Comparison of FCSEMS and Plastic Stents
Comparison of FCSEMS and Plastic Stents
The research design is a randomized prospective clinical trial comparing Endoscopic
 ultrasound (EUS) guided drainage of WON using FCSEMS and plastic stents. The trial will be
 conducted at the Florida Hospital Center for Interventional Endoscopy, Orlando, Florida.
The research design is a randomized prospective clinical trial comparing EUS-guided drainage
 of WON using FCSEMS and plastic stents. The trial will be conducted at the Florida Hospital
 Center for Interventional Endoscopy, Orlando, Florida.The sample size estimated for this
 study is 60 patients. All patients will undergo EUS-guided drainage of WON and be randomized
 to either FCSEM or plastic stents in a 1:1 ratio using a computer-generated randomized
 sequence. It will not be possible to blind the endoscopist to the stent type being inserted
 due to the differences in stent appearance. The statistician will be blinded to the stent
 type utilized.
Inclusion Criteria:

 1. The subject (or when applicable the subject's LAR) is capable of understanding and
 complying with protocol requirements.

 2. The subject (or when applicable the subject's LAR) is able to understand and willing
 to sign an informed consent form prior to the initiation of any study procedures.

 3. Males or females ≥ 18 years of age.

 4. WON diagnosed on contrast-enhanced dual phase CT abdomen/pelvis (CECT) or MRI with
 gadolinium (seen as a fluid collection in the setting of documented pancreatic
 necrosis that contains necrotic material and encased within a well-defined tissue
 layer).

 5. WON of any size with any quantity of solid/necrotic component and any no. of
 loculations, located within the pancreatic/peri-pancreatic space not requiring
 percutaneous drainage, within 2cm of the enteric wall

 6. Suspected/confirmed infected WON (defined as temp ≥ 100.5°F, serum White Blood Cells ≥
 15x109/L, positive blood cultures or positive Gram stain/culture of aspirated necrotic
 material), and/or symptomatic WON (defined as abdominal pain,
 gastric/intestinal/biliary outlet obstruction resulting in nausea, vomiting, early
 satiety, jaundice, or persistent malaise) ≥ 4 weeks from attack of acute pancreatitis.

 7. Documented history of acute or chronic pancreatitis:

 i. Acute pancreatitis is diagnosed if 2 of the following 3 criteria are met:

 1. Abdominal pain characteristic of acute pancreatitis

 2. Serum lipase/amylase ≥ x3 upper limit of normal

 3. Characteristic radiological findings of acute pancreatitis on CECT/MRI/US
 abdomen, such as homogeneous enhancement of pancreatic parenchyma, standing of
 peripancreatic fat ii. Chronic pancreatitis is diagnosed if characteristic
 radiological changes are seen on CT/MRI with Magnetic resonance
 cholangiopancreatography (MRCP) (such as pancreatic atrophy, dilated pancreatic
 duct, pancreatic calcification) or EUS (≥5/9 of Rosement criteria)

 8. Able to undergo general anesthesia

 Exclusion Criteria:

 1. Females who are pregnant or lactating. Pregnancy for females of childbearing potential
 will be determined by routine preoperative urine or serum Human Chorionic Gonadotropin
 testing.

 2. Irreversible coagulopathy (INR >1.5, thrombocytopenia with platelet count <50,000/mL)

 3. Has surgically altered gastrointestinal anatomy such as but not limited to Billroth
 II, Roux-en-Y, gastric bypass

 4. Age < 18 years

 5. Unable to obtain consent for the procedure from either the patient or LAR

 6. Use of anticoagulants that cannot be discontinued for the procedure

 7. Unable to tolerate general anesthesia

 8. WON that is not accessible for EUS-guided drainage

 9. Percutaneous drainage of WON is required or performed prior to EUS-guided drainage