Document Type

Poster

Publication Date

2012

Comments

This poster was presented at Digestive Disease Week 2012.

Abstract

Background

Endoscopic management of peri-pancreatic fluid collections (PFC) with or without organizing necrosis has been shown to decrease morbidity and mortality compared to early surgical management. Plastic stents are often used for transmural drainage, although the use of self-expanding metal stents (SEMS) has been reported. Theoretical benefits of SEMS include a large diameter for drainage and facilitation of endoscopic necrosectomy. We report a single-center experience to evaluate the efficacy and safety of SEMS for management of PFC.

Methods

A single-center retrospective review was performed of patients undergoing endoscopic management of PFC using SEMS from January through November 2011. Electronic database and medical records were reviewed for demographics, medical history, imaging and procedure data. The primary outcome, successful drainage, was defined as a 50% or greater decrease in PFC cross-sectional area. Secondary outcomes were achieving complete resolution, time to resolution, and complications.

Results

Thirteen patients with 14 PFCs were included. Mean age was 63 years (range 50-85), 77% were male. Gallstone disease was the cause of acute pancreatitis in 69%. Time from initial diagnosis of acute pancreatitis to endoscopic drainage of PFC was 9.1 weeks (range 1-28). Necrotic debris within the collection was present in 50% of PFCs. The mean size prior to intervention was 13.2 x 8.1 cm. A single fully covered biliary SEMS (10mm X 60 or 80mm) was initially placed in 12 of 14 cysts (86%) with one or two double-pigtail plastic stents through the SEMS lumen to prevent migration. The two remaining cysts were initially drained with plastic stents and subsequently revised to fully covered esophageal SEMS due to drainage failure from debris occluding the track. Both patients underwent successful necrosectomy (4 sessions in one case and 5 in the other). Thirteen collections were drained by trans-gastric approach, one through the duodenum. Mean follow-up was 7.2 weeks.Successful PFC drainage was achieved in 12 PFCs (86%) to date with a mean reduction in cross-sectional area of 87.5%. Complete resolution occurred in 4 (29%). Overall a mean of 1.9 procedures were performed.Stent occlusion (n=3) was the most frequent complication. Migration (n=1) and bleeding attributed to SEMS (n=1) occurred. All cases were successfully managed with endoscopic stent revision.

Conclusions

Fully covered self-expanding metal stents are an effective option for initial endoscopic access of peri-pancreatic fluid collections for the purposes of drainage and necrosectomy. Successful management can be achieved in the majority of patients with relatively few procedures. SEMS can be effectively utilized as salvage therapy for PFCs that fail endoscopic management with plastic stents and prevent the need for surgery or percutaneous drainage.

Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.