Direct endoscopic necrosectomy at the time of transmural stent placement results in earlier resolution of complex walled-off pancreatic necrosis: Results from a large multicenter United States trial.
Publication/Presentation Date
1-1-2019
Abstract
BACKGROUND AND OBJECTIVES: EUS-guided drainage, and direct endoscopic necrosectomy (DEN) of walled-off necrosis (WON) using a lumen-apposing metal stent (LAMS) is safe and effective. Early debridement of WON may improve overall clinical outcomes. The aim of this study is to perform a multicenter retrospective study to compare the clinical outcomes and predictors of success for endoscopic drainage of WON with LAMS followed by immediate or delayed DEN performed at standard intervals.
METHODS: Patients with WON managed by EUS-guided drainage with LAMS were divided into 2 groups: (1) those that underwent immediate DEN at the time of stent placement and (2) those that underwent delayed DEN 1 week after stent placement. DEN was subsequently performed every 1-2 week (s). Technical success (successful placement of LAMS), adverse events (AEs), and clinical success (complete resolution of the WON) were evaluated.
RESULTS: Totally, 271 patients underwent WON drainage with LAMS: 69 who underwent immediate DEN and 202 who underwent delayed DEN. The technical success for LAMS placement was 100% in both groups. There was no significant difference in the overall procedural AEs between the immediate and delayed DEN groups (P = 7.2% vs. 9.4%; P = 0.81). Stent dislodgement during index endoscopy occurred in three patients in the immediate DEN group compared to zero in the delayed DEN group (P = 0.016); all three dislodgements occurred during necrosectomy. Clinical success for WON resolution in the immediate DEN group was 91.3% compared to 86.1% in the delayed DEN group (P = 0.3). The mean number of necrosectomy sessions for WON resolution was significantly lower in the immediate DEN group compared to the delayed DEN group (3.1 vs. 3.9, P < 0.001). Performing DEN at the time of stent placement was an independent predictor for resolution of WON with lesser number of DEN sessions (odds ratio 2.3; P = 0.004).
CONCLUSIONS: DEN at the time of initial stent placement reduces the number of necrosectomy sessions required for successful clinical resolution of WON.
Volume
8
Issue
3
First Page
172
Last Page
179
ISSN
2303-9027
Published In/Presented At
Yan, L., Dargan, A., Nieto, J., Shariaha, R. Z., Binmoeller, K. F., Adler, D. G., DeSimone, M., Berzin, T., Swahney, M., Draganov, P. V., Yang, D. J., Diehl, D. L., Wang, L., Ghulab, A., Butt, N., & Siddiqui, A. A. (2019). Direct endoscopic necrosectomy at the time of transmural stent placement results in earlier resolution of complex walled-off pancreatic necrosis: Results from a large multicenter United States trial. Endoscopic ultrasound, 8(3), 172–179. https://doi.org/10.4103/eus.eus_108_17
Disciplines
Medicine and Health Sciences
PubMedID
29882517
Department(s)
Department of Medicine
Document Type
Article