title: Endoscopic Therapy With Lumen-apposing Metal Stents Is Safe and Effective for Patients With Pancreatic Walled-off Necrosis.
abstract: Endoscopic ultrasound-guided transmural drainage and necrosectomy have become the standard treatment for patients with pancreatic walled-off necrosis (WON). Lumen-apposing metal stents (LAMS) have shown success in the management of pancreatic fluid collections. However, there are few data on their specific roles in management of WON. We investigated the efficacy and safety of LAMS in treatment of WON.
  
  
  
  We performed a retrospective multicenter case series of 124 patients with WON who underwent endoscopic transmural drainage by using LAMS at 17 tertiary care centers from January 2014 through May 2015. Patients underwent endoscopic ultrasound-guided cystogastrostomy or cystoenterostomy with placement of an LAMS into the WON collection. At the discretion of the endoscopist, we performed direct endoscopic necrosectomy, irrigation with hydrogen peroxide, and/or nasocystic drain placement. We performed endoscopic retrograde cholangiopancreatography with pancreatic duct stent placement when indicated. Concomitant therapies included direct endoscopic debridement (n = 78), pancreatic duct stent placement for leak (n = 19), hydrogen peroxide-assisted necrosectomy (n = 38), and nasocystic irrigation (n = 22). We collected data for a median time of 4 months (range, 1-34 months) after the LAMS placement. The primary outcomes were rates of technical success (successful placement of the LAMS), clinical success (resolution of WON, on the basis of image analysis, without need for further intervention via surgery or interventional radiology), and adverse events.
  
  
  
  The median size of the WON was 9.5 cm (range, 4-30 cm). Eight patients had 2 LAMS placed for multiport access, all with technical success (100%). Clinical success was achieved in 107 patients (86.3%) after 3 months of follow-up. Thirteen patients required a percutaneous drain, and 3 required a surgical intervention to manage their WON. The stents remained patent in 94% of patients (117 of 124) and migrated in 5.6% of patients (7 of 124). The median number of endoscopic interventions was 2 (range, 1-9 interventions).
  
  
  
  On the basis of a retrospective analysis of 124 patients, endoscopic therapy of WON by using LAMS is safe and effective. Creation of a large and sustained cystogastrostomy or cystoenterostomy tract is effective in the drainage and treatment of WON.
authors.affiliation: Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York. Electronic address: rzs9001@med.cornell.edu.
authors.forename: Reem Z
authors.initials: RZ
authors.lastname: Sharaiha
authors.affiliation: Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York.
authors.forename: Amy
authors.initials: A
authors.lastname: Tyberg
authors.affiliation: Gastroenterology and Hepatology, Johns Hopkins Medical Institute, Baltimore, Maryland.
authors.forename: Mouen A
authors.initials: MA
authors.lastname: Khashab
authors.affiliation: Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York.
authors.forename: Nikhil A
authors.initials: NA
authors.lastname: Kumta
authors.affiliation: Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York.
authors.forename: Kunal
authors.initials: K
authors.lastname: Karia
authors.affiliation: Department of Gastroenterology and Hepatology, Borland Groover Clinic, Jacksonville, Florida.
authors.forename: Jose
authors.initials: J
authors.lastname: Nieto
authors.affiliation: Center for Endoscopic Research and Therapeutics (CERT), University of Chicago Medicine and Biological Sciences, Chicago, Illinois.
authors.forename: Uzma D
authors.initials: UD
authors.lastname: Siddiqui
authors.affiliation: Center for Endoscopic Research and Therapeutics (CERT), University of Chicago Medicine and Biological Sciences, Chicago, Illinois.
authors.forename: Irving
authors.initials: I
authors.lastname: Waxman
authors.affiliation: Gastroenterology and Hepatology, Ochsner Health System, New Orleans, Louisiana.
authors.forename: Virendra
authors.initials: V
authors.lastname: Joshi
authors.affiliation: Gastroenterology and Hepatology, Beth Israel Mt Sinai, New York, New York.
authors.forename: Petros C
authors.initials: PC
authors.lastname: Benias
authors.affiliation: Gastroenterology and Hepatology, University of Maryland, Baltimore, Maryland.
authors.forename: Peter
authors.initials: P
authors.lastname: Darwin
authors.affiliation: Gastroenterology and Hepatology, Mount Sinai Medical Center, New York, New York.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: DiMaio
authors.affiliation: Gastroenterology and Hepatology, Brooke Army Medical Center, Fort Sam Houston, Texas.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Mulder
authors.affiliation: Gastroenterology and Hepatology, Stanford Hospital and Clinics, Palo Alto, California.
authors.forename: Shai
authors.initials: S
authors.lastname: Friedland
authors.affiliation: Gastroenterology and Hepatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: David G
authors.initials: DG
authors.lastname: Forcione
authors.affiliation: Gastroenterology and Hepatology, North Shore-Long Island Jewish Health System, New York, New York.
authors.forename: Divyesh V
authors.initials: DV
authors.lastname: Sejpal
authors.affiliation: Gastroenterology and Hepatology, Columbia University Medical Center, New York, New York.
authors.forename: Tamas A
authors.initials: TA
authors.lastname: Gonda
authors.affiliation: Gastroenterology and Hepatology, Columbia University Medical Center, New York, New York.
authors.forename: Frank G
authors.initials: FG
authors.lastname: Gress
authors.affiliation: Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York.
authors.forename: Monica
authors.initials: M
authors.lastname: Gaidhane
authors.affiliation: Center for Endoscopic Research and Therapeutics (CERT), University of Chicago Medicine and Biological Sciences, Chicago, Illinois.
authors.forename: Ann
authors.initials: A
authors.lastname: Koons
authors.affiliation: Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York.
authors.forename: Ersilia M
authors.initials: EM
authors.lastname: DeFilippis
authors.affiliation: Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Salgado
authors.affiliation: Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York.
authors.forename: Kristen R
authors.initials: KR
authors.lastname: Weaver
authors.affiliation: Gastroenterology and Hepatology, Columbia University Medical Center, New York, New York.
authors.forename: John M
authors.initials: JM
authors.lastname: Poneros
authors.affiliation: Gastroenterology and Hepatology, Columbia University Medical Center, New York, New York.
authors.forename: Amrita
authors.initials: A
authors.lastname: Sethi
authors.affiliation: Gastroenterology and Hepatology, Montefiore, New York, New York.
authors.forename: Sammy
authors.initials: S
authors.lastname: Ho
authors.affiliation: Gastroenterology and Hepatology, Johns Hopkins Medical Institute, Baltimore, Maryland.
authors.forename: Vivek
authors.initials: V
authors.lastname: Kumbhari
authors.affiliation: Gastroenterology and Hepatology, Johns Hopkins Medical Institute, Baltimore, Maryland.
authors.forename: Vikesh K
authors.initials: VK
authors.lastname: Singh
authors.affiliation: Gastroenterology and Hepatology, Johns Hopkins Medical Institute, Baltimore, Maryland.
authors.forename: Alan H
authors.initials: AH
authors.lastname: Tieu
authors.affiliation: Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York.
authors.forename: Viviana
authors.initials: V
authors.lastname: Parra
authors.affiliation: Gastroenterology and Hepatology, University of Missouri Kansas City, Kansas City, Missouri.
authors.forename: Alisa
authors.initials: A
authors.lastname: Likhitsup
authors.affiliation: Gastroenterology and Hepatology, Brooke Army Medical Center, Fort Sam Houston, Texas.
authors.forename: Craig
authors.initials: C
authors.lastname: Womeldorph
authors.affiliation: Gastroenterology and Hepatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Brenna
authors.initials: B
authors.lastname: Casey
authors.affiliation: Gastroenterology and Hepatology, University of Missouri Kansas City, Kansas City, Missouri.
authors.forename: Sreeni S
authors.initials: SS
authors.lastname: Jonnalagadda
authors.affiliation: Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York.
authors.forename: Amit P
authors.initials: AP
authors.lastname: Desai
authors.affiliation: Gastroenterology and Hepatology, Beth Israel Mt Sinai, New York, New York.
authors.forename: David L
authors.initials: DL
authors.lastname: Carr-Locke
authors.affiliation: Gastroenterology and Hepatology, Weill Cornell Medical Center, New York, New York.
authors.forename: Michel
authors.initials: M
authors.lastname: Kahaleh
authors.affiliation: Gastroenterology and Hepatology, Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Ali A
authors.initials: AA
authors.lastname: Siddiqui
mesh_terms: D000368:Aged; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D008670:Metals
keywords: ERCP; Necrosectomy; Pancreatic Necrosis; Pancreatitis; Stents