John Libbey Eurotext

Hépato-Gastro & Oncologie Digestive

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Contribution of lumen apposing metal stent to the management of pancreatic pseudocysts Volume 29, issue 3, March 2022

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Authors
1 Service d’hépato-gastroentérologie, Pôle hépato-digestif, Nouvel Hôpital Civil, Hôpitaux universitaires de Strasbourg, 1, place de l’hôpital, 67000 Strasbourg
2 Institut hospitalo-universitaire de Strasbourg
3 Institut de recherche sur les maladies virales et hépatiques, Inserm U1110, Faculté de médecine de Strasbourg, Université de Strasbourg
* Correspondance : P. Mayer

Acute pancreatitis is a frequent condition with a significantmorbidity andmortality (approximately20%are complicated forms). Peripancreatic collections are a very common complication. The 2012 Atlanta classification distinguishes between 4 types of peripancreatic collections. Acute peripancreatic fluid collections and pseudocysts develop after acute interstitial oedematous pancreatitis and acute necrotic collections.Walled-off necrosis develops after acute necrotizing pancreatitis. Although these collections are mostly asymptomatic, it is sometimes necessary to drain them when symptoms appear. Management by endoscopic ultrasound(EUS) is the gold standard. Int his reviewof the literature,we will focus only ont he pseudocysts’ drainage. With the rapid development of therapeutic EUS, new stents have been developed: lumen apposing metal stent (LAMS). Several studies focused on their use in peripancreatic collections drainage and particularly in pseudocysts. The technical and clinical successes are very high for this type of stent, above 90% for these two criteria. However,thecostof thesestents is significant. LAMS redefine the management of peripancreatic collections. However, it is necessary to manage this type of condition in a collegial manner, due to sometimes-serious complications at the time of insertion or afterwards. Their superiority seems undeniable in the management of walled-off necrosis, but as far as pseudocysts with fluid content are concerned, the debate remains open. New studies should be carried out to clarify the position of these stents and their complications, especially in the management of pseudocysts.