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Large-caliber metal stents versus plastic stents for the management of pancreatic walled-off necrosis.

Abstract：

BACKGROUND AND AIMS:Symptomatic pancreatic walled-off necrosis (WON) may be managed by endoscopic transmural drainage and endoscopic transmural necrosectomy, with stent placement at endoscopic drainage sites. The optimal stent choice is yet to be determined. We compared outcomes after endoscopic management of WON using either large-caliber fully covered self-expandable metal stents (LC-SEMSs) or double-pigtail plastic stents (DPPSs). METHODS:We performed a retrospective comparison of outcomes among patients who received LC-SEMSs or DPPSs before endoscopic transmural necrosectomy for WON. RESULTS:Among 94 patients included, WON resolution rates did not differ between the DPPS (36 patients) and LC-SEMS (58 patients) groups, whether concomitant percutaneous drainage was considered a failure (75% vs 82.8%; P = .36) or not (91.7% vs 94.8%; P = .55). Of 75 patients (80%) successfully treated without percutaneous drainage, 37 (49%) underwent endoscopic transmural drainage without subsequent endoscopic transmural necrosectomy. WON was more likely to resolve without subsequent endoscopic transmural necrosectomy in the LC-SEMS group than the DPPS group (60.4% vs 30.8%; P = .01). WON resolution without subsequent endoscopic transmural necrosectomy remained more likely with LC-SEMSs (odds ratio, 4.5 [95% confidence interval, 1.5-15.5]) after adjusting for patient age and size and location of WON. Rates of adverse events were similar except for clinically significant bleeding requiring endoscopic intervention, which was higher with DPPSs than LC-SEMSs (14% vs 2%; P = .02). CONCLUSION:Management of pancreatic WON with LC-SEMSs appears to decrease both the need for repeated necrosectomy procedures and the risk of intervention-related hemorrhage.

journal_name

Gastrointest Endosc

journal_title

Gastrointestinal endoscopy

authors

Abu Dayyeh BK,Mukewar S,Majumder S,Zaghlol R,Vargas Valls EJ,Bazerbachi F,Levy MJ,Baron TH,Gostout CJ,Petersen BT,Martin J,Gleeson FC,Pearson RK,Chari ST,Vege SS,Topazian MD

doi

10.1016/j.gie.2017.04.032

subject

Has Abstract

pub_date

2018-01-01 00:00:00

pages

141-149

issue

1

eissn

0016-5107

issn

1097-6779

pii

S0016-5107(17)31857-6

journal_volume

87

pub_type

杂志文章

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