Comparing EUS-guided lumen-apposing metal stents with and without integrated electrocautery for endoscopic drainage of walled-off pancreatic necrosis.

BACKGROUND AND

OBJECTIVES

EUS-guided drainage using lumen-apposing metal stents (LAMSs) has become standard treatment of symptomatic walled-off pancreatic necrosis (WOPN). Delivery systems with integrated electrocautery (EC) enable direct access and stent deployment, whereas the conventional stent insertion requires several steps including access using a needle or cystotome, wire insertion, and enlargement of the created tract before the stent placement. This study aimed to compare the practicality of EUS-guided procedures and their outcomes between conventional LAMSs (cLAMSs) and integrated EC (EC-LAMSs).

METHODS

In consecutive patients undergoing EUS-guided LAMS insertion with or without integrated EC, data on procedure time, sedation, and technical and clinical success, as well as adverse events, were analyzed.

RESULTS

From our prospectively maintained database, we analyzed 107 consecutive procedures of transmural EUS-stenting for drainage of WOPN. Thirty-nine cLAMSs and 68 EC-LAMSs were placed. Mean WOPN size was 12.9 ± 4.2 cm with mean 30% ± 15% solid necrosis.Procedure times were shorter with EC-LAMSs (18.0 ± 6.6 vs. 39.7 ± 8.3 minutes; P < 0.05). All EUS-guided procedures with cLAMS drainage were performed under propofol sedation administered by anesthetist. In the EC-LAMS group, 36 patients tolerated the procedure under intravenous sedation (fentanyl/midazolam), and 17 interventions were performed as day case procedures. Adverse events and clinical outcome did not differ between both groups.

CONCLUSION

Compared with cLAMS, EC-LAMS deployment is faster and technically less demanding. This allows performing the procedure under conventional intravenous sedation and as day case procedure in selected patients.