Endoscopic Therapy With Lumen-apposing Metal Stents Is Safe and Effective for Patients With Pancreatic Walled-off Necrosis

Reem Z. Sharaiha, Amy Tyberg, Mouen A. Khashab, Nikhil A. Kumta, Kunal Karia, Jose Nieto, Uzma D. Siddiqui, Irving Waxman, Virendra Joshi, Petros C. Benias, Peter Darwin, Christopher J. DiMaio, Christopher J. Mulder, Shai Friedland, David G. Forcione, Divyesh V. Sejpal, Tamas A. Gonda, Frank G. Gress, Monica Gaidhane, Ann Koons & 18 others Ersilia M. DeFilippis, Sanjay Salgado, Kristen R. Weaver, John M. Poneros, Amrita Sethi, Sammy Ho, Vivek Kumbhari, Vikesh K. Singh, Alan H. Tieu, Viviana Parra, Alisa Likhitsup, Craig Womeldorph, Brenna Casey, Sreeni S. Jonnalagadda, Amit P. Desai, David L. Carr-Locke, Michel Kahaleh, Ali A. Siddiqui

Research output: Contribution to journalArticle

86 Citations (Scopus)

Abstract

Background & Aims Endoscopic ultrasound–guided transmural drainage and necrosectomy have become the standard treatment for patients with pancreatic walled-off necrosis (WON). Lumen-apposing metal stents (LAMS) have shown success in the management of pancreatic fluid collections. However, there are few data on their specific roles in management of WON. We investigated the efficacy and safety of LAMS in treatment of WON. Methods We performed a retrospective multicenter case series of 124 patients with WON who underwent endoscopic transmural drainage by using LAMS at 17 tertiary care centers from January 2014 through May 2015. Patients underwent endoscopic ultrasound–guided cystogastrostomy or cystoenterostomy with placement of an LAMS into the WON collection. At the discretion of the endoscopist, we performed direct endoscopic necrosectomy, irrigation with hydrogen peroxide, and/or nasocystic drain placement. We performed endoscopic retrograde cholangiopancreatography with pancreatic duct stent placement when indicated. Concomitant therapies included direct endoscopic debridement (n = 78), pancreatic duct stent placement for leak (n = 19), hydrogen peroxide–assisted necrosectomy (n = 38), and nasocystic irrigation (n = 22). We collected data for a median time of 4 months (range, 1–34 months) after the LAMS placement. The primary outcomes were rates of technical success (successful placement of the LAMS), clinical success (resolution of WON, on the basis of image analysis, without need for further intervention via surgery or interventional radiology), and adverse events. Results The median size of the WON was 9.5 cm (range, 4–30 cm). Eight patients had 2 LAMS placed for multiport access, all with technical success (100%). Clinical success was achieved in 107 patients (86.3%) after 3 months of follow-up. Thirteen patients required a percutaneous drain, and 3 required a surgical intervention to manage their WON. The stents remained patent in 94% of patients (117 of 124) and migrated in 5.6% of patients (7 of 124). The median number of endoscopic interventions was 2 (range, 1–9 interventions). Conclusions On the basis of a retrospective analysis of 124 patients, endoscopic therapy of WON by using LAMS is safe and effective. Creation of a large and sustained cystogastrostomy or cystoenterostomy tract is effective in the drainage and treatment of WON.

Original languageEnglish (US)
Pages (from-to)1797-1803
Number of pages7
JournalClinical Gastroenterology and Hepatology
Volume14
Issue number12
DOIs
StatePublished - Dec 1 2016
Externally publishedYes

Fingerprint

Stents
Necrosis
Metals
Therapeutics
Drainage
Pancreatic Ducts
Interventional Radiology
Endoscopic Retrograde Cholangiopancreatography
Debridement
Tertiary Care Centers
Hydrogen Peroxide
Hydrogen
Safety

Keywords

  • ERCP
  • Necrosectomy
  • Pancreatic Necrosis
  • Pancreatitis
  • Stents

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Endoscopic Therapy With Lumen-apposing Metal Stents Is Safe and Effective for Patients With Pancreatic Walled-off Necrosis. / Sharaiha, Reem Z.; Tyberg, Amy; Khashab, Mouen A.; Kumta, Nikhil A.; Karia, Kunal; Nieto, Jose; Siddiqui, Uzma D.; Waxman, Irving; Joshi, Virendra; Benias, Petros C.; Darwin, Peter; DiMaio, Christopher J.; Mulder, Christopher J.; Friedland, Shai; Forcione, David G.; Sejpal, Divyesh V.; Gonda, Tamas A.; Gress, Frank G.; Gaidhane, Monica; Koons, Ann; DeFilippis, Ersilia M.; Salgado, Sanjay; Weaver, Kristen R.; Poneros, John M.; Sethi, Amrita; Ho, Sammy; Kumbhari, Vivek; Singh, Vikesh K.; Tieu, Alan H.; Parra, Viviana; Likhitsup, Alisa; Womeldorph, Craig; Casey, Brenna; Jonnalagadda, Sreeni S.; Desai, Amit P.; Carr-Locke, David L.; Kahaleh, Michel; Siddiqui, Ali A.

In: Clinical Gastroenterology and Hepatology, Vol. 14, No. 12, 01.12.2016, p. 1797-1803.

Research output: Contribution to journalArticle

Sharaiha, RZ, Tyberg, A, Khashab, MA, Kumta, NA, Karia, K, Nieto, J, Siddiqui, UD, Waxman, I, Joshi, V, Benias, PC, Darwin, P, DiMaio, CJ, Mulder, CJ, Friedland, S, Forcione, DG, Sejpal, DV, Gonda, TA, Gress, FG, Gaidhane, M, Koons, A, DeFilippis, EM, Salgado, S, Weaver, KR, Poneros, JM, Sethi, A, Ho, S, Kumbhari, V, Singh, VK, Tieu, AH, Parra, V, Likhitsup, A, Womeldorph, C, Casey, B, Jonnalagadda, SS, Desai, AP, Carr-Locke, DL, Kahaleh, M & Siddiqui, AA 2016, 'Endoscopic Therapy With Lumen-apposing Metal Stents Is Safe and Effective for Patients With Pancreatic Walled-off Necrosis', Clinical Gastroenterology and Hepatology, vol. 14, no. 12, pp. 1797-1803. https://doi.org/10.1016/j.cgh.2016.05.011
Sharaiha, Reem Z. ; Tyberg, Amy ; Khashab, Mouen A. ; Kumta, Nikhil A. ; Karia, Kunal ; Nieto, Jose ; Siddiqui, Uzma D. ; Waxman, Irving ; Joshi, Virendra ; Benias, Petros C. ; Darwin, Peter ; DiMaio, Christopher J. ; Mulder, Christopher J. ; Friedland, Shai ; Forcione, David G. ; Sejpal, Divyesh V. ; Gonda, Tamas A. ; Gress, Frank G. ; Gaidhane, Monica ; Koons, Ann ; DeFilippis, Ersilia M. ; Salgado, Sanjay ; Weaver, Kristen R. ; Poneros, John M. ; Sethi, Amrita ; Ho, Sammy ; Kumbhari, Vivek ; Singh, Vikesh K. ; Tieu, Alan H. ; Parra, Viviana ; Likhitsup, Alisa ; Womeldorph, Craig ; Casey, Brenna ; Jonnalagadda, Sreeni S. ; Desai, Amit P. ; Carr-Locke, David L. ; Kahaleh, Michel ; Siddiqui, Ali A. / Endoscopic Therapy With Lumen-apposing Metal Stents Is Safe and Effective for Patients With Pancreatic Walled-off Necrosis. In: Clinical Gastroenterology and Hepatology. 2016 ; Vol. 14, No. 12. pp. 1797-1803.
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abstract = "Background & Aims Endoscopic ultrasound–guided transmural drainage and necrosectomy have become the standard treatment for patients with pancreatic walled-off necrosis (WON). Lumen-apposing metal stents (LAMS) have shown success in the management of pancreatic fluid collections. However, there are few data on their specific roles in management of WON. We investigated the efficacy and safety of LAMS in treatment of WON. Methods We performed a retrospective multicenter case series of 124 patients with WON who underwent endoscopic transmural drainage by using LAMS at 17 tertiary care centers from January 2014 through May 2015. Patients underwent endoscopic ultrasound–guided cystogastrostomy or cystoenterostomy with placement of an LAMS into the WON collection. At the discretion of the endoscopist, we performed direct endoscopic necrosectomy, irrigation with hydrogen peroxide, and/or nasocystic drain placement. We performed endoscopic retrograde cholangiopancreatography with pancreatic duct stent placement when indicated. Concomitant therapies included direct endoscopic debridement (n = 78), pancreatic duct stent placement for leak (n = 19), hydrogen peroxide–assisted necrosectomy (n = 38), and nasocystic irrigation (n = 22). We collected data for a median time of 4 months (range, 1–34 months) after the LAMS placement. The primary outcomes were rates of technical success (successful placement of the LAMS), clinical success (resolution of WON, on the basis of image analysis, without need for further intervention via surgery or interventional radiology), and adverse events. Results The median size of the WON was 9.5 cm (range, 4–30 cm). Eight patients had 2 LAMS placed for multiport access, all with technical success (100{\%}). Clinical success was achieved in 107 patients (86.3{\%}) after 3 months of follow-up. Thirteen patients required a percutaneous drain, and 3 required a surgical intervention to manage their WON. The stents remained patent in 94{\%} of patients (117 of 124) and migrated in 5.6{\%} of patients (7 of 124). The median number of endoscopic interventions was 2 (range, 1–9 interventions). Conclusions On the basis of a retrospective analysis of 124 patients, endoscopic therapy of WON by using LAMS is safe and effective. Creation of a large and sustained cystogastrostomy or cystoenterostomy tract is effective in the drainage and treatment of WON.",
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TY - JOUR

T1 - Endoscopic Therapy With Lumen-apposing Metal Stents Is Safe and Effective for Patients With Pancreatic Walled-off Necrosis

AU - Sharaiha, Reem Z.

AU - Tyberg, Amy

AU - Khashab, Mouen A.

AU - Kumta, Nikhil A.

AU - Karia, Kunal

AU - Nieto, Jose

AU - Siddiqui, Uzma D.

AU - Waxman, Irving

AU - Joshi, Virendra

AU - Benias, Petros C.

AU - Darwin, Peter

AU - DiMaio, Christopher J.

AU - Mulder, Christopher J.

AU - Friedland, Shai

AU - Forcione, David G.

AU - Sejpal, Divyesh V.

AU - Gonda, Tamas A.

AU - Gress, Frank G.

AU - Gaidhane, Monica

AU - Koons, Ann

AU - DeFilippis, Ersilia M.

AU - Salgado, Sanjay

AU - Weaver, Kristen R.

AU - Poneros, John M.

AU - Sethi, Amrita

AU - Ho, Sammy

AU - Kumbhari, Vivek

AU - Singh, Vikesh K.

AU - Tieu, Alan H.

AU - Parra, Viviana

AU - Likhitsup, Alisa

AU - Womeldorph, Craig

AU - Casey, Brenna

AU - Jonnalagadda, Sreeni S.

AU - Desai, Amit P.

AU - Carr-Locke, David L.

AU - Kahaleh, Michel

AU - Siddiqui, Ali A.

PY - 2016/12/1

Y1 - 2016/12/1

N2 - Background & Aims Endoscopic ultrasound–guided transmural drainage and necrosectomy have become the standard treatment for patients with pancreatic walled-off necrosis (WON). Lumen-apposing metal stents (LAMS) have shown success in the management of pancreatic fluid collections. However, there are few data on their specific roles in management of WON. We investigated the efficacy and safety of LAMS in treatment of WON. Methods We performed a retrospective multicenter case series of 124 patients with WON who underwent endoscopic transmural drainage by using LAMS at 17 tertiary care centers from January 2014 through May 2015. Patients underwent endoscopic ultrasound–guided cystogastrostomy or cystoenterostomy with placement of an LAMS into the WON collection. At the discretion of the endoscopist, we performed direct endoscopic necrosectomy, irrigation with hydrogen peroxide, and/or nasocystic drain placement. We performed endoscopic retrograde cholangiopancreatography with pancreatic duct stent placement when indicated. Concomitant therapies included direct endoscopic debridement (n = 78), pancreatic duct stent placement for leak (n = 19), hydrogen peroxide–assisted necrosectomy (n = 38), and nasocystic irrigation (n = 22). We collected data for a median time of 4 months (range, 1–34 months) after the LAMS placement. The primary outcomes were rates of technical success (successful placement of the LAMS), clinical success (resolution of WON, on the basis of image analysis, without need for further intervention via surgery or interventional radiology), and adverse events. Results The median size of the WON was 9.5 cm (range, 4–30 cm). Eight patients had 2 LAMS placed for multiport access, all with technical success (100%). Clinical success was achieved in 107 patients (86.3%) after 3 months of follow-up. Thirteen patients required a percutaneous drain, and 3 required a surgical intervention to manage their WON. The stents remained patent in 94% of patients (117 of 124) and migrated in 5.6% of patients (7 of 124). The median number of endoscopic interventions was 2 (range, 1–9 interventions). Conclusions On the basis of a retrospective analysis of 124 patients, endoscopic therapy of WON by using LAMS is safe and effective. Creation of a large and sustained cystogastrostomy or cystoenterostomy tract is effective in the drainage and treatment of WON.

AB - Background & Aims Endoscopic ultrasound–guided transmural drainage and necrosectomy have become the standard treatment for patients with pancreatic walled-off necrosis (WON). Lumen-apposing metal stents (LAMS) have shown success in the management of pancreatic fluid collections. However, there are few data on their specific roles in management of WON. We investigated the efficacy and safety of LAMS in treatment of WON. Methods We performed a retrospective multicenter case series of 124 patients with WON who underwent endoscopic transmural drainage by using LAMS at 17 tertiary care centers from January 2014 through May 2015. Patients underwent endoscopic ultrasound–guided cystogastrostomy or cystoenterostomy with placement of an LAMS into the WON collection. At the discretion of the endoscopist, we performed direct endoscopic necrosectomy, irrigation with hydrogen peroxide, and/or nasocystic drain placement. We performed endoscopic retrograde cholangiopancreatography with pancreatic duct stent placement when indicated. Concomitant therapies included direct endoscopic debridement (n = 78), pancreatic duct stent placement for leak (n = 19), hydrogen peroxide–assisted necrosectomy (n = 38), and nasocystic irrigation (n = 22). We collected data for a median time of 4 months (range, 1–34 months) after the LAMS placement. The primary outcomes were rates of technical success (successful placement of the LAMS), clinical success (resolution of WON, on the basis of image analysis, without need for further intervention via surgery or interventional radiology), and adverse events. Results The median size of the WON was 9.5 cm (range, 4–30 cm). Eight patients had 2 LAMS placed for multiport access, all with technical success (100%). Clinical success was achieved in 107 patients (86.3%) after 3 months of follow-up. Thirteen patients required a percutaneous drain, and 3 required a surgical intervention to manage their WON. The stents remained patent in 94% of patients (117 of 124) and migrated in 5.6% of patients (7 of 124). The median number of endoscopic interventions was 2 (range, 1–9 interventions). Conclusions On the basis of a retrospective analysis of 124 patients, endoscopic therapy of WON by using LAMS is safe and effective. Creation of a large and sustained cystogastrostomy or cystoenterostomy tract is effective in the drainage and treatment of WON.

KW - ERCP

KW - Necrosectomy

KW - Pancreatic Necrosis

KW - Pancreatitis

KW - Stents

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