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Peripancreatic fluid collections, plastic stents, and different sub-types of metal stents: Where does the evidence land?

BACKGROUND: Peripancreatic fluid collections (PFCs) are a frequent complication of acute pancreatitis. Symptomatic PFCs may need to be drained, and there are multiple endoscopic accessories that can facilitate the procedure. This paper aims to compare the success rate, number of procedures required...

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Autores principales: Al Lehibi, Abed, Al Jabri, Abdullah, Abbarh, Shahem, Al Balkhi, Areej, Al Otaibi, Nawwaf, Almasoudi, Thamer, Al Mtawa, Abdullah, AlGhamdi, Adel, Al Eid, Ahmad, Al Ghamdi, Ahmed, Al Khathlan, Abdullah, Qutub, Adel, Al Sayari, Khalid, Ahmad, Shameem
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer - Medknow 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8183362/
https://www.ncbi.nlm.nih.gov/pubmed/33063699
http://dx.doi.org/10.4103/sjg.SJG_244_20
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author Al Lehibi, Abed
Al Jabri, Abdullah
Abbarh, Shahem
Al Balkhi, Areej
Al Otaibi, Nawwaf
Almasoudi, Thamer
Al Mtawa, Abdullah
AlGhamdi, Adel
Al Eid, Ahmad
Al Ghamdi, Ahmed
Al Khathlan, Abdullah
Qutub, Adel
Al Sayari, Khalid
Ahmad, Shameem
author_facet Al Lehibi, Abed
Al Jabri, Abdullah
Abbarh, Shahem
Al Balkhi, Areej
Al Otaibi, Nawwaf
Almasoudi, Thamer
Al Mtawa, Abdullah
AlGhamdi, Adel
Al Eid, Ahmad
Al Ghamdi, Ahmed
Al Khathlan, Abdullah
Qutub, Adel
Al Sayari, Khalid
Ahmad, Shameem
author_sort Al Lehibi, Abed
collection PubMed
description BACKGROUND: Peripancreatic fluid collections (PFCs) are a frequent complication of acute pancreatitis. Symptomatic PFCs may need to be drained, and there are multiple endoscopic accessories that can facilitate the procedure. This paper aims to compare the success rate, number of procedures required for resolution and adverse events rate for PFCs EUS-guided drainage with plastic stents and lumen-apposing metal stents (LAMS). METHODS: This is a retrospective analysis of a consecutive sample of patients that was collected from 2013 – 2019. The medical records of these patients were reviewed, and the outcomes for each type of stent (plastic vs LAMS, and different subtypes of LAMS) were compared in terms of clinical success, number of re-interventions needed, and adverse events. RESULTS: A total of 33 patients (23 males) were treated for PFCs with EUS-guided drainage and stenting. The patients' ages ranged between 14 and 85 years (mean ± SD: 43.5 ± 19 years). Overall, there was no difference between plastic stents and LAMS in terms of symptomatic recovery (P = 0. 24), but metal stents had better results with regards to radiological resolution (P = 0.03), and were associated with a higher number of necrosectomies (P = 0.029). Adverse events occurred more frequently in patients who had plastic stents, but direct comparison between the two groups showed that the difference was not statistically significant (P = 0.2). Stratification for different LAMS subtypes showed no difference in terms of symptomatic or radiological resolution (P =0.49), number of rescue procedures (P = 0.41), and adverse events (P = 0.81). CONCLUSION: Our study, along with the current available evidence, suggests a slight advantage of metal stents over plastic stents in terms of clinical success, need for rescue procedures, and incidence of adverse events. Furthermore, it provides empirical evidence that the different sub-types of LAMS perform similarly when compared against each other.
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spelling pubmed-81833622021-06-21 Peripancreatic fluid collections, plastic stents, and different sub-types of metal stents: Where does the evidence land? Al Lehibi, Abed Al Jabri, Abdullah Abbarh, Shahem Al Balkhi, Areej Al Otaibi, Nawwaf Almasoudi, Thamer Al Mtawa, Abdullah AlGhamdi, Adel Al Eid, Ahmad Al Ghamdi, Ahmed Al Khathlan, Abdullah Qutub, Adel Al Sayari, Khalid Ahmad, Shameem Saudi J Gastroenterol Original Article BACKGROUND: Peripancreatic fluid collections (PFCs) are a frequent complication of acute pancreatitis. Symptomatic PFCs may need to be drained, and there are multiple endoscopic accessories that can facilitate the procedure. This paper aims to compare the success rate, number of procedures required for resolution and adverse events rate for PFCs EUS-guided drainage with plastic stents and lumen-apposing metal stents (LAMS). METHODS: This is a retrospective analysis of a consecutive sample of patients that was collected from 2013 – 2019. The medical records of these patients were reviewed, and the outcomes for each type of stent (plastic vs LAMS, and different subtypes of LAMS) were compared in terms of clinical success, number of re-interventions needed, and adverse events. RESULTS: A total of 33 patients (23 males) were treated for PFCs with EUS-guided drainage and stenting. The patients' ages ranged between 14 and 85 years (mean ± SD: 43.5 ± 19 years). Overall, there was no difference between plastic stents and LAMS in terms of symptomatic recovery (P = 0. 24), but metal stents had better results with regards to radiological resolution (P = 0.03), and were associated with a higher number of necrosectomies (P = 0.029). Adverse events occurred more frequently in patients who had plastic stents, but direct comparison between the two groups showed that the difference was not statistically significant (P = 0.2). Stratification for different LAMS subtypes showed no difference in terms of symptomatic or radiological resolution (P =0.49), number of rescue procedures (P = 0.41), and adverse events (P = 0.81). CONCLUSION: Our study, along with the current available evidence, suggests a slight advantage of metal stents over plastic stents in terms of clinical success, need for rescue procedures, and incidence of adverse events. Furthermore, it provides empirical evidence that the different sub-types of LAMS perform similarly when compared against each other. Wolters Kluwer - Medknow 2020-10-15 /pmc/articles/PMC8183362/ /pubmed/33063699 http://dx.doi.org/10.4103/sjg.SJG_244_20 Text en Copyright: © 2020 Saudi Journal of Gastroenterology https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Original Article
Al Lehibi, Abed
Al Jabri, Abdullah
Abbarh, Shahem
Al Balkhi, Areej
Al Otaibi, Nawwaf
Almasoudi, Thamer
Al Mtawa, Abdullah
AlGhamdi, Adel
Al Eid, Ahmad
Al Ghamdi, Ahmed
Al Khathlan, Abdullah
Qutub, Adel
Al Sayari, Khalid
Ahmad, Shameem
Peripancreatic fluid collections, plastic stents, and different sub-types of metal stents: Where does the evidence land?
title Peripancreatic fluid collections, plastic stents, and different sub-types of metal stents: Where does the evidence land?
title_full Peripancreatic fluid collections, plastic stents, and different sub-types of metal stents: Where does the evidence land?
title_fullStr Peripancreatic fluid collections, plastic stents, and different sub-types of metal stents: Where does the evidence land?
title_full_unstemmed Peripancreatic fluid collections, plastic stents, and different sub-types of metal stents: Where does the evidence land?
title_short Peripancreatic fluid collections, plastic stents, and different sub-types of metal stents: Where does the evidence land?
title_sort peripancreatic fluid collections, plastic stents, and different sub-types of metal stents: where does the evidence land?
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8183362/
https://www.ncbi.nlm.nih.gov/pubmed/33063699
http://dx.doi.org/10.4103/sjg.SJG_244_20
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