BACKGROUND Endoscopic management of symptomatic pancreatic fluid collections (PFCs) using self-expandable metal stents (SEMS) placement has emerged as an innovative therapeutic approach with excellent efficacy, safety...BACKGROUND Endoscopic management of symptomatic pancreatic fluid collections (PFCs) using self-expandable metal stents (SEMS) placement has emerged as an innovative therapeutic approach with excellent efficacy, safety, and relatively few adverse outcomes. However, their use has not been studied in patients with cirrhosis. Cirrhotics tend to be considered less than optimal candidates due to concern for portal hypertension and coagulopathy related complications. AIM To compare the efficacy and safety of using SEMS for drainage of symptomatic PFCs in cirrhotic vs non-cirrhotic patients. METHODS We conducted a retrospective comparative analysis of patients with symptomatic PFCs [pancreatic pseudocyst (PP) or walled-off necrosis (WON)] who underwent endoscopic ultrasound (EUS)-guided placement of fully covered self-expandable metals stents or lumen-apposing self-expandable metal stents. All patients were followed clinically until resolution of PFCs or death. Definition:(1) Technical success was defined as successful placement of SEMS;and (2) Clinical success was defined as complete resolution of the PFCs without additional interventions including interventional radiology or surgery. Number of procedures performed per patient, number of patients who achieved complete resolution of the PFCs without additional interventions and procedure related adverse events were recorded.RESULTS From January 2012 to December 2017, a total of 88 patients underwent EUSguided drainage of symptomatic PFCs. Of these, 58 non cirrhotic patients underwent plastic stent insertion for management of PFC and 30 patients, 5 with cirrhosis and 25 without cirrhosis, underwent EUS-guided transmural drainage with SEMS, including 18 (60%) PP and 12 (40%) WON. Technical success was achieved in all 30 patients. Clinical success was achieved in 60% cirrhotic patients and 92% non-cirrhotics (P = 0.12). Procedure-related adverse events were 60% in cirrhotic and 28% non-cirrhotic (P = 0.62). Moreover, fatal adverse events were statistically more common in cirrhotics compared with non-cirrhotics (0 vs 40%;P = 0.023). Successful stent removal following resolution of the PFC, was 60% in cirrhotics and 80% in non-cirrhotics (P = 0.57). Post-procedure length of hospitalization was 18.6 ± 20.3 d in cirrhotics and 5.6 ± 13.7 d in non-cirrhotics (P = 0.084). CONCLUSION EUS-guided management of PFC using SEMS placement has a high technical and clinical success rate in non-cirrhotics. However, in cirrhotics caution must be exercised given the high morbidity and mortality as evidenced by our cohort, particularly for the endoscopic debridement of WONs. Larger, multicenter studies are warranted to further characterize the risk profile and outcomes in these patients.展开更多
To evaluate the risk of immediate and delayed bleeding following sphincterotomy procedure. METHODSThis retrospective cohort study was conducted with all patients who underwent endoscopic sphincterotomy during January ...To evaluate the risk of immediate and delayed bleeding following sphincterotomy procedure. METHODSThis retrospective cohort study was conducted with all patients who underwent endoscopic sphincterotomy during January 2006 to September 2015 at a tertiary academic center. Patients were grouped according to pre procedural usage of serotonin reuptake inhibitors (SRIs). Both groups were matched for demographic and clinical characteristics. Patients with thrombocytopenia, increased international normalized ratio, or a history of bleeding or coagulation disorders, concurrent use of other antiplatelet/anticoagulants were excluded from the study. RESULTSA total of 447 patients were included, of which 219 (45.9%) used SRIs and 228 (54.1%) cases did not. There was no significant difference in acute or delayed bleeding during endoscopic sphincterotomy between the two groups. (8.2% vs 12.3%, P = 0.16). CONCLUSIONThe use of SRIs was not associated with an increased risk of post-sphincterotomy bleeding. To our best knowledge, this is the first study to explore this association.展开更多
文摘BACKGROUND Endoscopic management of symptomatic pancreatic fluid collections (PFCs) using self-expandable metal stents (SEMS) placement has emerged as an innovative therapeutic approach with excellent efficacy, safety, and relatively few adverse outcomes. However, their use has not been studied in patients with cirrhosis. Cirrhotics tend to be considered less than optimal candidates due to concern for portal hypertension and coagulopathy related complications. AIM To compare the efficacy and safety of using SEMS for drainage of symptomatic PFCs in cirrhotic vs non-cirrhotic patients. METHODS We conducted a retrospective comparative analysis of patients with symptomatic PFCs [pancreatic pseudocyst (PP) or walled-off necrosis (WON)] who underwent endoscopic ultrasound (EUS)-guided placement of fully covered self-expandable metals stents or lumen-apposing self-expandable metal stents. All patients were followed clinically until resolution of PFCs or death. Definition:(1) Technical success was defined as successful placement of SEMS;and (2) Clinical success was defined as complete resolution of the PFCs without additional interventions including interventional radiology or surgery. Number of procedures performed per patient, number of patients who achieved complete resolution of the PFCs without additional interventions and procedure related adverse events were recorded.RESULTS From January 2012 to December 2017, a total of 88 patients underwent EUSguided drainage of symptomatic PFCs. Of these, 58 non cirrhotic patients underwent plastic stent insertion for management of PFC and 30 patients, 5 with cirrhosis and 25 without cirrhosis, underwent EUS-guided transmural drainage with SEMS, including 18 (60%) PP and 12 (40%) WON. Technical success was achieved in all 30 patients. Clinical success was achieved in 60% cirrhotic patients and 92% non-cirrhotics (P = 0.12). Procedure-related adverse events were 60% in cirrhotic and 28% non-cirrhotic (P = 0.62). Moreover, fatal adverse events were statistically more common in cirrhotics compared with non-cirrhotics (0 vs 40%;P = 0.023). Successful stent removal following resolution of the PFC, was 60% in cirrhotics and 80% in non-cirrhotics (P = 0.57). Post-procedure length of hospitalization was 18.6 ± 20.3 d in cirrhotics and 5.6 ± 13.7 d in non-cirrhotics (P = 0.084). CONCLUSION EUS-guided management of PFC using SEMS placement has a high technical and clinical success rate in non-cirrhotics. However, in cirrhotics caution must be exercised given the high morbidity and mortality as evidenced by our cohort, particularly for the endoscopic debridement of WONs. Larger, multicenter studies are warranted to further characterize the risk profile and outcomes in these patients.
文摘To evaluate the risk of immediate and delayed bleeding following sphincterotomy procedure. METHODSThis retrospective cohort study was conducted with all patients who underwent endoscopic sphincterotomy during January 2006 to September 2015 at a tertiary academic center. Patients were grouped according to pre procedural usage of serotonin reuptake inhibitors (SRIs). Both groups were matched for demographic and clinical characteristics. Patients with thrombocytopenia, increased international normalized ratio, or a history of bleeding or coagulation disorders, concurrent use of other antiplatelet/anticoagulants were excluded from the study. RESULTSA total of 447 patients were included, of which 219 (45.9%) used SRIs and 228 (54.1%) cases did not. There was no significant difference in acute or delayed bleeding during endoscopic sphincterotomy between the two groups. (8.2% vs 12.3%, P = 0.16). CONCLUSIONThe use of SRIs was not associated with an increased risk of post-sphincterotomy bleeding. To our best knowledge, this is the first study to explore this association.
