Endoscopic drainage of pancreatic fluid collections using a fully covered expandable metal stent with antimigratory fins
Isaac Raijman1, Paul R Tarnasky2, Sandeep Patel3, Douglas S Fishman4, Sri Naveen Surapaneni3, Laura Rosenkranz3, Jayant P Talreja5, Dang Nguyen1, Monica Gaidhane6, Michel Kahaleh6
1 Digestive Associates of Houston, Houston, Texas, USA
2 Methodist Hospital, Dallas, Texas, USA
3 University of Texas Health Science Center, San Antonio, Texas, USA
4 Texas Children Hospital, Houston, Texas, USA
5 University of Virginia, Charlottesville, Virginia, USA
6 Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, USA
Dr. Michel Kahaleh
Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York
Source of Support: None, Conflict of Interest: Michel Kahaleh MD
has received grant support from Boston Scientific, Fujinon, EMcison,
Xlumena Inc., MaunaKea, Apollo Endosurgery, ASPIRE Bariatrics, W.l.
Gore, Cook, GIDynamics and MI Tech. He is a consultant for Boston
Scientific, Concordia and Xlumena Inc. All other authors have no
conflicts of interest to report.
Background and Objectives: Endoscopic drainage is the first consideration in treating pancreatic fluid collections (PFCs). Recent data suggests it may be useful in complicated PFCs as well. Most of the available data assess the use of plastic stents, but scarce data exists on metal stent management of PFCs. The aim of our study to evaluate the efficacy and safety of a metal stent in the management of PFCs. Patients and Methods: Data were collected prospectively on 47 patients diagnosed with PFCs from March 2007 to August 2011 at 3 tertiary care centers. These patients underwent endoscopic transmural placement of a fully covered self-expanding metal stent (FCSEMS) with antimigratory fins of 10 mm diameter. Results: The stent was successfully placed in all patients, and left in place an average of 13 weeks (range 0.4-36 weeks). Etiology of the PFC was biliary pancreatitis (23), pancreas divisum (2), trauma (4), hyperlipidemia (3), alcoholic (8), smoking (2), idiopathic (4), and medication-induced (1). PFCs resolved in 36 patients, for an overall success rate of 77%. Complications included fever (3), stent migration (2) and abdominal pain (1). Conclusions: The use of FCSEMS is successful in the majority of patients with low complication rates. A large sample-sized RCT is needed to confirm if the resolution of PFCs is long-standing.