PMID- 29882517
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220408
IS  - 2303-9027 (Print)
IS  - 2226-7190 (Electronic)
IS  - 2226-7190 (Linking)
VI  - 8
IP  - 3
DP  - 2019 May-Jun
TI  - Direct endoscopic necrosectomy at the time of transmural stent placement results 
      in earlier resolution of complex walled-off pancreatic necrosis: Results from a 
      large multicenter United States trial.
PG  - 172-179
LID - 10.4103/eus.eus_108_17 [doi]
AB  - BACKGROUND AND OBJECTIVES: EUS-guided drainage, and direct endoscopic 
      necrosectomy (DEN) of walled-off necrosis (WON) using a lumen-apposing metal 
      stent (LAMS) is safe and effective. Early debridement of WON may improve overall 
      clinical outcomes. The aim of this study is to perform a multicenter 
      retrospective study to compare the clinical outcomes and predictors of success 
      for endoscopic drainage of WON with LAMS followed by immediate or delayed DEN 
      performed at standard intervals. METHODS: Patients with WON managed by EUS-guided 
      drainage with LAMS were divided into 2 groups: (1) those that underwent immediate 
      DEN at the time of stent placement and (2) those that underwent delayed DEN 1 
      week after stent placement. DEN was subsequently performed every 1-2 week (s). 
      Technical success (successful placement of LAMS), adverse events (AEs), and 
      clinical success (complete resolution of the WON) were evaluated. RESULTS: 
      Totally, 271 patients underwent WON drainage with LAMS: 69 who underwent 
      immediate DEN and 202 who underwent delayed DEN. The technical success for LAMS 
      placement was 100% in both groups. There was no significant difference in the 
      overall procedural AEs between the immediate and delayed DEN groups (P = 7.2% vs. 
      9.4%; P = 0.81). Stent dislodgement during index endoscopy occurred in three 
      patients in the immediate DEN group compared to zero in the delayed DEN group (P 
      = 0.016); all three dislodgements occurred during necrosectomy. Clinical success 
      for WON resolution in the immediate DEN group was 91.3% compared to 86.1% in the 
      delayed DEN group (P = 0.3). The mean number of necrosectomy sessions for WON 
      resolution was significantly lower in the immediate DEN group compared to the 
      delayed DEN group (3.1 vs. 3.9, P < 0.001). Performing DEN at the time of stent 
      placement was an independent predictor for resolution of WON with lesser number 
      of DEN sessions (odds ratio 2.3; P = 0.004). CONCLUSIONS: DEN at the time of 
      initial stent placement reduces the number of necrosectomy sessions required for 
      successful clinical resolution of WON.
FAU - Yan, Linda
AU  - Yan L
AD  - Division of Gastroenterlogy, Department of Internal Medicine, Thomas Jefferson 
      University, Philadelphia, PA, USA.
FAU - Dargan, Andrew
AU  - Dargan A
AD  - Division of Gastroenterlogy, Department of Internal Medicine, Thomas Jefferson 
      University, Philadelphia, PA, USA.
FAU - Nieto, Jose
AU  - Nieto J
AD  - Division of Gastroenterlogy, Borland Groover Clinic, Jacksonville, FL, USA.
FAU - Shariaha, Reem Z
AU  - Shariaha RZ
AD  - Division of Gastroenterlogy, Department of Internal Medicine, Weill Cornell 
      Medical Center, New York City, NY, USA.
FAU - Binmoeller, Kenneth F
AU  - Binmoeller KF
AD  - Division of Gastroenterlogy, Department of Internal Medicine, California Pacific 
      Medical Center, San Francisco, CA, USA.
FAU - Adler, Douglas G
AU  - Adler DG
AD  - Division of Gastroenterlogy, Department of Internal Medicine, University of Utah, 
      Salt Lake City, UT, USA.
FAU - DeSimone, Michael
AU  - DeSimone M
AD  - Division of Gastroenterlogy, Department of Internal Medicine, Beth Israel 
      Deaconess Medical Center, Boston, MA, USA.
FAU - Berzin, Tyler
AU  - Berzin T
AD  - Division of Gastroenterlogy, Department of Internal Medicine, Beth Israel 
      Deaconess Medical Center, Boston, MA, USA.
FAU - Swahney, Mandeep
AU  - Swahney M
AD  - Division of Gastroenterlogy, Department of Internal Medicine, Beth Israel 
      Deaconess Medical Center, Boston, MA, USA.
FAU - Draganov, Peter V
AU  - Draganov PV
AD  - Division of Gastroenterlogy, Department of Internal Medicine, University of 
      Florida, Gainesville, FL, USA.
FAU - Yang, Dennis J
AU  - Yang DJ
AD  - Division of Gastroenterlogy, Department of Internal Medicine, University of 
      Florida, Gainesville, FL, USA.
FAU - Diehl, David L
AU  - Diehl DL
AD  - Division of Gastroenterlogy, Department of Internal Medicine, Geisinger Health 
      System, Danville, PA, USA.
FAU - Wang, Lillian
AU  - Wang L
AD  - Division of Gastroenterlogy, Department of Internal Medicine, Geisinger Health 
      System, Danville, PA, USA.
FAU - Ghulab, Asma
AU  - Ghulab A
AD  - Division of Gastroenterlogy, Department of Internal Medicine, Thomas Jefferson 
      University, Philadelphia, PA, USA.
FAU - Butt, Nausharwan
AU  - Butt N
AD  - Division of Gastroenterlogy, Department of Internal Medicine, Thomas Jefferson 
      University, Philadelphia, PA, USA.
FAU - Siddiqui, Ali A
AU  - Siddiqui AA
AD  - Division of Gastroenterlogy, Department of Internal Medicine, Thomas Jefferson 
      University, Philadelphia, PA, USA.
LA  - eng
PT  - Journal Article
PL  - China
TA  - Endosc Ultrasound
JT  - Endoscopic ultrasound
JID - 101622292
PMC - PMC6590004
OTO - NOTNLM
OT  - Direct endoscopic necrosectomy
OT  - EUS
OT  - pancreatic walled-off necrosis
COIS- None
EDAT- 2018/06/09 06:00
MHDA- 2018/06/09 06:01
PMCR- 2019/05/01
CRDT- 2018/06/09 06:00
PHST- 2018/06/09 06:00 [pubmed]
PHST- 2018/06/09 06:01 [medline]
PHST- 2018/06/09 06:00 [entrez]
PHST- 2019/05/01 00:00 [pmc-release]
AID - 233853 [pii]
AID - EUS-8-172 [pii]
AID - 10.4103/eus.eus_108_17 [doi]
PST - ppublish
SO  - Endosc Ultrasound. 2019 May-Jun;8(3):172-179. doi: 10.4103/eus.eus_108_17.