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Sa1408 Are Metal Stents Better Than Plastic Stents for Malignant Distal Common Bile Duct Stricture? a Meta-Analysis and Systematic Review.
Abstracts is different from 1) ! 0.0001. Pooled data are shown in table 1. The pooled effects estimated by fixed and random effect models were similar. The p for chi-squared heterogeneity for all the pooled accuracy estimates was O 0.10. Conclusions: Metallic stents seem to have lower odds of occlusion when compared to plastic stents. Metallic stents had marginally lower re-intervention rate and are patent twice as long as plastic stents in patients with malignant distal CBD strictures. Table 1 Proportion
Metallic stent group
Stent patency (in days)
167.7 (95% CI Z 159.2 73.3 (95% CI Z 69.8 to 176.3) to 76.9) 1.1 (95% CI Z 0.9 1.7 (95% CI Z 1.5 to 1.3) to 1.9) 0.48 (95% CI Z 0.34 to 0.67) with p ! 0.0001
Re-intervention rate Stent occlusion - Odds ratio
Plastic stent group
Sa1409 No Bite Block Required: One Institution’s Experience With Percutaneous Endoscopic Treatment of Walled Off Abdominal Abscess and Necrosis Bradley Mathers*, Matthew T. Moyer, Abraham Mathew, Charles E. Dye, Niraj J. Gusani, Brandy Dougherty-Hamod, Thomas J. Mcgarrity Penn State Hershey Medical Center, Hershey, PA
Figure 1. Kaplan-Meier Survival Curves for a) Overall Survival - pancreatic cancer vs non-pancreatic cancer (13.7 vs 17.1 months; P Z .004), b) Poststent survival - pancreatic cancer vs non-pancreatic cancer (2.7 vs 2.4 months; P Z .6), c) Post-stent survival in pancreatic cancer - chemotherapy vs no chemotherapy after stent placement (5.4 vs 1.5 months; P ! .0001), d) Post-stent survival in non-pancreatic cancer - chemotherapy vs no chemotherapy after stent placement (9.2 vs 1.8 months; P Z .0014), e) Post-stent survival in pancreatic cancer - metastasis vs no metastasis (1.8 vs 4.6 months; P Z .005); f) Post-stent survival in non-pancreatic cancer metastasis vs no metastasis (2.1 vs 6.1 months; P Z .009)
Sa1408 Are Metal Stents Better Than Plastic Stents for Malignant Distal Common Bile Duct Stricture? a Meta-Analysis and Systematic Review. Harsha Moole*1, Srinivas R. Puli2 1 Department of Internal Medicine, University of Illinois College of Medicine Peoria, Peoria, IL; 2Department of Gastroenterology and Hepatology, University of Illinois College of Medicine Peoria, Peoria, IL Background: Metallic stents and plastic stents are used for palliating inoperable malignant distal common bile duct (CBD) strictures. There have been recent retrospective studies and randomized controlled trials that evaluated the clinical efficacy of metal and plastic stents. This is a meta-analysis to pool the evidence for metallic versus plastic stents in managing malignant distal CBD strictures. Aim: Compare metallic to plastic stenting in malignant distal CBD strictures. Primary outcomes are stent patency, stent occlusion rates and re-intervention rates. Method: Study Selection Criteria: Studies using metallic and plastic stents for palliation in patients with malignant distal CBD stricture / obstruction. Data collection & extraction: Articles were searched in Medline, Pubmed, Ovid journals, CINAH, International pharmaceutical abstracts, old Medline, Medline nonindexed citations, and Cochrane Central Register of Controlled Trials & Database of Systematic Reviews. Two reviewers independently searched and extracted data. Any differences were resolved by mutual agreement. Statistical Method: Pooled proportions were calculated using both Mantel-Haenszel method (fixed effects model) and DerSimonian Laird method (random effects model). The heterogeneity among studies was tested using Cochran’s Q test based upon inverse variance weights. Results: Initial search identified 1376 reference articles, of which 112 were selected and reviewed. 11 studies (NZ947) for metallic and plastic stents which met the inclusion criteria were included in this analysis. Pooled analysis by fixed effects showed metallic stent patency to be 167.7 days (95% CI Z 159.2 to 176.3) compared to 73.3days (95% CI Z 69.8 to 76.9) in plastic stents. Number of re-interventions per patient in metallic stent group is 1.1 (95% CI Z 0.9 to 1.3) compared to 1.7 (95% CI Z 1.5 to 1.9) in plastic stent group. Metallic stents have lower odds of occlusion when compared to plastic stents with an odds ratio of 0.48 (95% CI Z 0.34 to 0.67), p (tests if odds ratio
AB202 GASTROINTESTINAL ENDOSCOPY Volume 81, No. 5S : 2015
Background: Percutaneous endoscopic necrosectomy (PEN) has been described as a minimally invasive intervention for the debridement of walled off pancreatic necrosis (WOPN) in case series from both India and China. In this case series, we aim to confirm these findings in a U.S. referral center and further evaluate the clinical value of PEN in the treatment of severe WOPN as well as other intraabdominal fluid collections. Methods: Twelve consecutive patients with WOPN or other abdominal abscess requiring debridement and washout underwent CT-guided drainage catheter placement. These patients subsequently underwent PEN and were evaluated retrospectively. Drains were upsized to 24-28 French diameters and each patient underwent PEN with repeat debridement performed until complete. Drains were then removed once output fell below 30 ml/day and imaging confirmed resolution. The primary endpoints were time to clinical resolution defined as the number of days between the first PEN and removal of all drains and sustained resolution at one year follow up. Results: n patients were treated for WOPN, one for necrotic hepatic abscesses, and one for omental necrosis. Six patients (50%) had significant manifestations of disease severity including sepsis and multiorgan failure. The median time to intervention was 85 days (range 21-248 days) with an average of 2.3 PENs performed. Complete removal of drains was accomplished in eleven patients (92%). The median time to resolution was 57 days (range Z 10-210 days). No serious adverse events occurred; however, three patients developed pancreaticocutaneous fistulas. Seven patients completed one-year surveillance of which none required drain replacement. No patients required surgery or repeat endoscopy. Conclusions: Percutaneous endoscopic necrosectomy is a safe and effective intervention for intraabdominal fluid collections and necrosis in appropriately selected patients. Our study demonstrates a high clinical success rate with minimal complications. This modality offers several advantages including use of conscious sedation, improved accessibility, and an excellent safety profile.
Patient demographics and procedure details Sex, Age M, 63 M, 46 F, 51 F, 34
F, 65 F, 73 F, 45 F, 26 F, 53 M, 41 F, 61 F, 54
Etiology of necrosis
Sepsis/ Multiorgan Failure
Size of necrosis (cm)
Time to intervention (days)
Number of PEN
Time to resolution (days)
Adverse events
1 year sustained resolution
Pancreatic
No
10.5 x 3.7
99
2
57
Fistula
Yes
Hepatic
Yes
21
4
74
None
Yes
Pancreatic
Yes
Pancreatic
Yes
Pancreatic
Yes
11.9 x 9.7 12.7 x 6.4 23.8 x 15.5 21.2 x 14.9 13.5 x 7.6 12.3 x 5.5 14.7 x 3.8
61
2
171
Fistula
Yes
68
5
123
None
n/a
87
4
n/a
None
n/a
Omental
No
9.8 x 3.5
86
1
31
None
Yes
Pancreatic
No
79
1
10
None
n/a
Pancreatic
No
14.1 x 12.9 6.4 x 2.5
248
1
19
None
Yes
Pancreatic
No
11.6 x 5.2
124
1
57
None
Yes
Pancreatic
Yes
7.0 x 3.2
53
1
59
None
n/a
Pancreatic
No
12.4 x 2.5
159
1
210
Fistula
Yes
Pancreatic
Yes
10.6 x 9.6
84
5
40
None
n/a
www.giejournal.org
Metallic stent group
Stent patency (in days)
167.7 (95% CI Z 159.2 73.3 (95% CI Z 69.8 to 176.3) to 76.9) 1.1 (95% CI Z 0.9 1.7 (95% CI Z 1.5 to 1.3) to 1.9) 0.48 (95% CI Z 0.34 to 0.67) with p ! 0.0001
Re-intervention rate Stent occlusion - Odds ratio
Plastic stent group
Sa1409 No Bite Block Required: One Institution’s Experience With Percutaneous Endoscopic Treatment of Walled Off Abdominal Abscess and Necrosis Bradley Mathers*, Matthew T. Moyer, Abraham Mathew, Charles E. Dye, Niraj J. Gusani, Brandy Dougherty-Hamod, Thomas J. Mcgarrity Penn State Hershey Medical Center, Hershey, PA
Figure 1. Kaplan-Meier Survival Curves for a) Overall Survival - pancreatic cancer vs non-pancreatic cancer (13.7 vs 17.1 months; P Z .004), b) Poststent survival - pancreatic cancer vs non-pancreatic cancer (2.7 vs 2.4 months; P Z .6), c) Post-stent survival in pancreatic cancer - chemotherapy vs no chemotherapy after stent placement (5.4 vs 1.5 months; P ! .0001), d) Post-stent survival in non-pancreatic cancer - chemotherapy vs no chemotherapy after stent placement (9.2 vs 1.8 months; P Z .0014), e) Post-stent survival in pancreatic cancer - metastasis vs no metastasis (1.8 vs 4.6 months; P Z .005); f) Post-stent survival in non-pancreatic cancer metastasis vs no metastasis (2.1 vs 6.1 months; P Z .009)
Sa1408 Are Metal Stents Better Than Plastic Stents for Malignant Distal Common Bile Duct Stricture? a Meta-Analysis and Systematic Review. Harsha Moole*1, Srinivas R. Puli2 1 Department of Internal Medicine, University of Illinois College of Medicine Peoria, Peoria, IL; 2Department of Gastroenterology and Hepatology, University of Illinois College of Medicine Peoria, Peoria, IL Background: Metallic stents and plastic stents are used for palliating inoperable malignant distal common bile duct (CBD) strictures. There have been recent retrospective studies and randomized controlled trials that evaluated the clinical efficacy of metal and plastic stents. This is a meta-analysis to pool the evidence for metallic versus plastic stents in managing malignant distal CBD strictures. Aim: Compare metallic to plastic stenting in malignant distal CBD strictures. Primary outcomes are stent patency, stent occlusion rates and re-intervention rates. Method: Study Selection Criteria: Studies using metallic and plastic stents for palliation in patients with malignant distal CBD stricture / obstruction. Data collection & extraction: Articles were searched in Medline, Pubmed, Ovid journals, CINAH, International pharmaceutical abstracts, old Medline, Medline nonindexed citations, and Cochrane Central Register of Controlled Trials & Database of Systematic Reviews. Two reviewers independently searched and extracted data. Any differences were resolved by mutual agreement. Statistical Method: Pooled proportions were calculated using both Mantel-Haenszel method (fixed effects model) and DerSimonian Laird method (random effects model). The heterogeneity among studies was tested using Cochran’s Q test based upon inverse variance weights. Results: Initial search identified 1376 reference articles, of which 112 were selected and reviewed. 11 studies (NZ947) for metallic and plastic stents which met the inclusion criteria were included in this analysis. Pooled analysis by fixed effects showed metallic stent patency to be 167.7 days (95% CI Z 159.2 to 176.3) compared to 73.3days (95% CI Z 69.8 to 76.9) in plastic stents. Number of re-interventions per patient in metallic stent group is 1.1 (95% CI Z 0.9 to 1.3) compared to 1.7 (95% CI Z 1.5 to 1.9) in plastic stent group. Metallic stents have lower odds of occlusion when compared to plastic stents with an odds ratio of 0.48 (95% CI Z 0.34 to 0.67), p (tests if odds ratio
AB202 GASTROINTESTINAL ENDOSCOPY Volume 81, No. 5S : 2015
Background: Percutaneous endoscopic necrosectomy (PEN) has been described as a minimally invasive intervention for the debridement of walled off pancreatic necrosis (WOPN) in case series from both India and China. In this case series, we aim to confirm these findings in a U.S. referral center and further evaluate the clinical value of PEN in the treatment of severe WOPN as well as other intraabdominal fluid collections. Methods: Twelve consecutive patients with WOPN or other abdominal abscess requiring debridement and washout underwent CT-guided drainage catheter placement. These patients subsequently underwent PEN and were evaluated retrospectively. Drains were upsized to 24-28 French diameters and each patient underwent PEN with repeat debridement performed until complete. Drains were then removed once output fell below 30 ml/day and imaging confirmed resolution. The primary endpoints were time to clinical resolution defined as the number of days between the first PEN and removal of all drains and sustained resolution at one year follow up. Results: n patients were treated for WOPN, one for necrotic hepatic abscesses, and one for omental necrosis. Six patients (50%) had significant manifestations of disease severity including sepsis and multiorgan failure. The median time to intervention was 85 days (range 21-248 days) with an average of 2.3 PENs performed. Complete removal of drains was accomplished in eleven patients (92%). The median time to resolution was 57 days (range Z 10-210 days). No serious adverse events occurred; however, three patients developed pancreaticocutaneous fistulas. Seven patients completed one-year surveillance of which none required drain replacement. No patients required surgery or repeat endoscopy. Conclusions: Percutaneous endoscopic necrosectomy is a safe and effective intervention for intraabdominal fluid collections and necrosis in appropriately selected patients. Our study demonstrates a high clinical success rate with minimal complications. This modality offers several advantages including use of conscious sedation, improved accessibility, and an excellent safety profile.
Patient demographics and procedure details Sex, Age M, 63 M, 46 F, 51 F, 34
F, 65 F, 73 F, 45 F, 26 F, 53 M, 41 F, 61 F, 54
Etiology of necrosis
Sepsis/ Multiorgan Failure
Size of necrosis (cm)
Time to intervention (days)
Number of PEN
Time to resolution (days)
Adverse events
1 year sustained resolution
Pancreatic
No
10.5 x 3.7
99
2
57
Fistula
Yes
Hepatic
Yes
21
4
74
None
Yes
Pancreatic
Yes
Pancreatic
Yes
Pancreatic
Yes
11.9 x 9.7 12.7 x 6.4 23.8 x 15.5 21.2 x 14.9 13.5 x 7.6 12.3 x 5.5 14.7 x 3.8
61
2
171
Fistula
Yes
68
5
123
None
n/a
87
4
n/a
None
n/a
Omental
No
9.8 x 3.5
86
1
31
None
Yes
Pancreatic
No
79
1
10
None
n/a
Pancreatic
No
14.1 x 12.9 6.4 x 2.5
248
1
19
None
Yes
Pancreatic
No
11.6 x 5.2
124
1
57
None
Yes
Pancreatic
Yes
7.0 x 3.2
53
1
59
None
n/a
Pancreatic
No
12.4 x 2.5
159
1
210
Fistula
Yes
Pancreatic
Yes
10.6 x 9.6
84
5
40
None
n/a
www.giejournal.org