Algorithm for the multidisciplinary management of hemorrhage in EUS-guided drainage for pancreatic fluid collections

Table 3 Details of hemorrhage associated with endoscopic ultrasound-guided drainage of pancreatic fluid collections

Study	Year	Country	Design	Center	Stent style	No.	PFC style	Location of drainage	Age	Male	Bleeding rate	Cause and treatment of bleeding	Diagnosis of bleeding
Lang et al[38]	2018	United States	RS	Single	LAMS	19	PPC/WON	TG	51.6	NR	19%	1 Splenic artery pseudoaneurysms-left gastric and splenic artery embolization after cyst-gastrostomy; 2 Collateral vessel bleed-conservative transfused blood; 3 Intracavitary variceal bleed-endoscopically using balloon tamponade	NR
					DDPS	84	PP C/WON	TG/TD	51.6	NR	1%	Stent erosion into the gastric wall-EGD was performed, and a visible vessel was treated with cautery for durable hemostasis	NR
Siddiqui et al[46]	2017	United States	RS	Multi	LAMS	86	WON	TG/TD/Multiport	51.5	89%	7%	Related to stent erosion into a vessel as the WON cavity wall collapses or related to pseudoaneurysm in the cavity wall-significant hemorrhage treated by coil embolization by interventional radiology	NR
					DDPS	106	WON	TG/TD/Multiport	56.3	64%	2%	Due to inadvertent puncture of an artery; another was not reported-Successfully treated with coil embolization by interventional radiology	NR
					FCSEMS	121	WON	TG/TD/Multiport	51.9	79%	0%	None	None
Bapaye et al[13]	2017	India	RS	Single	BFMS	72	WON	Mostly TG	43.8	86%	3%	Because of erosion of the splenic artery by the indwelling inner end of the stent-treated by blood transfusion; splenic artery arteriography embolization	Angiograms
					MPS	61	WON	Mostly TG	40.6	88%	8%	Because of tract dilatation-Blood transfusion; endoscopic clip application; surgery	Angiograms
Bang et al[50]	2017	United States	RCT	Single	LAMS	12	WON	NR	NR	NR	25%	With the resultant friction against regional vasculature surrounding the necrotic cavity precipitating bleeding-Blood transfusions interventional radiology-guided coil embolization	EUS and CT angiograms
					DDPS	9	WON	NR	NR	NR	0%	None	None
Lakhtakia et al[54]	2016	India	RS	Single	FCSEMS	205	WON	NR	34.8	88%	3%	No details of the cause of bleeding-Minor bleeding was self-limiting; major bleeding treated by selective coil embolization; another major bleeding treated by surgery	Abdominal angiography
Siddiqui et al[31]	2016	United States	RS	Multi	LAMS	82	PPC/WON	TG/TD	53.1	67%	7%	No details of the cause of bleeding-Self-limited bleeding	NR
Ang et al[20]	2016	Singapore	RS	Multi	FCSEMS	12	PPC/WON	NR	50	58%	0%	None	None
					DPPS	37	PPC/WON	NR	56	49%	5%	No details of the cause of bleeding-Treated by blood transfusion	NR
Vazquez-Sequeiros et al[39]	2016	Spanish	RS	Multi	FCSEMS	211	PPC/WON	TG/TD	58.1	69%	7%	Portal hypertension due to splenic vein thrombosis and antithrombotic drug therapy in the presence of stent-induced ulceration may have been responsible-Interventional radiology embolization; surgical intervention; repeated endoscopic treatments (sclerotherapy); percutaneous radiology-guided drainage	NR
Sharaiha et al[7]	2016	United States	RS	Multi	LAMS	124	WON	NR	54.2	61%	2%	No details of the cause of bleeding-Embolization by interventional radiology	NR
Sharaiha et al[47]	2015	United States	RS	Multi	ECSEMS	112	PPC	TG/TD	53.2	55%	4%	Significant bleeding due to inadvertent puncture of an artery-Successfully treated with coil embolization by interventional radiology	NR
					DDPS	118	PPC	TG/TD	52.2	69%	NR	NR	NR
Gornals et al[11]	2015	Spain	RS	Single	LAMS	12	WON	TG/TD	52.6	75%	17%	All fluid is evacuated and the cavity lumen is collapsed, or due to a vessel injury from the inner stent end-Arteriography plus endoscopic treatment	Abdominal angiography
Rinninella et al[44]	2015	Italy	RS	Multi	FCSEMS	93	PFC	TG/TD	60	76%	1%	Massive bleeding related to the concomitant use of a NCDC-Surgery	NR
Mukai et al[14]	2015	Japan	RS	Single	FC BFMS	43	WON	NR	54.4	86%	5%	The specific reason for bleeding is unclear-No details regarding the treatment of the bleeding events	NR
					Plastic	27	WON	NR	55.9	78%	0%	None	None
Lee et al[55]	2014	South Korea	PS	Single	FCSEMS	25	PFC	TG/TD	53.7	88%	0%	None	None
					DDPS	25	PFC	TG/TD	51.6	76%	4%	NR	NR
Yamamoto et al[56]	2013	Japan	RS	Single	FCSEMS	9	PPC/WON	TG	45	67%	11%	The bleeding was caused by vessel damage because of inflammation-Trans-arterial embolization	Angiography
Bang et al[63]	2013	United States	RS	Multi	MTGT	53	WON	TG/TD	53	69%	2%	No details of the cause of bleeding-Coil embolization under radiological guidance	NR
Puri et al[48]	2012	India	PS	Single	DPPS	40	PPC	TG/TD	39	78%	3%	Pseudoaneurysm of the blood vessel in the cystic wall ruptured-Surgery	NR
Itoi et al[12]	2012	Japan	RS	Single	LAMS	15	PPC	TG/TD	55.4	80%	20%	No details of the cause of bleeding-Minor, self-limited	None
Varadarajulu et al[27]	2011	United States	RS	Single	DDPS	211	PPC/WON	TG/TD/TE/TJ	52	61%	1%	No details of the cause of bleeding-Required embolization with interventional radiology; conservatively	NR
Varadarajulu et al[64]	2011	United States	PS	Single	DDPS	110	PPC/WON	TG/TD	NR	NR	1%	Coagulant disorder (with underlying acquired factor VIII inhibitors) -Conservative treatment	Arteriography
Talreja et al[53]	2008	United States	PS	Single	FCSEMS	18	PFC	TG/TD	51	67%	13%	Bleeding from the pseudocyst wall-Treated with balloon tamponade and arterial embolization	NR

PPC: Pancreatic pseudocyst; WON: Walled-off necrosis; PFC: Pancreatic fluid collections; PS: Prospective study; RS: Retrospective study; RCT: Randomized controlled trial; Single: Single-center; Multi: Multi-center; FCSEMS: Fully covered self-expandable metal stent; LAMS: Lumen-apposing metal stents; DDPS: Double-pigtail plastic stents; BFMS: Fully covered bi-flanged metal stents; MPS: Multiple plastic stents; MTGT: Multiple transluminal gateway technique; TG: Trans-gastric route; TD: Trans-duodenal route; TE: Trans-esophageal route; TJ: Trans-jejunal route; CT: Computed tomography; EUS: Endoscopic ultrasound; NCDC: Nasocystic drainage catheter; NR: Not reported.