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Objective:To evaluate the efficacy and safety of lumen-apposing metal stent (LAMS) for the treatment of pancreatic walled-off necrosis (WON).Methods:A retrospective cohort study was performed on data of 43 consecutive patients with pancreatic WON who underwent endoscopic ultrasound-guided drainage by LAMS or plastic stents (PS) in Hangzhou First People's Hospital from December 2010 to June 2020. According to the type of stent used, the patients were divided into the LAMS group ( n=16) and the PS group ( n=27). The technical success rate, the clinical success rate, the operation time, the session of endoscopic necrosectomy, the stent insertion time and adverse events were compared between the two groups. Results:All 43 patients were successfully stented, indicating a technical success rate of 100% in both groups. For the LAMS group, the clinical success rate, the operation time, the session of endoscopic necrosectomy, the stent insertion time and overall incidence of adverse events were 75.0% (12/16), 26.0 (19.1, 39.8) min, 0.5 (0, 2.0) times, (41.3±28.4) days, and 43.7% (7/16), respectively, whereas these indices of the PS group were 37.0% (10/27) ( χ2=5.795, P=0.016), 31.0 (26.0, 48.0) min ( Z=1.221, P=0.222), 0 (0, 0) times ( Z=2.245, P=0.025), (176.1±99.1) days ( t=5.187, P<0.001) and 14.8% (4/27) ( χ2=8.893, P=0.064), respectively. Conclusion:LAMS placement is safe and effective for the treatment of pancreatic WON with a higher clinical success rate compared with PS. However, it requires more endoscopic intervention.
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Objective To evaluate the therapeutic effect of endoscopic management of plastic stents of post-liver transplantation anastomotic biliary stricture. Methods From January 2010 to October 2015, clinical data of patients with post-liver transplantation anastomotic biliary stricture and received endoscopic retrograde cholangiopancreatog﹣raphy and plastic stents management was collected. The technical success rate, ERCP-related complications, clinical remission rate and long-term complications were main outcome measurements to compare the efficacy and safety of different number of stents in managing post-liver transplantation anastomotic biliary stricture. Results Among the 18 patients (0.5 ~ 60.0 months) with post-liver transplantation ABSs, seven patients received less plastic stents treat﹣ment (< 3 stents), nine patients with persistent anastomotic or recurrent stricture received multiple plastic stents treatment (≥ 3 stents), two patients received multiple plastic stents treatment once suffered with post-liver trans﹣plantation ABSs. The endoscopic technical success rate was seventy-six over eighty (95.0 %). Among the seven pa﹣tients received less plastic stents treatment, one loss to follow-up, two were still under treatment, one died of acute hepatic failure, one died of septic stock, one combined with biliary fistula resulted in treatment failure, one achieved clinical remission, the clinical remission rate was one third (33.3 %). Among the eleven patients received multiple plastic stents treatment, two loss to follow-up, one was still under treatment, two received surgery because of failed treatment, six achieved clinical remission, the clinical remission rate was 75.0 % (6/8). The average diameters and stent durations of management of 1 stent, 2 stents, 3 stents, 4 stents, 5 stents, 7 stents were 8.5 F, 17.0 F, 24.0 F, 28.0 F, 36.0 F, 50.0 F. Among the six early postoperative complications, five cases occurred in less stent manage﹣ment and one occurred in MPSs management, the early postoperative complication rate was 7.5 %(6/80). No severe ERCP-related complications and procedure-related deaths. Conclusions Endoscopic management of plastic stents is safe and effective for post-liver transplantation ABSs. Providing larger biliary support, the multiple plastic stents treatment was superior to less plastic stents treatment in view of clinical remission rate, especially for refractory one. Multiple plastic stents did not increase the incidence of complications, it could be used as the first-line treatment of post-liver transplantation duct-to-duct biliary anastomosis for its safety and effectivity.
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BACKGROUND/AIMS: The efforts to improve biliary plastic stents (PSs) for decreasing biofilm formation and overcome short patency time have been continued. The aim of this study is to evaluate the effect of advanced hydrophilic coating for patency and biodurability of PS. METHODS: Using an in vitro bile flow phantom model, we compared patency between prototype PS with hydrophilic coating (PS+HC) and prototype PS without hydrophilic coating (PS-HC). We performed an analysis of the degree of luminal narrowing by microscopic examination. Using an in vivo swine bile duct dilation model made by endoscopic papillary closure and stent insertion, we evaluated biodurability of hydrophilic coating. RESULTS: In the phantom model, PS+HC showed less biofilm formation and luminal narrowing than PS-HC at 8 weeks (p<0.05). A total of 31 stents were inserted into the dilated bile duct of seven swine models, and 24 stents were successfully retrieved 8 weeks later. There was no statistical difference of stent patency between the polyethylene PS+HC and the polyurethane PS+HC. The biodurability of hydrophilic coating was sustained up to 8 weeks, when assessing the coating layer by scanning electron microscopy examination. CONCLUSIONS: Advanced hydrophilic coating technology may extend the patency of PS compared to uncoated PS.
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Animals , Bile Ducts , Bile , Biofilms , In Vitro Techniques , Microscopy, Electron, Scanning , Phenobarbital , Plastics , Polyethylene , Polyurethanes , Stents , SwineABSTRACT
Objective To compare the safety and efficacy of simultaneous bilateral biliary metal stents with plastic stents under endoscope for treatment of malignant hilar biliary obstruction (MHBO). Methods From May 2007 to December 2011, 142 MHBO patients were selected for this study, with 32 receiving bilateral metal stent drainage and 110 receiving bilateral plastic stent drainage. The success rate of endoscopic operations, postoperative jaundice-reducing effect, post-endoscopic retrograde cholangiopancreatography (ERCP) complications, and stent patency period were observed. Results The procedures were successful in all patients in the two groups. The postoperative jaundice-reducing effect rates were 96. 9% (31/32) in the metal stent group and 88.2%(97/110) in the plastic stent group (P>0. 05). Two patients in the metal stent group and six in the plastic stent group had post-ERCP cholangitis, which was relieved by anti-inflammatory intervention, replacement of stents or endoscopic nasobiliary drainage. Two patients in the plastic stent group had stent slip. There were no pancreatitis, gastrointestinal bleeding, perforation or ERCP-related deaths in the two groups. Two patients in the metal stent group and 4 in the plastic stent group died, and the biliary stents were patent until they died. Eight patients in metal stent group and 29 patients in the plastic stent group developed recurrent obstructive jaundice, which were treated by reimplantation or replacement of the plastic stents. The post-ERCP complication rates were similar in the two groups (P>0. 05). Themedian patency period of the metal stent was (248. 53± 138. 61) d and that of the plastic stent was (101. 76±38. 53) d, showing significant difference byLog-rank test (P3 months, double metal stent biliary drainage has more advantages.
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Objective To evaluate the safety and long-term outcomes of endoscopic deployment ofmultiple plastic stents for treatment of biliary stricture after living donor liver transplantation (LDLT). Methods Between June 2005 and June 2012, 31 patients with biliary strictures after LDLT received endoscopic retrograde cholangiopancreatography (ERCP) and multiple plastic stents placement. The technical success rate and ERCP-related complications were observed. The patients were followed up and the duration of stents treatment, stricture eliminating rate, and sustained clinical success rate were recorded. Results The ERCP findings revealed stricture in 22 cases and stricture plus leakage in 9. The endoscopic technical success rate was 87. 1% (27/31). ERCP-related complications included acute pancreatitis in 1 case, acute cholangitis 2 and partial stent migration in 2. There were no procedure-related deaths. The median period from stent deployment to removal was 9. 6 months. The stricture eliminating rate was 95% (19/20) and sustained clinical success rate was 88. 2% (15/17) during a follow-up of 5-43 months (median 38 months). Conclusion Endoscopic deployment of multiple plastic stents is safe and effective for biliary stricture after LDLT, with acceptable long-termoutcomes, and the method may be a firtt-line therapy option for biliary stricture after LDLT.
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The conventional management of pancreatic fluid collections (PFCs) involves surgery or percutaneous drainage. While surgery is associated with significant complications and mortality, percutaneous drainage is associated with prolonged hospitalization and oftentimes the need for other adjunctive treatment measures. Therefore, the use of endoscopy to drain PFCs is becoming increasingly popular. Randomized trials have demonstrated that endoscopic ultrasound-guided drainage is superior to conventional endoscopy in terms of technical success and potentially decreases the rates of procedural complications. While transmural drainage is usually undertaken by deployment of plastic endoprosthesis, of late, fully covered self-expandable metal stents are being placed with increasing frequency. However, the benefits of this approach are unclear and require further validation in prospective trials.