title: EUS-guided drainage of pancreatic fluid collections using a novel lumen-apposing metal stent on an electrocautery-enhanced delivery system: a large retrospective study (with video).
abstract: OBJECTIVE
  A lumen-apposing, self-expanding metal stent incorporated in an electrocautery-enhanced delivery system for EUS-guided drainage of pancreatic fluid collections (PFCs) recently has become available. The aim of this study was to analyze the safety and clinical effectiveness of this newly developed device in this clinical setting.
  
  
  METHODS
  This was a retrospective analysis of all consecutive patients with PFCs who underwent EUS-guided drainage using the study device in 13 European centers.
  
  
  RESULTS
  Ninety-three patients with PFCs (80% with complex collections) underwent drainage using the study device. Penetration of the PFC was accomplished directly with the study device in 74.2% of patients, and successful stent placement was accomplished in all but 1 patient, mostly without fluoroscopic assistance. Direct endoscopic necrosectomy (DEN) was carried out in 31 of 52 cases (59.6%) of walled-off necrosis and in 2 of 4 cases (50%) of acute peripancreatic fluid collection. Complete resolution of the PFC was obtained in 86 cases (92.5%), with no recurrence during follow-up. Treatment failure occurred in 6 patients because of persistent infection requiring surgery (n = 3), perforation and massive bleeding caused by the nasocystic drainage catheter (NCDC) (n = 2), and the need for a larger opening to extract large necrotic tissue pieces (n = 1). Major adverse events occurred in 5 patients (perforation and massive bleeding caused by the NCDC in 2 patients, 1 pneumoperitoneum and 1 stent dislodgement during DEN, and 1 postdrainage infection) and were mostly not related to the drainage procedure.
  
  
  CONCLUSIONS
  EUS-guided drainage with the electrocautery-enhanced delivery system is a safe, easy to perform, and a highly effective minimally invasive treatment modality for PFCs.
authors.affiliation: Digestive Endoscopy Unit, Catholic University, Rome, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Rinninella
authors.affiliation: Department of Surgical Gastroenterology, L Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Rastislav
authors.initials: R
authors.lastname: Kunda
authors.affiliation: Department of Gastroenterology, Klinikum Neuperlach, Munich, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Dollhopf
authors.affiliation: Endoscopy Unit, Hospital Costa del Sol, Marbella, Spain.
authors.forename: Andres
authors.initials: A
authors.lastname: Sanchez-Yague
authors.affiliation: Department of Gastroenterology, Municipal Hospital, Gera, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Will
authors.affiliation: Endoscopy Unit, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Tarantino
authors.affiliation: Endoscopy Unit, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Gornals Soler
authors.affiliation: Department of Internal Medicine I, Asklepios Klinik Altona, Hamburg, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Ullrich
authors.affiliation: Department of Medicine II Klinikum rects der Isar, Technical University of Munich, Munich, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Meining
authors.affiliation: Endoscopy Unit, Hospital Clinico San Carlos, Madrid, Spain.
authors.forename: Josè Miguel
authors.initials: JM
authors.lastname: Esteban
authors.affiliation: Department of Gastroenterology, Kliniken Nagold, Nagold, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Enz
authors.affiliation: Digestive Endoscopy Unit, Hôpital L'Archet 2, University Hospital of Nice, Nice, France.
authors.forename: Geoffroy
authors.initials: G
authors.lastname: Vanbiervliet
authors.affiliation: Department Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Frank
authors.initials: F
authors.lastname: Vleggaar
authors.affiliation: Digestive Endoscopy Unit, Catholic University, Rome, Italy.
authors.forename: Fabia
authors.initials: F
authors.lastname: Attili
authors.affiliation: Digestive Endoscopy Unit, Catholic University, Rome, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Larghi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004322:Drainage / Q000295:instrumentation* / Q000379:methods; D004564:Electrocoagulation / Q000295:instrumentation*; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010189:Pancreatic Juice; D010195:Pancreatitis / Q000628:therapy*; D012189:Retrospective Studies; D000069322:Self Expandable Metallic Stents; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional