Lumen Apposing Metal Stents vs Double Pigtail Stents
Pancreatitis,Acute Necrotizing
About this trial
This is an interventional treatment trial for Pancreatitis,Acute Necrotizing focused on measuring Walled of necrosis, Endoscopic drainage, Lumen apposing metal stents
Eligibility Criteria
Inclusion Criteria:
Inclusion criteria (all criteria must be fulfilled):
Patients with acute, necrotizing pancreatitis and
- WON exceeding a diameter of 15 cm (measured on contrast-enhanced CT (CECT); see details on imaging tests below). WON is defined based on the revised Atlanta criteria as a mature, encapsulated pancreatic or peripancreatic necrosis with a well-defined inflammatory wall[12].
- Imaging test(s) must be done within 1 week before the index drainage procedure.
- Debut of pancreatitis must be within 3 months before the index drainage procedure.
- One or more indication(s) for endoscopic, transmural drainage must be established:
1. Confirmed or suspected infection.1 2. Severe intraabdominal hypertension or abdominal compartment syndrome. 3. Persisting abdominal pain, early satiety, or general discomfort. 4. Obstruction of the GI or biliary tract. 5. Leakage of pancreatic juice, e.g. ascites or pleural effusion.
3. Preoperatively, the WON must be considered eligible for endoscopic, transgastric drainage with both conventional double pigtail and LAMS technique. Distance between the gastric wall and WON must not exceed one cm and there must be no major interposed vessels.
Infection in WON:
- Confirmed infected necrosis is defined as a) positive culture from WON obtained by fine- needle aspiration prior to or at the first drainage procedure or b) presence of gas in WON on CECT prior to drainage with no earlier puncture/drainage and no signs of perforation to the GI tract.
- Infected necrosis is suspected when a patient with WON present with clinical signs of persistent sepsis without other causes of infection.
Exclusion Criteria:
- Patients under the age of 18.
- Pregnancy.
- Known or suspected malignant disease.
- Pancreatitis secondary to trauma or surgical intervention.
- Chronic pancreatitis.
- Collections that may only be drained from the duodenum.
- Previous surgical or endoscopic drainage or necrosectomy.
Sites / Locations
- Copenhagen University Hospital Hvidovre
Arms of the Study
Arm 1
Arm 2
Active Comparator
Experimental
Double pigtail
Lumen apposing metal stent
Plastic stent group EUS-guided drainage shall be performed as follows: a) Puncture of WON with a 19 GA Access needle (Cook Medical), b) aspiration of fluid in WON for microbiological assessment, c) insertion of guidewire (0.035 inch, 450 cm, Dreamwire (Boston Scientific), d) creation of transmural tract with needle knife over the guidewire, e) dilatation of tract to a diameter of 15 mm with dilation balloon (EZDilate, Olympus), f) insertion of two 7-Fr/6 cm double pigtail stents and a 7-Fr naso-cystic irrigation catheter.
LAMS shall be the Hot AXIOS stent with electrocautery-enhanced delivery system (Boston Scientific). The stent is a through-the-scope, fully covered, self-expandable metal stents with a diameter of 20 mm and a length of 10 mm. Before placement of the LAMS, the WON shall be punctured with a 19 GA Access needle (Cook Medical) and fluid in WON aspirated for microbiological assessment. Thereafter the LAMS shall be placed as follows: After directly puncturing the WON using the electrocautery tip (without the use of a guidewire to assist in stent insertion), the delivery catheter is advanced into the WON and the distal flange is deployed under EUS-guidance. The proximal flange is then released under EUS guidance or endoscopic view. After placement of the LAMS, a 7-Fr/4cm double pigtail and a 7-Fr nasocystic irrigation catheter shall be placed through the LAMS.