Observational Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. May 16, 2018; 10(5): 93-98
Published online May 16, 2018. doi: 10.4253/wjge.v10.i5.93
Endoscopic ultrasound-guided drainage of pancreatic walled-off necrosis using self-expanding metal stents without fluoroscopy
Barbara Braden, Andreas Koutsoumpas, Michael A Silva, Zahir Soonawalla, Christoph F Dietrich
Barbara Braden, Andreas Koutsoumpas, Translational Gastroenterology Unit, Oxford University Hospitals, Oxford OX3 9DU, United Kingdom
Michael A Silva, Zahir Soonawalla, Hepatobiliary Surgery, Oxford University Hospitals, Oxford OX3 9DU, United Kingdom
Christoph F Dietrich, Caritas Krankenhaus, Bad Mergentheim 97980, Germany
Author contributions: Braden B and Dietrich CF contributed to study conception and design, performed the interventions and data acquisition; Braden B, Koutsoumpas A, Silva MA, Soonawalla Z and Dietrich CF contributed to data acquisition, data analysis and interpretation, editing, reviewing and final approval of article.
Institutional review board statement: After discussion with the local Ethics Service, they considered this observational project to be an audit rather than a research project, therefore ethical approval was not required.
Informed consent statement: Informed consent was obtained from all patients.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Data sharing statement: Data set available from corresponding author braden@em.uni-frankfurt.de. Consent has not been obtained for sharing of this data but all data have been anonymised and the risk of identification is therefore low.
STROBE statement: Guidelines of the STROBE Statement have been adopted.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Barbara Braden, BSc, FEBG, MD, PhD, Professor, Translational Gastroenterology Unit, Oxford University Hospitals, NHS Foundation Trust, Headley Way, Oxford OX3 9DU, United Kingdom. braden@em.uni-frankfurt.de
Telephone: +44-186-5228760 Fax: +44-186-5228763
Received: January 3, 2018
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
Research background

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.

Research motivation

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.

Research objectives

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.

Research methods

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.

Research results

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%.

Research conclusions

Non-fluoroscopic EUS-guided transmural insertion of FCSEMS for drainage of WOPN is feasible and appears to be safe and effective.

Research perspectives

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.