Published online May 16, 2018. doi: 10.4253/wjge.v10.i5.93
Peer-review started: January 4, 2018
First decision: January 22, 2018
Revised: February 20, 2018
Accepted: March 14, 2018
Article in press: March 15, 2018
Published online: May 16, 2018
Transluminal placement of specially designed fully covered self-expandable and lumen-apposing metal stents (FCSEMS) has improved the management and clinical outcome of walled-off pancreatic necrosis (WOPN). Most often this procedure is performed under fluoroscopy after EUS-guided access.
Without the need for fluoroscopy EUS-guided drainage using large diameter metal stents would also become available in endoscopy units and at the bedside of critically ill patients. This procedure is often crucial for the management of patients with complex pancreatic necrosis.
The principal aim of this study is to assess the feasibility and safety of fluoroless, purely EUS-guided insertion of self-expandable and lumen-apposing stents for the drainage of walled-off pancreatic necrosis.
In 27 consecutive patients, we investigated the EUS-visibility of all procedural steps required to insert a fully covered self-expandable metal stent as transluminal drainage of walled-off pancreatic necrosis. EUS-visibility, technical success, outcome and adverse events were analysed.
All procedural steps could be visualised by EUS alone. Fluoroscopy was avoided in all patients undergoing transmural stent placement. EUS-guided insertion of the FCSEMS was technically successful achieving correct stent positioning in 92.6%.
Non-fluoroscopic EUS-guided transmural insertion of FCSEMS for drainage of WOPN is feasible and appears to be safe and effective.
Large multi-center studies and prospective registries would provide more information on the use of EUS-guided WOPN drainage as bedside intervention, its safety and long-term outcome, the best time intervals when to remove the metal stents.