Self-Expandable Metal Stent (SEMS) Versus Lumen-Apposing Metal Stent (LAMS) for Drainage of Pancreatic Fluid Collections: A Randomized Clinical Trial

Nenhuma Miniatura disponível
Citações na Scopus
Tipo de produção
article
Data de publicação
2023
DOI
Web of Science
PubMed
Dimensions
Título da Revista
ISSN da Revista
Título do Volume
Editora
SPRINGERNATURE
Autores
MCCARTY, Thomas R.
Citação
CUREUS JOURNAL OF MEDICAL SCIENCE, v.15, n.4, article ID e37731, 12p, 2023
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Background and aim Endoscopic ultrasound (EUS)-guided drainage is the gold standard approach for the treatment of encapsulated pancreatic collections (EPCs) including pseudocyst and walled-off pancreatic necrosis (WON), and is associated with an equivalent clinical efficacy to surgical drainage with fewer complications and less morbidity. Drainage may be achieved via several types of stents including a fully covered self-expandable metallic stent (SEMS) and lumen-apposing metal stent (LAMS). However, to date there have been no randomized trials to compare these devices. This study aimed to compare the efficacy and safety of the SEMS versus LAMS for EUS-guided drainage of EPCs. Methods A phase IIB randomized trial was designed to compare the SEMS versus LAMS for the treatment of EPCs. Technical success, clinical success, adverse events (AEs), and procedure time were evaluated. A sample size of 42 patients was determined.<br /> Results There was no difference between the two groups in technical (LAMS 80.95% vs 100% SEMS, p=0.107), clinical (LAMS 85.71% vs 95.24% SEMS, p=0.606) or radiological success (LAMS 92.86% vs 83.33% SEMS, p=0.613). There was no difference in AEs including stent migration rate and mortality. The procedure time was longer in the LAMS group (mean time 43.81 min versus 24.43 min, p=0.001). There was also a difference in the number of intra-procedure complications (5 LAMS vs 0 SEMS, p=0.048). Conclusion SEMS and LAMS have similar technical, clinical, and radiological success as well as AEs. However, SEMS has a shorter procedure time and fewer intra-procedure complications compared to non-electrocauteryenhanced LAMS in this phase IIB randomized controlled trial (RCT). The choice of the type of stent used for EUS drainage of EPCs should consider device availability, costs, and personal and local experience.
Palavras-chave
lams, sems, lumen-apposing metal stent, self-expandable metal stent, pancreatic pseudocyst, encapsulated pancreatic collection, pancreatic fluid collection, eus-drainage
URI
https://observatorio.fm.usp.br/handle/OPI/59192
Referências
  1. Bakker OJ, 2012, JAMA-J AM MED ASSOC, V307, P1053, DOI 10.1001/jama.2012.276
  2. Bang JY, 2022, DIGEST ENDOSC, V34, P612, DOI 10.1111/den.14099
  3. Bang JY, 2020, DIGEST ENDOSC, V32, P298, DOI 10.1111/den.13470
  4. Bang JY, 2019, GUT, V68, P1200, DOI 10.1136/gutjnl-2017-315335
  5. Bang JY, 2018, ANN SURG, V267, P561, DOI 10.1097/SLA.0000000000002082
  6. Bang JY, 2016, DIGEST ENDOSC, V28, P103, DOI 10.1111/den.12557
  7. Bang JY, 2015, DIGEST ENDOSC, V27, P486, DOI 10.1111/den.12418
  8. Baron TH, 2020, GASTROENTEROLOGY, V158, P67, DOI 10.1053/j.gastro.2019.07.064
  9. Bekkali NLH, 2017, ENDOSC INT OPEN, V5, pE1189, DOI 10.1055/s-0043-120831
  10. Belle S, 2010, ENDOSCOPY, V42, P493, DOI 10.1055/s-0029-1244021
  11. Berzosa M, 2012, ENDOSCOPY, V44, P543, DOI 10.1055/s-0031-1291710
  12. Binmoeller KF, 2011, ENDOSCOPY, V43, P337, DOI 10.1055/s-0030-1256127
  13. Boxhoorn L, 2023, GUT, V72, P66, DOI 10.1136/gutjnl-2021-325632
  14. Chandrasekhara V, 2020, ENDOSC INT OPEN, V08, pE1639, DOI 10.1055/a-1243-0092
  15. Chavan R, 2022, ENDOSCOPY, V54, P861, DOI 10.1055/a-1747-3283
  16. Cotton PB, 2010, GASTROINTEST ENDOSC, V71, P446, DOI 10.1016/j.gie.2009.10.027
  17. Fabbri C, 2012, ENDOSCOPY, V44, P429, DOI 10.1055/s-0031-1291624
  18. Farias GFA, 2019, MEDICINE, V98, DOI 10.1097/MD.0000000000014255
  19. Funari MP, 2022, DIGEST ENDOSC, V34, P359, DOI 10.1111/den.14080
  20. Gornals JB, 2013, SURG ENDOSC, V27, P1428, DOI 10.1007/s00464-012-2591-y
  21. Guzmán-Calderón E, 2022, J HEPATO-BIL-PAN SCI, V29, P198, DOI 10.1002/jhbp.1008
  22. Kayal A, 2021, SURG ENDOSC, V35, P2698, DOI 10.1007/s00464-020-07699-x
  23. Khizar H, 2023, ANN MED, V55, P578, DOI 10.1080/07853890.2022.2164048
  24. dos Santos MEL, 2022, CUREUS J MED SCIENCE, V14, DOI 10.7759/cureus.30930
  25. Lera ME, 2019, ENDOSCOPY, V51, pE77, DOI 10.1055/a-0820-1456
  26. Lyu YX, 2021, PANCREAS, V50, P571, DOI 10.1097/MPA.0000000000001798
  27. Minaga K, 2022, DIGEST ENDOSC, V34, P1242, DOI 10.1111/den.14331
  28. Mohan BP, 2019, ENDOSC ULTRASOUND, V8, P82, DOI 10.4103/eus.eus_7_19
  29. Schulz Kenneth F, 2010, Open Med, V4, pe60, DOI [10.1136/bmj.c869, 10.1016/j.ijsu.2011.10.001, 10.1016/j.jclinepi.2010.03.004]
  30. Muthusamy VR, 2016, GASTROINTEST ENDOSC, V83, P481, DOI 10.1016/j.gie.2015.11.027
  31. Penn DE, 2012, GASTROINTEST ENDOSC, V76, P679, DOI 10.1016/j.gie.2012.04.457
  32. Proença IM, 2020, WORLD J GASTROENTERO, V26, P7104, DOI 10.3748/wjg.v26.i45.7104
  33. Psaltis E, 2022, WORLD J GASTRO ENDOS, V14, P443, DOI 10.4253/wjge.v14.i7.443
  34. Rana SS, 2022, ENDOSCOPY, V54, P920, DOI 10.1055/a-1857-5600
  35. Talreja JP, 2008, GASTROINTEST ENDOSC, V68, P1199, DOI 10.1016/j.gie.2008.06.015
  36. van Brunschot S, 2018, LANCET, V391, P51, DOI 10.1016/S0140-6736(17)32404-2
  37. Zhou XZ, 2021, J CLIN GASTROENTEROL, V55, P652, DOI 10.1097/MCG.0000000000001539

Coleções
Artigos e Materiais de Revistas Científicas - HC/ICHC