Metal versus plastic for pancreatic pseudocyst drainage: clinical outcomes and success

Gastrointest Endosc. 2015 Nov;82(5):822-7. doi: 10.1016/j.gie.2015.02.035. Epub 2015 May 1.

Abstract

Background: Endoscopic transmural drainage of pancreatic pseudocysts (PPs) by using double-pigtail (DP) plastic stents requires placement of multiple stents and can be restricted by inadequate drainage and leakage risk. Recently, the use of fully covered self-expanding metal stents (FCSEMSs) has been reported as an alternative to DP plastic stents.

Objective: To evaluate the clinical outcomes, success rate, and adverse events of EUS-guided drainage of PPs with DP plastic stents and FCSEMSs.

Design: Retrospective cohort study.

Setting: Two tertiary-care academic medical centers.

Patients: This study involved 230 patients (mean age, 52.6 years) with PPs who underwent EUS-guided transmural drainage including 118 that were drained by using DP plastic stents and 112 by using FCSEMSs. A transgastric approach was used in 210 patients (91%), and transduodenal drainage was performed in 20 patients (9%).

Interventions: Stent deployment under EUS guidance.

Main outcome measurements: Technical success, early adverse events, stent occlusion requiring reintervention, and long-term success.

Results: At 12-month follow-up after the initial procedure, complete resolution of PPs by using DP plastic stents was lower compared with those that underwent drainage with FCSEMSs (89% vs 98%; P = .01). Procedural adverse events were noted in 31% in the DP plastic stent group and 16% in the FCSEMS group (P = .006). On multivariable analysis, patients with plastic stents were 2.9 times more likely to experience adverse events (odds ratio 2.9; 95% confidence interval, 1.4-6.3).

Limitations: Retrospective study.

Conclusion: In patients with PPs, EUS-guided drainage by using FCSEMSs improves clinical outcomes and lowers adverse event rates compared with those drained with DP plastic stents.

Publication types

  • Multicenter Study

MeSH terms

  • Drainage / instrumentation*
  • Endoscopy, Digestive System / methods*
  • Endosonography
  • Female
  • Follow-Up Studies
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Pancreatic Pseudocyst / diagnosis
  • Pancreatic Pseudocyst / surgery*
  • Prosthesis Design
  • Retrospective Studies
  • Stents*
  • Surgery, Computer-Assisted / methods*
  • Time Factors
  • Tomography, X-Ray Computed
  • Treatment Outcome