Endoscopic removal and replacement of the same lumen-apposing metal stent for multiple endoscopic necrosectomy sessions

Abstract

Background This study evaluated the feasibility, efficacy, and safety of removal and replacement of a lumen-apposing metal stent (LAMS) to facilitate direct endoscopic necrosectomy (DEN).

Methods Endoscopic ultrasound-guided LAMS placement for walled-off necrosis (WON) was performed. During subsequent endoscopy, the LAMS was removed, DEN was performed, and the same LAMS was redeployed across the transmural tract.

Results 140 LAMS were placed for drainage (43 pseudocysts, 97 WON) from 10/1/2016 to 11/15/2019, and 40 patients (mean age 43.9 [SD 15.4] years; 70 % males; mean WON size 10.9 [SD 4.9] × 8.7 [SD 3.8] cm) underwent removal and replacement of the same LAMS for multiple DEN sessions. LAMS was successfully replaced across the transmural tract during all 81 DEN sessions. Complete resolution was achieved after a median of 2 DEN sessions (range 1–7; mean 2.4 [SD 1.5]), with stent retrieval after a mean of 64.1 (SD 31.6) days after initial placement. No stent damage, tissue ingrowth, or major bleeding occurred.

Conclusions Removal and replacement of LAMS during multiple necrosectomies is feasible, safe, and facilitates DEN.

Publication History

Received: 18 January 2020

Accepted: 02 June 2020

Accepted Manuscript online:
02 June 2020

Article published online:
08 July 2020

• References

• 1 Baron TH, DiMaio CJ, Wang AY. et al. American Gastroenterological Association Clinical Practice Update: Management of pancreatic necrosis. Gastroenterology 2020; 158: 67-75.e1
• 2 Baron TH, Thaggard WG, Morgan DE. et al. Endoscopic therapy for organized pancreatic necrosis. Gastroenterology 1996; 111: 755-764
• 3 Seewald S, Groth S, Omar S. et al. Aggressive endoscopic therapy for pancreatic necrosis and pancreatic abscess: a new safe and effective treatment algorithm (videos). Gastrointest Endosc 2005; 62: 92-100
• 4 Itoi T, Binmoeller KF, Shah J. et al. Clinical evaluation of a novel lumen-apposing metal stent for endosonography-guided pancreatic pseudocyst and gallbladder drainage (with videos). Gastrointest Endosc 2012; 75: 870-876
• 5 Shah RJ, Shah JN, Waxman I. et al. Safety and efficacy of endoscopic ultrasound-guided drainage of pancreatic fluid collections with lumen-apposing covered self-expanding metal stents. Clin Gastroenterol Hepatol 2015; 13: 747-752
• 6 Thompson CC, Kumar N, Slattery J. et al. A standardized method for endoscopic necrosectomy improves complication and mortality rates. Pancreatology 2016; 16: 66-72
• 7 Seifert H, Biermer M, Schmitt W. et al. Transluminal endoscopic necrosectomy after acute pancreatitis: a multicentre study with long-term follow-up (the GEPARD Study). Gut 2009; 58: 1260-1266
• 8 Bakker OJ, Van Santvoort HC, Van Brunschot S. et al. Endoscopic transgastric vs surgical necrosectomy for infected necrotizing pancreatitis: a randomized trial. JAMA 2012; 307: 1053-1061
• 9 Okuno M, Mukai T, Ichikawa H. et al. Endoscopic replacement technique for migrated lumen-apposing metal stent during endoscopic pancreatic necrosectomy. VideoGIE 2019; 4: 220-222
• 10 Mistry T, Shah M, Javia S. et al. Retrieval and redeployment of migrated lumen-apposing metal stent to facilitate endoscopic necrosectomy of walled-off necrosis. VideoGIE 2018; 3: 151-152
• 11 Guarner-Argente C, Colán-Hernández J, Concepción-Martín M. et al. Replacement of the same lumen-apposing metallic stent for multiple necrosectomy sessions. Endoscopy 2015; 47 (Suppl. 01) E447-448
• 12 Puli SR, Graumlich JF, Pamulaparthy SR. et al. Endoscopic transmural necrosectomy for walled-off pancreatic necrosis: a systematic review and meta-analysis. Can J Gastroenterol Hepatol 2014; 28: 50-53