Endoscopic ultrasound-guided pancreatic fluid collection drainage: Where are we?

Table 1 Indications of drainage of pancreatic fluid collections[3]

Indication	Description
Clinical suspicion or documented infected pancreatic collection
Persistent or new onset organ failure
Pressure symptoms	Gastric outlet obstruction; intestinal obstruction; biliary obstruction; persistent symptoms (e.g., pain, “persistent unwellness”); and disconnected pancreatic duct (i.e. full transection of the pancreatic duct) with ongoing symptoms
Other relative indications	Persistently increasing size on follow-up; and poor appetite secondary to collection

Table 2 Technical specifications of the available metal stents used for endoscopic drainage

Stent	Company	Lumen diameter, mm	Length of stent, cm	Deployment sheath diameter, Fr
Hot Axios	Boston Scientific, MA, United States	6/8/10/15/20	1-3	9.0/10.8
Niti-S Hot Spaxus	Taewoong Medical, South Korea	8/10/16	2	10.0
Niti-S Hot Nagi	Taewoong Medical, South Korea	10/12/14/16	1-3	10.0
Niti-S Nagi	Taewoong Medical, South Korea	10/12/14/16	1-3	10.0

Table 3 Advantages and disadvantages of metal and plastic stents for drainage of pancreatic fluid collections

Circumstance	LAMS/biflanged metal stent	Plastic stent
Advantage	One-step procedure	Low cost
	Short procedure time	No need for removal
	No need for fluoroscopy guidance	Prevents the recurrence of pseudocyst in pancreatic leak when left indefinitely
	Rapid access into the cavity with easy treatment of complications
Disadvantage	Higher cost	Multi-step procedure
	Needs removal (in all) and replacement with plastic stent (in selective cases)	Longer procedure time
		Need for fluoroscopy guidance
		High migration rate

LAMS: Lumen-apposing metal stent.

Table 4 Outcomes of endoscopic drainage of pancreatic collection with various types of stents

Ref.	Collection	n	Clinical success	Adverse events	Conclusion
Lee et al[21], 2014	WON and Pseudocyst	PS = 25, FCMS = 25	PS: 90.0%, FCMS: 87.0%	PS: 8.0%, FCMS: 0%	Efficacy, AE, and reintervention rates were equal
Mukai et al[39], 2015	WON	PS = 27, BFMS = 43	PS: 90.6%, FCMS: 97.7%	PS: 18.5%, FCMS: 7.0%	Efficacy and AE were equal; reintervention rates more with PS
Siddiqui et al[14], 2017	WON	PS = 106 FCMS = 121, LAMS = 86	PS: 81.0%, FCMS: 95.0%, LAMS: 90.0%	PS: 7.5%, FCMS: 1.6%, LAMS: 9.3%	Efficacy was higher with FCMS and LAMS than with PS
Bapaye et al[15], 2017	WON	PS = 61, BFMS = 72	PS: 73.7%, BFMS: 94.0%	PS: 36.1%, BFMS: 5.6%	Efficacy was higher with BFMS than with PS; AE and reintervention rates were lower with BFMS
Bang et al[22], 2019	WON	PS = 29, LAMS = 31	PS: 96.6%, LAMS: 93.5%	PS: 6.9%, LAMS: 32.3%	Procedure duration was shorter with LAMS; stent-related AEs and procedure costs were higher with LAMS
Shin et al[19], 2019	WON and pseudocyst	PS: 17, LAMS: 10	PS: 88.2%, LAMS: 100.0%	PS: 25.0%, LAMS: 20.0%	Clinical success, technical success, and AE were similar; procedure time was higher with PS
Ge et al[18], 2020	WON	PS: 78, LAMS: 34	PS: 92.1%, LAMS: 94.1%	PS: 7.7%, LAMS: 41.2%	LAMS had higher AEs than PS
Muktesh et al[17], 2022	WON	PS = 45, BFMS = 53	PS: 81.8%, BFMS: 96.2%	PS: 8.8%, BFMS: 5.6%	Efficacy higher with BFMS; AE and reintervention rates were lower with BFMS
Boxhoorn et al[20], 2023	WON	PS: 51, LAMS: 53	-	-	Need for endoscopic necrosectomy, AEs, and mortality were similar between the plastic and metal stent
Kakadiya et al[23], 2023	WON	PS = 24, BFMS = 24	PS: 83.3%, BFMS: 87.5%	PS: 28.7%, BFMS: 4.1%	Clinical and technical success were similar; procedure time and AE were higher with PS

AE: Adverse event; BFMS: Biflanged metal stents; FCMS: Fully-covered metal stent; LAMS: Lumen-apposing metal stent; PS: Plastic stent; WON: Walled-off necrosis.