Lumen-Apposing Metal Stents: Which One and Why?

摘要

I ransluminal endoscopic therapies have evolved rapidly in recent years accompanied by the development of novel endoscopic ultrasound (EUS)-guided stenting devices. In 2012, the Atlanta criteria for acute pancreatitis and the management of pancreatic fluid collections (PFCs) updated terminology and management recommendations, including the importance of transluminal endoscopic approaches in the management of acute pancreatitis and its subsequent complications.1 Updates to these criteria coincided with the evolution of natural orifice transluminal endoscopic surgery, which was shown to reduce the proinflammatory response and improve composite clinical outcomes in the management of walled off pancreatic necrosis (WON) when compared with surgical necrosectomy. 2 3 4 Subsequent randomized studies have confirmed endoscopic drainage for pancreatic pseudocysts to reduce hospital length of stay and cost compared with surgical drainage without sacrificing efficacy. 5 Recognition of the potential for nonsurgical approaches to PFCs spurred the development of various stent options for transluminal endoscopic drainage beyond traditional double pigtail plastic stents or metal biliary and esophageal stents used previously. 6 7