LAMS for all pancreatic fluid collections?

 

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In this issue of Endoscopy International Open, Ortizo and co-workers from the Irvine Medical Center of the University of California report on their experience with self-expandable metal biliary and esophageal stents (FCSEMS) for the drainage of pseudocysts (PC) and pancreatic walled off necrosis (WON) [1]. In this retrospective analysis, they demonstrate in a series of 65 patients that use of FCSEMS is highly effective and safe. In patients with a PC they achieved a 100 % resolution rate (25 out of 25 patients) without any adverse events (AEs). In WON cases, the resolution rate was 78 % (31 out of 40 patients) with an AE rate of 25 % (10 out of 40 patients). One patient had self-limiting bleeding after initial placement, two patients had stent migration detected on follow-up imaging without clinical consequence, and seven patients showed signs of stent dysfunction/occlusion with infection for which the FCSEMS was replaced, in some cases, upsizing from a 10-mm biliary to a large 20-mm-diameter esophageal FCSEMS. Of the 40 WON patients, 22 % (9 patients) required a radiological intervention or surgery. No inward FCSEMS migration was reported. In 67.5 % of WON cases (27 of 40 patients) at least one debridement was required with an average of 3.9 procedures per patient. The authors rightfully point out some limitations to be considered when interpreting their results, most notably the retrospective study design. Nevertheless, their experience adds to a growing body of data that FCSEMS seem to perform at least as good as LAMS with regard to clinical efficacy, with potentially less complications, at lower costs [2] [3].

Publication History

Article published online:
31 August 2020

© 2020. Owner and Copyright ©

© Georg Thieme Verlag KG
Stuttgart · New York

• References

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