title: Endoscopic ultrasonography-guided transmural drainage of walled-off pancreatic necrosis: Comparison between a specially designed fully covered bi-flanged metal stent and multiple plastic stents.
abstract: OBJECTIVE
  Endoscopic ultrasonography (EUS)-guided drainage of walled-off necrosis (WON) may be carried out by placement of multiple plastic stents (MPS) or specially designed fully covered bi-flanged metal stents (BFMS). Comparative data on efficacy of these two stent types for WON drainage are limited. This retrospective study compares outcomes of WON drainage using BFMS and MPS.
  
  
  METHODS
  During a 10-year period, 133 patients underwent EUS-guided WON drainage. MPS or BFMS were placed in a WON cavity through a single puncture, and direct endoscopic necrosectomy (DEN) was carried out whenever clinically necessary. Data in the two cohorts were retrospectively compared for primary outcomes - clinical success, adverse events and mortality; and secondary outcomes - DEN requirement, mean DEN sessions, need for salvage surgery and hospital stay.
  
  
  RESULTS
  MPS were placed in 61 and BFMS in 72 patients. Patients undergoing BFMS drainage required fewer DEN sessions (mean 1.46 vs 2.74, P < 0.05), had fewer adverse events (5.6% vs 36.1%, P < 0.05), needed salvage surgery less often (2.7% vs 26.2%, P < 0.05), and had significantly shorter hospital stay (4.1 vs 8 days, P < 0.05) compared to those undergoing MPS drainage. There was no difference in DEN requirement (P = 0.217) and mortality (P = 0.5) in both groups. Overall clinical success with BFMS was superior to MPS (94% vs 73.7%, P < 0.05).
  
  
  CONCLUSIONS
  BFMS appear to be superior to MPS for EUS-guided WON drainage in terms of clinical success, number of DEN sessions, adverse events, need for salvage surgery and hospital stay.
authors.affiliation: Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India.
authors.forename: Amol
authors.initials: A
authors.lastname: Bapaye
authors.affiliation: Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India.
authors.forename: Nachiket A
authors.initials: NA
authors.lastname: Dubale
authors.affiliation: Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India.
authors.forename: Keyur A
authors.initials: KA
authors.lastname: Sheth
authors.affiliation: Smt. Kashibai Navale Medical College, Pune, India.
authors.forename: Jay
authors.initials: J
authors.lastname: Bapaye
authors.affiliation: Department of Gastroenterology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK.
authors.forename: Jayapal
authors.identifier: http://orcid.org/0000-0001-6573-1371
authors.initials: J
authors.lastname: Ramesh
authors.affiliation: Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India.
authors.forename: Harshal
authors.initials: H
authors.lastname: Gadhikar
authors.affiliation: Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India.
authors.forename: Sheetal
authors.initials: S
authors.lastname: Mahajani
authors.affiliation: Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India.
authors.forename: Suhas
authors.initials: S
authors.lastname: Date
authors.affiliation: Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India.
authors.forename: Rajendra
authors.initials: R
authors.lastname: Pujari
authors.affiliation: Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India.
authors.forename: Ravindra
authors.initials: R
authors.lastname: Gaadhe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D013505:Digestive System Surgical Procedures / Q000379:methods; D004322:Drainage / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000000981:diagnostic imaging* / Q000601:surgery; D019283:Pancreatitis, Acute Necrotizing / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: endoscopic drainage; endoscopic ultrasonography (EUS)-guided drainage; pancreatic fluid collection; pseudocysts; walled-off pancreatic necrosis (WON)