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Lumen-apposing covered self-expanding metallic stent for symptomatic pancreatic fluid collections: assessment of outcomes and complications with CT and MRI

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Abstract

Purpose

To assess technical and clinical outcomes following lumen-apposing covered self-expanding metallic stent (LAMS) placement for symptomatic pancreatic fluid collections (PFC) with CT and MRI.

Methods

In this retrospective study, patients with PFC who underwent LAMS placement between March 2015 and June 2018 were included. Primary outcomes included technical success, defined as successful stent placement with resolution of PFC, and clinical success, defined as lack of fluid recurrence after stent removal. Secondary outcomes included time duration from stent placement to removal, complications, and re-intervention need.

Results

28 consecutive patients (20 men, mean age: 53 years ± 17; range 21–75) who underwent endoscopic drainage of symptomatic walled-off necrosis (WON, 21/28, 75%), pseudocyst (PC, 5/28, 18%) or acute necrotic collection (ANC, 2/28, 7%) were included. LAMS were placed successfully in 27/28 (96%) patients. On follow-up imaging after at least one month (n = 24), the volume of the PFC decreased by 99.9% from 425 cm3 [IQR 214 – 636] to 0.6 cm3 [IQR 0–43.9]. After stent removal, 26/27 (96%) patients remained collection free. The median time duration from stent placement to removal was 42 days [IQR 34–71]. Complications (10/28; 36%) included stent occlusion (n = 1), stent migration (n = 3), intraprocedural bleeding (n = 2), postprocedural bleeding (n = 2), and pseudoaneurysm formation (n = 2). Re-intervention was required in 7/27 (26%).

Conclusion

Following LAMS placement in patients with symptomatic PFC, high technical and clinical success rates of 96% and 96%, respectively, are achieved. Awareness of common complications seen on cross-sectional imaging might help radiologists and gastroenterologist in the patients’ management.

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Acknowledgement

Khoschy Schawkat, MD, received a grant from the Swiss National Science Foundation (SNSF, Grant No. 181917) and a grant from the Swiss Society of Radiology.

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Authors and Affiliations

  1. Division of Abdominal Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02115, USA

    Khoschy Schawkat, Michael Luo, Kristy Lee & Kevin Beker

  2. Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland

    Khoschy Schawkat

  3. Division of Gastroenterology, Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA

    Mizrahi Meir & Tyler M. Berzin

  4. Dover, USA

    Koenraad J. Mortele

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  1. Khoschy Schawkat
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Correspondence to Khoschy Schawkat.

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This HIPAA compliant, retrospective cohort study was approved by our institutional review board and patient’s informed consent was waived.

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Schawkat, K., Luo, M., Lee, K. et al. Lumen-apposing covered self-expanding metallic stent for symptomatic pancreatic fluid collections: assessment of outcomes and complications with CT and MRI. Abdom Radiol 46, 757–767 (2021). https://doi.org/10.1007/s00261-020-02638-9

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