title: EUS-guided drainage of peripancreatic fluid collections and necrosis by using a novel lumen-apposing stent: a large retrospective, multicenter U.S. experience (with videos).
abstract: OBJECTIVE
  EUS-guided drainage of peripancreatic fluid collection (PFC) (pancreatic pseudocyst [PP] or walled-off necrosis [WON]) by using a novel lumen-apposing, fully covered, self-expandable metal stent (LAMS) has been promising, but few of these data are from the United States. The aim of this study was to evaluate clinical outcomes and safety of EUS-guided drainage of pancreatic pseudocysts and WON by using the LAMS.
  
  
  METHODS
  We conducted a multicenter, retrospective study on 82 patients with symptomatic PFC who underwent EUS-guided drainage by using the LAMS at 4 U.S. tertiary care centers. Outcomes evaluated included successful placement of the LAMS, the number of patients in whom complete resolution of PPs or WON was achieved, the number of procedures performed per patient to achieve PFC resolution, and adverse events.
  
  
  RESULTS
  The mean size of the PFC was 11.8 cm. LAMSs were successfully placed in 80 patients (97.5%). Twelve patients had PP and 68 had WON. The median stent in-dwelling time was 2 months (range 1-3 months). Endoscopic debridement with the LAMS in WON was performed in 54 patients. The patency of the stent was maintained in 98.7% of the patients (77/78). There was spontaneous dislodgment of 2 LAMSs. Successful endoscopic therapy by using the LAMS was successful in 12 of 12 patients (100%) with PP compared with 60 of 68 patients (88.2%) with WON. All stents were endoscopically removed from all patients after peripancreatic fluid collection (PFC) resolution. There was 1 PFC recurrence during the 3-month median follow-up period. Procedure-related adverse events occurred in 8 patients (9.8%), and included stent maldeployment (n = 2), and self-limited bleeding (n = 6). In 1 patient with stent maldeployment gastric perforation developed, and the patient underwent surgical repair.
  
  
  CONCLUSIONS
  EUS-guided drainage of PFCs by using the novel LAMS has high technical and long-term success rates. Due to its ease of use, the LAMSs may simplify and streamline EUS-guided management of PFCs, particularly for the endoscopic debridement of WON, and may help in its widespread adoption as an alternative to surgery.
authors.affiliation: Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: Ali A
authors.initials: AA
authors.lastname: Siddiqui
authors.affiliation: Division of Gastroenterology and Hepatology, University of Utah Hospital, Salt Lake City, Utah.
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Adler
authors.affiliation: Borland-Groover Clinic, Jacksonville, Florida.
authors.forename: Jose
authors.initials: J
authors.lastname: Nieto
authors.affiliation: Interventional Endoscopy Services (IES), California Pacific Medical Center, San Francisco, California.
authors.forename: Janak N
authors.initials: JN
authors.lastname: Shah
authors.affiliation: Interventional Endoscopy Services (IES), California Pacific Medical Center, San Francisco, California.
authors.forename: Kenneth F
authors.initials: KF
authors.lastname: Binmoeller
authors.affiliation: Interventional Endoscopy Services (IES), California Pacific Medical Center, San Francisco, California.
authors.forename: Steve
authors.initials: S
authors.lastname: Kane
authors.affiliation: Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: Linda
authors.initials: L
authors.lastname: Yan
authors.affiliation: Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: Sobia N
authors.initials: SN
authors.lastname: Laique
authors.affiliation: Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kowalski
authors.affiliation: Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: David E
authors.initials: DE
authors.lastname: Loren
authors.affiliation: Division of Gastroenterology and Hepatology, University of Utah Hospital, Salt Lake City, Utah.
authors.forename: Linda Jo
authors.initials: LJ
authors.lastname: Taylor
authors.affiliation: Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Satish
authors.initials: S
authors.lastname: Munigala
authors.affiliation: Interventional Endoscopy Services (IES), California Pacific Medical Center, San Francisco, California.
authors.forename: Yasser M
authors.initials: YM
authors.lastname: Bhat
mesh_terms: D000328:Adult; D000368:Aged; D001826:Body Fluids; D003646:Debridement; D004322:Drainage / Q000009:adverse effects / Q000295:instrumentation*; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000601:surgery; D010179:Pancreas / Q000473:pathology* / Q000601:surgery; D010192:Pancreatic Pseudocyst / Q000601:surgery*; D011475:Prosthesis Failure; D019919:Prosthesis Implantation / Q000009:adverse effects; D012008:Recurrence; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D014481:United States