Volume 87 - 2024 - Fasc.1 - Original articles
Comparative outcome of single versus two double-pigtail stents for endoscopic drainage of pancreatic fluid collections with minimal necrosis: a retrospective analysis
Background: Endoscopic ultrasound (EUS)-guided
cystogastrostomy is the treatment of choice for managing
symptomatic pancreatic fluid collections (PFC). However, studies
on the number of stents for optimal drainage of PFCs are limited.
Hence, the present study was conducted to compare the outcome
of single versus two double-pigtail stents for endoscopic drainage
of PFCs.
Methods: This is a single-center, retrospective analysis of
patients undergoing endoscopic drainage of PFCs with minimal
necrosis (pseudocyst or walled-off necrosis with <30% solid
content) at a tertiary center in South India from October 2020 to
October 2022. Post-procedure, patients were followed up for clinical
improvement, and stents were removed after documentation of cyst
size reduction on imaging.
Results: Sixty-three patients (82.5% males, median age: 34
years) fulfilling the selection criteria were included. For single stent
placement (n = 47), stents of size 8.5 Fr or 10 Fr were used, while
for placement of two stents (n = 16), 7 Fr stents were used. The
technical success rate was 100%. Intraprocedural and early postprocedural
adverse events (all mild to moderate) were comparable
between the groups (17.0% with single stent vs. 25.0% with two
stents, p = NS). Clinical success was achieved in 93.6% of patients,
with no difference between both groups. Three patients in the single
stent group required additional procedures. All patients underwent
successful stent removal after a median follow-up of 14 weeks.
Conclusion: A single pigtail stent of 8.5 Fr or 10 Fr size for EUSguided
cystogastrostomy provides efficacy and safety similar to
that of two stents.
Peroral endoscopic myotomy: a two-center retrospective study of practice and adverse events
Background and study aims: Peroral endoscopic myotomy
(POEM) is the preferred technique for the treatment of esophageal
motility disorders and is less invasive than surgery. This study was
performed to compare two university centers in the practice of
POEM, in terms of efficacy and adverse events, for the treatment
of esophageal motility disorder.
Patients and method: Retrospective comparative study of
patients undergoing a POEM between September 2020 and
December 2022 from the University Hospital of Liège (Belgium)
and Besançon (France). The clinical success was defined by an
Eckardt score ≤ 3 after the procedure.
Results: Fifty-five patients were included. In both centers,
87,3% of the patients had achalasia (mostly type II), and 12,7%
had another esophageal motility disorder. The use of antibiotic
prophylaxis was systematic in Liège center but not in Besançon
center (100% and 9.1% respectively). The mean value of the
post-operative Eckardt score was 1.55± 2.48 in both center with
93.2% of patients with a score ≤ 3 (92% in Besançon and 94.74%
in Liège). The rate of adverse event was generally low. There
were two minor adverse events more frequent in Liège, clinical
capnomediastinum and pain at day one, but they were managed
with conservative treatment. Only 7.3% of the total patients had
an infectious phenomenon that did not correlate with the use of
antibiotic prophylaxis.
Conclusion: The post-operative Eckardt score and the adverse
event rate were comparable between the university centers. This
study confirmed that POEM is a safe and effective technique. It
also showed that using an antibiotic prophylaxis does not influence
the development of infectious adverse events.
