EUS-guided drainage of pancreatic fluid collections using a novel lumen-apposing metal stent on an electrocautery-enhanced delivery system: a large retrospective study (with video).

BACKGROUND AND AIMS: A lumen-apposing, self-expanding metal stent incorporated in an electrocautery-enhanced delivery system for EUS-guided drainage of pancreatic fluid collections (PFCs) recently has become available. The aim of this study was to analyze the safety and clinical effectiveness of this newly developed device in this clinical setting. METHODS: This was a retrospective analysis of all consecutive patients with PFCs who underwent EUS-guided drainage using the study device in 13 European centers. RESULTS: Ninety-three patients with PFCs (80% with complex collections) underwent drainage using the study device. Penetration of the PFC was accomplished directly with the study device in 74.2% of patients, and successful stent placement was accomplished in all but 1 patient, mostly without fluoroscopic assistance. Direct endoscopic necrosectomy (DEN) was carried out in 31 of 52 cases (59.6%) of walled-off necrosis and in 2 of 4 cases (50%) of acute peripancreatic fluid collection. Complete resolution of the PFC was obtained in 86 cases (92.5%), with no recurrence during follow-up. Treatment failure occurred in 6 patients because of persistent infection requiring surgery (n = 3), perforation and massive bleeding caused by the nasocystic drainage catheter (NCDC) (n = 2), and the need for a larger opening to extract large necrotic tissue pieces (n = 1). Major adverse events occurred in 5 patients (perforation and massive bleeding caused by the NCDC in 2 patients, 1 pneumoperitoneum and 1 stent dislodgement during DEN, and 1 postdrainage infection) and were mostly not related to the drainage procedure. CONCLUSIONS: EUS-guided drainage with the electrocautery-enhanced delivery system is a safe, easy to perform, and a highly effective minimally invasive treatment modality for PFCs.

[Autoimmune pancreatitis--a rare and difficult differential diagnosis to pancreatic cancer]. / Autoimmunpankreatitis--eine seltene und schwierige Differentialdiagnose zum Pankreaskarzinom.

BACKGROUND: Autoimmune pancreatitis (AIP) is a rare disorder. Typical clinical symptoms include extrahepatic cholestasis, abdominal pain, and weight loss. CASE REPORT: The case of a patient with cholestatic icterus and double duct sign is reported, who underwent surgery (Whipple operation) because of suspected pancreatic cancer. Histology of the resected pancreas head revealed AIP. Due to this diagnosis, measurement of IgG4 showed a significantly elevated serum level. Postoperatively, cholestasis parameters remained elevated, which was interpreted as associated sclerosing cholangitis. Therapy with corticosteroids led to normalization of the cholestasis within 4 weeks. CONCLUSION: AIP should be taken into account as differential diagnosis to pancreatic cancer, especially in cases without clear demarcation of a pancreatic tumor. Measurement of IgG4 may be an important parameter to avoid unnecessary surgery.