SNFGE SNFGE
 
Thématique :
- Endoscopie/Imagerie
Originalité :
Réexamen
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Docteur Florian ROSTAIN
Coup de coeur :
 
 
Gastrointestinal Endoscopy
  2016/04  
 
  2016 Mar 9. pii: S0016-5107(16)00235-2  
  doi: 10.1016/j.gie.2016.02.044  
 
  Evaluation of short- and long-term effectiveness and safety of fully covered self-expandable metal stents for drainage of pancreatic fluid collections: results of the Spanish nationwide registry.  
 
  Vazquez-Sequeiros E, Baron TH, Pérez-Miranda M, Sánchez-Yagüe A, Gornals J, Gonzalez-Huix F, de la Serna C, Gonzalez Martin JA, Gimeno-Garcia AZ, Marra-Lopez C, Castellot A, Alberca F, Fernandez-Urien I, Aparicio JR, Legaz ML, Sendino O, Loras C, Subtil JC, Nerin J, Perez-Carreras M, Diaz-Tasende J, Perez G, Repiso A, Vilella A, Dolz C, Alvarez A, Rodriguez S, Esteban JM, Juzgado D, Albillos A; Spanish Group for FCSEMS in pancreas collections.  
  http://www.ncbi.nlm.nih.gov/pubmed/?term=Evaluation+of+short-+and+long-term+effectiveness+and+safety+of+fully+covered+self-expandable+metal+stents+for+drainage+of+pancreatic+fluid+collections%3A+results+of+the+Spanish+nationwide+registry.  
 
 

BACKGROUND AND AIMS:

Initial reports suggest that fully covered self expandable metal stents (FCSEMS) may be better suited for drainage of dense pancreatic fluid collections (PFCs) like walled-off pancreatic necrosis (WOPN). The primary aim was to analyze the effectiveness and safety of FCSEMS for drainage of different types of PFCs in a large cohort. The secondary aim was to investigate which type of FCSEMS is superior.

METHODS:

This was a retrospective, noncomparative review of a nationwide database involving all hospitals of Spain performing EUS-guided PFC drainage. From April 2008 to August 2013, all patients undergoing drainage of a PFC with an FCSEMS were included in a database. Main outcome measurements were technical success, short (2 weeks) and long-term (6 months) effectiveness, adverse events (AEs), and need for surgery.

RESULTS:

The study included 211 patients (pseudocyst/WOPN 53/47%). FCSEMSs used were straight biliary (66%) or lumen-apposing metal stent (LAMS, 34%). Technical success was achieved in 97% of cases (95% CI, 93%-99%). Short-term and long-term clinical success was obtained in 94% (95% CI, 89%-97%) and 85% of patients (95% CI, 79%-89%), respectively. AEs occurred in 21% of cases (95% CI, 16%-27%): infection (11%), bleeding (7%), stent migration and/or perforation (3%). By multivariate analysis, patient age (>58 years old) and prior failed drainage were the most important factors associated with negative outcome.

CONCLUSIONS:

(1) FCSEMSs are effective and safe for PFC drainage. (2) Older patients with a history of unsuccessful drainage are more likely to fail EUS-guided drainage. (3) The type of FCSEMS does not appear to influence patient outcome.

 
Question posée
 
Quelle est l’efficacité et la sécurité du drainage des collections pancréatiques par prothèse métallique ?
 
Question posée
 
Etude rétrospective issue d’un registre national espagnol sur tous les cas de drainage d’une collection pancréatique par prothèse métallique d’avril 2008 à août 2013. Deux cents onze patients inclus ; succès technique : 97% ; succès clinique à 2 semaines : 94% ; succès clinique à 6 mois 85% Effets indésirables dans 21% des cas dont 11% d’infection, 7% d’hémorragie, 3% de migration du stent et /ou perforation.
 
Commentaires

Le drainage des collections péri-pancréatiques par prothèses métallique est efficace.

Les résultats de cette étude sont identiques selon que la collection soit liquidienne ou nécrotique.

 
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