Value of lumen-apposing metal stent in the treatment of 27 cases with peripancreatic fluid accumulation in acute pancreatitis / 中华消化杂志

ABSTRACT

Objective To assess the application value of lumen-apposing,fully covered,self-expandable metal stent (LAMS) in the treatment of peripancreatic fluid collection (PFC).Methods From July 2015 to July 2017,at Drum Tower Hospital Affiliated to Medical School of Nanjing University,the patients with PFC who received LAMS under endoscopic ultrasound were enrolled.The inclusion criteria was the first treatment,age ≥ 18 years old,PFC diameter ＞ 6 cm and clinical manifestations of compression,or increased diameter of PFC after continuous observation,or signs of infection,course ＞four weeks,and the distance between the cyst wall and the digestive gastrointestinal wall less than 1 cm;exclude other pancreatic cystic lesions,such as serous cystic neoplasm,mucinous cystic neoplasm and solid pseudopapillary neoplasm.The clinical data of enrolled patients were retrospectively analyzed,and the efficacy and postoperative complication were summarized.Results A total of 27 patients with PFC were enrolled.All patients were successfully punctured and placed with LAMS.The percentage of complete drainage rate of PFC was 96.3％ (26/27).The median LAMS maintenance time was 26 days,with a range of four to 135 days.Seventeen patients received debridement treatment through LAMS,and the number of debridement treatment was (2.5± 1.3) times.Two patients underwent endoscopic retrograde cholangiopancreatography (ERCP) and were placed with pancreatic stent,five patients received percutaneous drainage,and one patient underwent surgical drainage.Among 27 patients with PFC,eight patients (29.6％) coexisted with complications,including stent displacement in two cases,postoperative infection in three cases,perforation in two cases and bleeding in one case.They all improved after conservative treatment and none of them died.Conclusion LAMS is effective and relatively safe in the treatment of PFC,and may change the clinical treatment strategy of PFC.