Background and Aims

Lumen-apposing metal stents (LAMSs) are used to perform necrosectomy in walled-off necrosis (WON). Although necrosectomy is not required for pancreatic pseudocyst (PP), an increasing number of PPs are also being drained with LAMSs in view of their ease of deployment. The aim of the present study was to evaluate the safety and efficacy of using LAMSs to drain PPs.

Methods

At 1 tertiary center from January 2014 to May 2016, all consecutive patients with PPs were drained by LAMSs, and the data were retrospectively reviewed. After observing cyst-cavity infection in patients enrolled initially (group I), 10F double-pigtail stents (DPSs) were placed across LAMSs in the subsequent patients (group II). Data on technical success, PP resolution, adverse events, and reintervention rates were collected.

Results

Forty-seven patients with PPs (mean size, 9.5 ± 4.0 cm) were enrolled (group I, 24; group II, 23). There was 1 perforation at deployment (technical success, 98%). In the remaining 46 patients, resolution of the PP was observed in 44 patients (96%). Four patients (17%) in group I presented with PP infection requiring reinterventions. Food material was observed in the cyst cavity. None of the patients in group II had PP infection (relative risk, .84; 95% confidence interval, .71-1.0; P = .054).

Conclusions

Similar to WON, LAMSs are also effective in endoscopic drainage of PPs. However, there was a trend toward higher PP infection with LAMSs, and placing a DPS across the LAMS minimized this risk.

中文翻译：

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带和不带双尾钉塑料支架的置管金属支架引流胰腺假性囊肿的安全性和有效性

背景和目标

装有腔的金属支架（LAMS）用于对壁坏死（WON）进行坏死切除术。尽管胰腺假性囊肿（PP）不需要行坏死切除术，但鉴于其易于部署，越来越多的PPs也被LAMS引流。本研究的目的是评估使用LAMS排出PP的安全性和有效性。

方法

在2014年1月至2016年5月的1个三级中心，所有连续的PP患者均被LAMS引流，并回顾性地回顾了数据。在最初入组的患者中观察到囊腔感染后（I组），随后的患者在LAMS上放置了10F双辫子支架（DPS）（II组）。收集了有关技术成功率，PP解决率，不良事件和再干预率的数据。

结果

纳入47例PPs（平均大小，9.5±4.0 cm）的患者（I组，24； II组，23）。部署时有1处穿孔（技术成功率为98％）。在其余的46位患者中，有44位患者（96％）观察到PP的消退。第一组中有四名患者（17％）表现出需要再次干预的PP感染。在囊腔中观察到食物物质。第二组患者均无PP感染（相对危险度为.84； 95％置信区间为.71-1.0；P  = .054）。

结论

类似于WON，LAMS在内窥镜下PP的引流中也很有效。但是，LAMS有更高的PP感染趋势，并且在LAMS上放置DPS可以最大程度地降低这种风险。