title: Management of pancreatic collections with a novel endoscopically placed fully covered self-expandable metal stent: a national experience (with videos).
abstract: BACKGROUND
  Recent medical literature on novel lumen-apposing stents for the treatment of pancreatic fluid collections (PFCs) is limited by small numbers, solo operators, and single-center experience.
  
  
  OBJECTIVE
  To evaluate a recently developed lumen-apposing, fully covered self-expandable metal stent (FCSEMS) in the management of PFCs.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Thirteen tertiary and private health care centers across Australia.
  
  
  METHODS
  Forty-seven patients (median age 51 years) who underwent endoscopic management of PFCs.
  
  
  METHODS
  Insertion of FCSEMS after PFC puncture under EUS guidance. A subgroup of 9 patients underwent direct endoscopic necrosectomy.
  
  
  METHODS
  Technical and clinical success rate, adverse event rate.
  
  
  RESULTS
  The technical success rate was 53 of 54 patients (98.1%), and the initial clinical success rate was 36 of 47 (76.6%), which was sustained for more than 6 months in 34 of 36 (94.4%). Early adverse events included 4 cases (7.4%) of stent migration during direct endoscopic necrosectomy, 4 cases (7.4%) of sepsis, 1 case (1.9%) of bleeding, and 1 case (1.9%) of stent migration into the fistula tract. Late adverse events were 6 (11.1%) spontaneous stent migrations, 3 (5.6%) recurrent stent occlusions, 3 (5.6%) tissue ingrowth/overgrowth, and 2 (3.7%) bleeding into PFC. The majority of stents inserted (48 of 54, 88.9%) and removed (31 of 35, 88.6%) in our study were described by the operator as superior to pigtail stents with regard to ease of use.
  
  
  CONCLUSIONS
  Retrospective study.
  
  
  CONCLUSIONS
  Although FCSEMSs are technically easier to insert and remove compared with traditional pigtail stents, there are significant limitations to the widespread use of FCSEMSs in the management of PFCs. These include cost, adverse events, and lower-than-expected resolution rates.
authors.affiliation: Department of Gastroenterology, Austin Health Melbourne, Victoria, Australia.
authors.forename: Sujievvan
authors.initials: S
authors.lastname: Chandran
authors.affiliation: Department of Gastroenterology, Austin Health Melbourne, Victoria, Australia.
authors.forename: Marios
authors.initials: M
authors.lastname: Efthymiou
authors.affiliation: Department of Gastroenterology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
authors.forename: Arthur
authors.initials: A
authors.lastname: Kaffes
authors.affiliation: Department of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia.
authors.forename: John Wei
authors.initials: JW
authors.lastname: Chen
authors.affiliation: Department of Gastroenterology, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Vu
authors.initials: V
authors.lastname: Kwan
authors.affiliation: Department of Gastroenterology, Pindara Private Hospital, Gold Coast, Queensland, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Murray
authors.affiliation: Department of Gastroenterology, St. Vincent's Hospital, Sydney, New South Wales, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Williams
authors.affiliation: Department of Gastroenterology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
authors.forename: Nam Quoc
authors.initials: NQ
authors.lastname: Nguyen
authors.affiliation: Department of Gastroenterology, Lyell McEwin Hospital, Adelaide, South Australia, Australia.
authors.forename: William
authors.initials: W
authors.lastname: Tam
authors.affiliation: Department of Gastroenterology, Townsville Hospital, Townsville, Queensland, Australia.
authors.forename: Christine
authors.initials: C
authors.lastname: Welch
authors.affiliation: Department of Gastroenterology, Fremantle Hospital, Fremantle, Western Australia, Australia.
authors.forename: Andre
authors.initials: A
authors.lastname: Chong
authors.affiliation: Department of Gastroenterology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Department of Gastroenterology, Royal Brisbane Hospital, Brisbane, Queensland, Australia.
authors.forename: Ben
authors.initials: B
authors.lastname: Devereaux
authors.affiliation: Department of Gastroenterology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Tagkalidis
authors.affiliation: Department of Anaesthetics, Austin Health, Melbourne, Victoria, Australia.
authors.forename: Frank
authors.initials: F
authors.lastname: Parker
authors.affiliation: Department of Gastroenterology, Austin Health Melbourne, Victoria, Australia; Department of Medicine, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Rhys
authors.initials: R
authors.lastname: Vaughan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004322:Drainage / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D010192:Pancreatic Pseudocyst / Q000209:etiology / Q000601:surgery*; D010195:Pancreatitis / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents; D025321:Surgery, Computer-Assisted / Q000379:methods; D055815:Young Adult
chemical_list: D008670:Metals