Lumen-apposing metal stents in management of pancreatic fluid collections: The nobody's land of removal timing

• Published in: Saudi journal of gastroenterology Vol. 25; no. 6; pp. 335 - 340
• Main Authors: De Angelis, Claudio, Venezia, Ludovica, Cortegoso Valdivia, Pablo, Rizza, Stefano, Bruno, Mauro, Pellicano, Rinaldo
• Format: Journal Article
• Language: English
• Published: India Wolters Kluwer India Pvt. Ltd 01.11.2019; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt. Ltd; Wolters Kluwer - Medknow; Wolters Kluwer Medknow Publications
• Subjects: Collections; Cysts; Endoscopy; eus; eus-guided drainage; Evaluation; Health aspects; lumen apposing metal stent; Medical errors; Necrosis; pancreatic fluid collection; pancreatic pseudocyst; Pancreatitis; Patients; removal timing; Review; Stents; Studies; walled-off necrosis; United States > US; EUS; removal timing; EUS-guided drainage; pancreatic pseudocyst; walled-off necrosis; lumen apposing metal stent; pancreatic fluid collection
• ISSN: 1319-3767; 1998-4049
• DOI: 10.4103/sjg.SJG_166_19

Pancreatic fluid collections (PFCs) develop as a result of damage to the major or peripheral pancreatic ducts, complication due to acute or chronic pancreatitis, trauma or iatrogenic causes. PFCs include pancreatic pseudocysts (PPs) and walled-off necrosis (WON). PFCs usually resolve spontaneously and are asymptomatic, but if they persist, increase in dimension or became symptomatics, therapeutic intervention is required. Available therapeutic interventions include surgical, percutaneous, and endoscopic drainage. The endoscopic approach is nowadays considered the first line-treatment of PFCs due to various advantages when compared with surgical or percutaneous drainage: decreased morbidity, length of hospital stay, and reduced costs. In the last few years, the endoscopic ultrasound (EUS)-guided transmural drainage, initially with plastic stents, gained popularity. More recently, fully covered self-expanding lumen-apposing metal stents (LAMS) have been demonstrated to be both, safe and effective with high clinical and technical success, reducing the risk of perforation, peritoneal leakage, migration and facilitating the drainage of necrotic contents. In the last few years, several studies evaluating the safety and efficacy of LAMS and their differences with plastic stents have been performed, but literature on the removal timing of this device and associated complications is still limited. The aim of this review is to analyze studies reporting information about the retrieval timing of LAMS and the related adverse events.