Gertrud Jechart

A novel lumen-apposing metal stent for endoscopic ultrasound-guided drainage of pancreatic fluid collections: a prospective cohort study

BACKGROUND AND STUDY AIMS A novel large-diameter, lumen-apposing, self-expanding metal stent with bilateral flanges was recently developed for endoscopic ultrasound (EUS)-guided transmural drainage of symptomatic pancreatic fluid collections (PFCs). The aim of this study was to evaluate the efficacy and safety of this stent in a large cohort. PATIENTS AND METHODS Patients with a PFC undergoing EUS-guided drainage with this novel stent were prospectively enrolled in this multicenter cohort study. RESULTS There were 61 patients: 46 patients (75 %) with walled-off necrosis (WON) and 15 (25 %) with a pancreatic pseudocyst. Stent placement was technically successful in 60 patients (98 %, 95 %CI 95 % - 100 %). Clinical success, defined as resolution of clinical symptoms in combination with a decrease in the PFC size to ≤ 2 cm on imaging, was achieved in 93 % of patients with a pancreatic pseudocyst (95 %CI 77 % - 100 %) and in 81 % of patients with WON (95 %CI 69 % - 94 %). Treatment failure occurred in nine patients (16 %, 95 %CI 6 % - 26 %), including four patients who required surgical intervention. Stent removal was performed in 82 % of patients after a median of 32 days (range 2 - 178) and was rated as easy in all but one patient. In 10 patients, endoscopic stent removal was not performed because of stent migration (n = 3), stent dislodgement during necrosectomy (n = 3), stent removal during surgery (n = 2), or refusal by the patient (n = 2). In total, five major complications were reported (9 %, 95 %CI 2 % - 16 %), including PFC infection (n = 4) and perforation (n = 1). CONCLUSION EUS-guided drainage using this novel stent is feasible and the clinical results obtained are promising with a low major complication rate.

Indications and techniques for lower intestinal endoscopy

The search for inflammatory and neoplastic lesions are the main indications for colonoscopy. A high rate of detection of polyps has become a quality criterion that depends on skilled handling of the colonoscope, on expertise and concentration during the examination, on excellent bowel preparation, and on a high standard of technical equipment. The diagnostic benefits outweigh the risk of bleeding, perforation and infection in almost all situations. Contraindications are signs of perforated intestine or imminent perforation due to deep ulcerations, necroses, or fulminant colitis. The patients comorbidity must be considered to assess the physical stress of bowel preparation, colonoscopy and sedation. Informed consent is necessary and must be documented in all cases. It is advisable to explain planned therapeutic manoeuvres before the examination, since all non-invasive polyps must be removed completely. Total colonoscopy is possible in 95-99% of cases, but technical efforts are under way to solve the problem of looping and fixed colon angulations. Optimising optical imaging is another main focus of industrial development. The combination of narrow-band imaging, zoom magnification, and high-definition processor technology is currently the most promising tool for identifying small and flat lesions in the colon.