Lumen-apposing metal stents for pancreatic fluid collection drainage: a review of current outcomes
Keywords:acute pancreatitis, lumen-apposing metal stent, pseudocyst, walled-off necrosis, direct endoscopic necrosectomy
Local complications of acute pancreatitis in the form of pancreatic fluid collections are a source of substantial morbidity and mortality demanding a multidisciplinary expert approach. The use of minimally invasive methods in this setting has been associated with shortened hospital stays, decreased costs and improved outcomes. In addition, endoscopically performed necrosectomy has been used to facilitate drainage but was limited due to the lack od dedicated equipment and was performed in rare expert centers. Recently developed lumen-apposing metal stents were designed to overcome the shortcomings of previously used methods. Their diameter and biphalanged design prevents migration, facilitates drainage, and permits repeated endoscope entry into the necrotic cavity to perform direct necrosectomy. Recent reports on larger series of patients laud their technical and clinical success rate with relatively low adverse event occurrence considering the invasiveness of the procedure and the population of patients involved. The uptake of endoscopically performed drainage can be attributed to the increasing use of lumen-apposing metal stents as evident by the number reports published in recent years. Growing experience and future studies should lead to evidence based guidelines and refinement of these methods.
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