Endoscopic ultrasound-guided drainage using lumen-apposing fully covered, self-expandable metal stent for treatment of infected pancreatic necrosis and pseudocyst: analysis of 13 cases and literature review

Abstract

Objective To investigate the feasibility, efficacy and safety of endoscopic ultrasound (EUS)-guided drainage of peripancreatic fluid collection (PFC) using lumen-apposing fully covered, self-expandable metal stent (LAMS) for treatment of infected pancreatic necrosis (IPN) and pancreatic pseudocyst (PPC). Methods We retrospectively analyzed the data of 13 patients (including 11 male and 2 female patients, mean age 42.6±12.1 years) with IPN (12 cases) or PPC (1 case) treated with EUS-guided drainage of PFC using LAMS in our department from January, 2012 to December, 2017. We also searched China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Database Network, Cochrane Library, Pubmed, and Web of Science for relevant studies to analyze the efficacy and safety of LAMS in the treatment of IPN and PPC. Results Stent placement was successful in all the 13 patients treated in our department. Twelve (92.3%) of the patients were cured, and 1 (7.7%) died for severe infection and intra-abscess hemorrhage. None of the patients experienced stent displacement, abscess or cyst cavity rupture (or perforation), or drainage tube occlusion. Six (46.2%) of the patients had pulmonary infections after the operation. The mean length of hospital stay of the patients was 44.8 d (range 9-153 d). We retrieved 12 relevant studies from the databases involving a total of 331 patients (193 with IPN and 138 with PPC), among whom 326 (98.5%) were successfully treated and 5 (1.5%) died. In the total of 344 cases after combining our cases with the reported cases (including 206 patients with IPN and 138 with PPC), the success rate of LAMS surgery was 100%, the cure rate was 98.3% (338 cases), and the mortality rate was 1.7% (6 cases); stent displacement occurred in 13 cases (3.8%), postoperative bleeding in 11 cases (3.2%), stent occlusion in 3 cases (0.9%), postoperative abscess perforation in 1 case (0.3%), and postoperative with lung and urinary tract infections in 19 cases (5.5%). Conclusion EUS-guided drainage of PFC using LAMS has a high success rate for treatment of IPN and PPC and achieves good clinical outcomes with a low incidence of complications and a low mortality rate of the patients.

Keywords

• infected pancreatic necrosis
• pancreatic pseudocyst
• endoscopic ultrasound
• metal stent
• debridement and drainage