Metal versus plastic for pancreatic pseudocyst drainage: clinical outcomes and success.
BACKGROUND
Endoscopic transmural drainage of pancreatic pseudocysts (PPs) by using double-pigtail (DP) plastic stents requires placement of multiple stents and can be restricted by inadequate drainage and leakage risk. Recently, the use of fully covered self-expanding metal stents (FCSEMSs) has been reported as an alternative to DP plastic stents.


OBJECTIVE
To evaluate the clinical outcomes, success rate, and adverse events of EUS-guided drainage of PPs with DP plastic stents and FCSEMSs.


METHODS
Retrospective cohort study.


METHODS
Two tertiary-care academic medical centers.


METHODS
This study involved 230 patients (mean age, 52.6 years) with PPs who underwent EUS-guided transmural drainage including 118 that were drained by using DP plastic stents and 112 by using FCSEMSs. A transgastric approach was used in 210 patients (91%), and transduodenal drainage was performed in 20 patients (9%).


METHODS
Stent deployment under EUS guidance.


METHODS
Technical success, early adverse events, stent occlusion requiring reintervention, and long-term success.


RESULTS
At 12-month follow-up after the initial procedure, complete resolution of PPs by using DP plastic stents was lower compared with those that underwent drainage with FCSEMSs (89% vs 98%; P = .01). Procedural adverse events were noted in 31% in the DP plastic stent group and 16% in the FCSEMS group (P = .006). On multivariable analysis, patients with plastic stents were 2.9 times more likely to experience adverse events (odds ratio 2.9; 95% confidence interval, 1.4-6.3).


CONCLUSIONS
Retrospective study.


CONCLUSIONS
In patients with PPs, EUS-guided drainage by using FCSEMSs improves clinical outcomes and lowers adverse event rates compared with those drained with DP plastic stents.
Weill Cornell Medical College, New York, New York, USA.
Reem Z
RZ
Sharaiha
Weill Cornell Medical College, New York, New York, USA.
Ersilia M
EM
DeFilippis
Weill Cornell Medical College, New York, New York, USA.
Prashant
P
Kedia
Weill Cornell Medical College, New York, New York, USA.
Monica
M
Gaidhane
Weill Cornell Medical College, New York, New York, USA.
Christine
C
Boumitri
Jefferson Medical College, Philadelphia, Pennsylvania, USA.
Huei-Wen
HW
Lim
Jefferson Medical College, Philadelphia, Pennsylvania, USA.
Eugene
E
Han
Jefferson Medical College, Philadelphia, Pennsylvania, USA.
Harkarit
H
Singh
Jefferson Medical College, Philadelphia, Pennsylvania, USA.
Saad S
SS
Ghumman
Jefferson Medical College, Philadelphia, Pennsylvania, USA.
Thomas
T
Kowalski
Jefferson Medical College, Philadelphia, Pennsylvania, USA.
David
D
Loren
Weill Cornell Medical College, New York, New York, USA.
Michel
M
Kahaleh
Jefferson Medical College, Philadelphia, Pennsylvania, USA.
Ali
A
Siddiqui
D004322:Drainage / Q000295:instrumentation*; D016145:Endoscopy, Digestive System / Q000379:methods*; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010192:Pancreatic Pseudocyst / Q000175:diagnosis / Q000601:surgery*; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome