, UMass Memorial Medical Center, Worcester, MA, USA; 2Department of Gastroenterology, Staten Island University Hospital, Staten Island, NY, USA Introduction: Mature peripancreatic fluid collection (MPFC) is a known and often challenging consequence of acute pancreatitis and often requires intervention. The most common method accepted is the “step-up approach,” which consists of percutaneous drainage followed, if necessary, by minimally invasive retroperitoneal necrosectomy. Our paper aims to distinguish between plastic stents and lumen-apposing stents in the endoscopic management of MPFC in terms of morbidity, mortality, and haste of fluid collection resolution. Methods: A retrospective analysis was performed at UMass Memorial Medical Center in patients with a diagnosis of MPFC. Utilizing medical records, clinical data, radiology, as well as endoscopic evidence, patients were differentiated by stent type used (plastic versus lumen-apposing) for the management of the MPFC. The primary outcome of the study was to assess the time to MPFC resolution following the placement of either plastic or lumen-apposing stents (on endoscopic ultrasound or computerized tomography scan) using a multivariate analysis with a logistic regression model. Results: A total of 54 patients were included in this study from UMass Memorial Medical Center between 2012 and 2015. Twelve (22%) of these patients received lumen-apposing stents and 42 (78%) of these patients received plastic pigtail stents. For the lumen-apposing stent group, the mean interval between stent placement and resolution of MPFC was 57 days as compared to 102 days for plastic pigtail stents (p=0.02). The mean interval for placement/removal of lumen-apposing stents was 48 days as compared to 81 days for plastic pigtail stents (p=0.01). Stent migration was seen in 5 patients (11%) who received a plastic pigtail stent compared to 0 (0%) patients who received a lumen-apposing stent. Discussion: Our study demonstrates that lumen-apposing stents result in a significant reduction in the interval between stent placement and MPFC resolution as well as the time from stent placement to removal, when compared to plastic pigtail stents, the prior standard-of-care. Our study reached similar conclusions regarding the number of stents placed. However, we did not find a significant difference between the complication rates, specifically peri- and postprocedural bleeding or perforation, between the 2 study groups, as demonstrated in prior papers. Keywords: pancreas, lumen-apposing, necrosectomy, fluid collection, plastic pigtail stenthttps://www.dovepress.com/comparing-efficacy-of-lumen-apposing-stents-to-plastic-stents-in-the-e-peer-reviewed-article-CEGPancreasLumen-apposingNecrosectomy |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Fasullo M Al-Azzawi Y Kheder J Abergel J Wassef W |
spellingShingle |
Fasullo M Al-Azzawi Y Kheder J Abergel J Wassef W Comparing efficacy of lumen-apposing stents to plastic stents in the endoscopic management of mature peripancreatic fluid collections: a single-center experience Clinical and Experimental Gastroenterology Pancreas Lumen-apposing Necrosectomy |
author_facet |
Fasullo M Al-Azzawi Y Kheder J Abergel J Wassef W |
author_sort |
Fasullo M |
title |
Comparing efficacy of lumen-apposing stents to plastic stents in the endoscopic management of mature peripancreatic fluid collections: a single-center experience |
title_short |
Comparing efficacy of lumen-apposing stents to plastic stents in the endoscopic management of mature peripancreatic fluid collections: a single-center experience |
title_full |
Comparing efficacy of lumen-apposing stents to plastic stents in the endoscopic management of mature peripancreatic fluid collections: a single-center experience |
title_fullStr |
Comparing efficacy of lumen-apposing stents to plastic stents in the endoscopic management of mature peripancreatic fluid collections: a single-center experience |
title_full_unstemmed |
Comparing efficacy of lumen-apposing stents to plastic stents in the endoscopic management of mature peripancreatic fluid collections: a single-center experience |
title_sort |
comparing efficacy of lumen-apposing stents to plastic stents in the endoscopic management of mature peripancreatic fluid collections: a single-center experience |
publisher |
Dove Medical Press |
series |
Clinical and Experimental Gastroenterology |
issn |
1178-7023 |
publishDate |
2018-06-01 |
description |
Matthew Fasullo,1 Yasir Al-Azzawi,1 Joan Kheder,1 Jeffrey Abergel,2 Wahid Wassef1 1Department of Gastroenterology, UMass Memorial Medical Center, Worcester, MA, USA; 2Department of Gastroenterology, Staten Island University Hospital, Staten Island, NY, USA Introduction: Mature peripancreatic fluid collection (MPFC) is a known and often challenging consequence of acute pancreatitis and often requires intervention. The most common method accepted is the “step-up approach,” which consists of percutaneous drainage followed, if necessary, by minimally invasive retroperitoneal necrosectomy. Our paper aims to distinguish between plastic stents and lumen-apposing stents in the endoscopic management of MPFC in terms of morbidity, mortality, and haste of fluid collection resolution. Methods: A retrospective analysis was performed at UMass Memorial Medical Center in patients with a diagnosis of MPFC. Utilizing medical records, clinical data, radiology, as well as endoscopic evidence, patients were differentiated by stent type used (plastic versus lumen-apposing) for the management of the MPFC. The primary outcome of the study was to assess the time to MPFC resolution following the placement of either plastic or lumen-apposing stents (on endoscopic ultrasound or computerized tomography scan) using a multivariate analysis with a logistic regression model. Results: A total of 54 patients were included in this study from UMass Memorial Medical Center between 2012 and 2015. Twelve (22%) of these patients received lumen-apposing stents and 42 (78%) of these patients received plastic pigtail stents. For the lumen-apposing stent group, the mean interval between stent placement and resolution of MPFC was 57 days as compared to 102 days for plastic pigtail stents (p=0.02). The mean interval for placement/removal of lumen-apposing stents was 48 days as compared to 81 days for plastic pigtail stents (p=0.01). Stent migration was seen in 5 patients (11%) who received a plastic pigtail stent compared to 0 (0%) patients who received a lumen-apposing stent. Discussion: Our study demonstrates that lumen-apposing stents result in a significant reduction in the interval between stent placement and MPFC resolution as well as the time from stent placement to removal, when compared to plastic pigtail stents, the prior standard-of-care. Our study reached similar conclusions regarding the number of stents placed. However, we did not find a significant difference between the complication rates, specifically peri- and postprocedural bleeding or perforation, between the 2 study groups, as demonstrated in prior papers. Keywords: pancreas, lumen-apposing, necrosectomy, fluid collection, plastic pigtail stent |
topic |
Pancreas Lumen-apposing Necrosectomy |
url |
https://www.dovepress.com/comparing-efficacy-of-lumen-apposing-stents-to-plastic-stents-in-the-e-peer-reviewed-article-CEG |
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