Evaluation of the short- and long-term effectiveness and safety of fully covered self-expandable metal stents for drainage of pancreatic fluid collections: results of a Spanish nationwide registry
Por:
Vazquez-Sequeiros, E, Baron, T, Perez-Miranda, M, Sanchez-Yague, A, Gornals, J, Gonzalez-Huix, F, de la Serna, C, Angel Gonzalez Martin, J, Gimeno-Garcia, A, Marra-Lopez, C, Castellot, A, Alberca, F, Fernandez-Urien, I, Ramon Aparicio, J, Luisa Legaz, M, Sendino, O, Loras, C, Carlos Subtil, J, Nerin, J, Perez-Carreras, M, Diaz-Tasende, J, Perez, G, Repiso, A, Vilella, A, Dolz, C, Alvarez, A, Rodriguez, S, Miguel Esteban, J, Juzgado, D, Albillos, A and Spanish Grp FCSEMS Pancreas Collec
Publicada:
1 sep 2016
Resumen:
Background and Aims: Initial reports suggest that fully covered
self-expandable metal stents (FCSEMSs) may be better suited for drainage
of dense pancreatic fluid collections (PFCs), such as walled-off
pancreatic necrosis. The primary aim was to analyze the effectiveness
and safety of FCSEMSs for drainage of different types of PFCs in a large
cohort. The secondary aim was to investigate which type of FCSEMS is
superior.
Methods: This was a retrospective, noncomparative review of a nationwide
database involving all hospitals in Spain performing EUS-guided PFC
drainage. From April 2008 to August 2013, all patients undergoing PFC
drainage with an FCSEMS were included in a database. The main outcome
measurements were technical success, short-term (2 weeks) and long-term
(6 months) effectiveness, adverse events, and need for surgery.
Results: The study included 211 patients (pseudocyst/walled-off
pancreatic necrosis, 53%/47%). The FCSEMSs used were straight biliary
(66%) or lumen-apposing (34%). Technical success was achieved in 97% of
patients (95% confidence interval [CI], 93%-99%). Short-term- and
long-term clinical success was obtained in 94% (95% CI, 89%-97%) and
85%(95% CI, 79%-89%) of patients, respectively. Adverse events occurred
in 21% of patients (95% CI, 16%-27%): infection (11%), bleeding (7%),
and stent migration and/or perforation (3%). By multivariate analysis,
patient age (> 58 years) and previous failed drainage were the most
important factors associated with negative outcome.
Conclusions: An FCSEMS is effective and safe for PFC drainage. Older
patients with a history of unsuccessful drainage are more likely to fail
EUS-guided drainage. The type of FCSEMS does not seem to influence
patient outcome.
Filiaciones:
Vazquez-Sequeiros, E:
Univ Hosp Ramon y Cajal, Inst Ramon y Cajal Invest Sanitaria, Endoscopy Unit, Div Gastroenterol, Madrid, Spain
Univ Hosp Quiron, Div Gastroenterol, Madrid, Spain
Baron, T:
Univ N Carolina, Div Gastroenterol & Hepatol, Chapel Hill, NC USA
Perez-Miranda, M:
Hosp Univ Rio Hortega, Dept Gastroenterol & Hepatol, Valladolid, Spain
Sanchez-Yague, A:
Hosp Costa del Sol, Dept Gastroenterol, Marbella, Spain
Vithas Xanit Internacl Hosp, Dept Gastroenterol, Benalmadena, Spain
Gornals, J:
Hosp Univ Bellvitge Inst Invest Biomed Bellvitge, Digest Dis Dept, Endoscopy Unit, Barcelona, Spain
Gonzalez-Huix, F:
Clin Girona, Endoscopy Unit, Girona, Spain
de la Serna, C:
Hosp Univ Rio Hortega, Dept Gastroenterol & Hepatol, Valladolid, Spain
Angel Gonzalez Martin, J:
Univ Hosp Ramon y Cajal, Inst Ramon y Cajal Invest Sanitaria, Endoscopy Unit, Div Gastroenterol, Madrid, Spain
Gimeno-Garcia, A:
Hosp Univ Canarias, Dept Gastroenterol, San Cristobal De La Lagu, Spain
Marra-Lopez, C:
Araba Univ Hosp, Dept Gastroenterol, Vitoria, Spain
Castellot, A:
Complejo Hosp Univ Insular Materno Infant, Gran Canaria, Spain
Alberca, F:
Hosp Clin Univ Arrixava, Dept Gastroenterol, Unidad Gest Clin Digest, Murcia, Spain
Fernandez-Urien, I:
Hosp Navarra, Dept Gastroenterol, Pamplona, Spain
:
Hosp Gen Univ Alicante, Endoscopy Unit, Alicante, Spain
Luisa Legaz, M:
Hosp Gen La Mancha Ctr, Dept Gastroenterol, Alcazar De San Juan, Spain
Sendino, O:
Univ Barcelona, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Inst Digest & Metab Dis, Endoscopy Unit,Gastroenterol Dept,Hosp Clin,IDIBA, Barcelona, Spain
Loras, C:
Hosp Univ Mutua Terrassa, Serv Aparell Digest Unitat Endoscopia, Dept Gastroenterol, Terrassa, Spain
Carlos Subtil, J:
Univ Navarra Clin, Dept Gastroenterol, Pamplona, Spain
Nerin, J:
Hosp Clin Univ Lozano Blesa, Dept Gastroenterol, Zaragoza, Spain
Perez-Carreras, M:
Hosp Univ 12 Octubre, Dept Gastroenterol, Endoscopy Unit, Serv Med Aparato Digest, Madrid, Spain
Diaz-Tasende, J:
Hosp Univ 12 Octubre, Dept Gastroenterol, Endoscopy Unit, Serv Med Aparato Digest, Madrid, Spain
Perez, G:
Hosp Univ Cent Asturias, Dept Gastroenterol, Endoscopy Unit, Oviedo, Spain
Repiso, A:
Hosp Virgen Salud, Dept Gastroenterol, Endoscopy Unit, Toledo, Spain
Vilella, A:
Hosp Son Llatzer, Endoscopy Unit, Dept Gastroenterol, Palma de Mallorca, Spain
Dolz, C:
Hosp Son Llatzer, Endoscopy Unit, Dept Gastroenterol, Palma de Mallorca, Spain
Alvarez, A:
Complejo Asistencial Univ Salamanca, Dept Gastroenterol, Salamanca, Spain
Rodriguez, S:
Complejo Asistencial Univ Zamora, Dept Gastroenterol, Zamora, Spain
Miguel Esteban, J:
Hosp Clin San Carlos, Endoscopy Unit, Madrid, Spain
Juzgado, D:
Univ Hosp Quiron, Div Gastroenterol, Madrid, Spain
Albillos, A:
Univ Hosp Ramon y Cajal, Inst Ramon y Cajal Invest Sanitaria, Endoscopy Unit, Div Gastroenterol, Madrid, Spain
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