Endosonography-guided drainage of pancreatic fluid collections with a novel lumen-apposing stent
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The purpose of this study is to report our initial experience with a new fully covered metallic stent with a novel design (AXIOS) to prevent migration and fluid leakage, in the drainage of pancreatic fluid collections (PFC).
We included nine patients from four Spanish centers undergoing endoscopic ultrasound (EUS)-guided drainage of PFC with placement of an AXIOS stent. The lesions were accessed via transgastric (n = 7), transesophageal (n = 1), and transduodenal (n = 1) by using a novel access device (NAVIX) in six cases or a 19-G needle in three. Patients were individually followed prospectively for procedure indications, demographic data, previous imaging techniques, technical aspects, clinical outcomes, complications, and follow-up after endoscopic drainage.
The mean size of lesions was 105 ± 26.3 mm (range, 70–150). In six cases, cystoscopy was performed through the stent, including necrosectomy in two. Median procedure time was 25 ± 13 min. A median number of two sessions were performed. The technical success rate was 88.8 % (8/9) due to one failure of the delivery system. One patient developed a tension pneumothorax immediately after transesophageal drainage. No migrations were reported, and all stents were removed easily. All patients had a successful treatment outcome achieving complete cyst resolution. Mean time to stent retrieval was 33 ± 40 days. Mean follow-up was 50 ± 1.3 weeks (range, 45–55), and only one patient presented a recurrence 4 weeks after the stent removal. Furthermore, comparison with ten previous consecutively recruited PFC cases drained by EUS-guided using plastic pigtail stents was done. Technical and clinical successes were similar. However, two stent migrations, two recurrences, and two complications were found. The number of stents used (n = 15) and the median procedure time (42.8 ± 3.1 min) were significantly higher.
Drainage of PFC using dedicated devices as this novel metallic stent with special design seems to be an effective, feasible and safe alternative technique.
KeywordsPseudocyst Transmural drainage Endosonography Pancreatobiliary Endoscopy Therapeutics
Participants listed bellow served in the study as scientific advisors: Modesto Varas-Lorenzo and Jorge C. Espinós. Endoscopy Unit, Centro Médico Teknon, Barcelona, Spain.
Drs. Gornals, De la Serna, Sanchez-Yague, Loras, Sanchez-Cantos, and Pérez-Miranda have no conflicts of interest or financial ties to disclose.
Video Endosonography-guided transgastric drainage of a pancreatic pseudocyst using a lumen-apposing metallic covered stent (WMV 22657 kb)
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