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Endosonography-guided drainage of pancreatic fluid collections with a novel lumen-apposing stent

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Abstract

Background

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).

Methods

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.

Results

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.

Conclusions

Drainage of PFC using dedicated devices as this novel metallic stent with special design seems to be an effective, feasible and safe alternative technique.

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Acknowledgments

Participants listed bellow served in the study as scientific advisors: Modesto Varas-Lorenzo and Jorge C. Espinós. Endoscopy Unit, Centro Médico Teknon, Barcelona, Spain.

Disclosures

Drs. Gornals, De la Serna, Sanchez-Yague, Loras, Sanchez-Cantos, and Pérez-Miranda have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge - IDIBELL (Bellvitge Biomedical Research Institute), Centro Médico Teknon, Barcelona, Spain

    Joan B. Gornals

  2. Hospital Universitari de Bellvitge, Feixa Llarga Str. s/n., 08907 L’Hospitalet de Llobregat, Barcelona, Spain

    Joan B. Gornals

  3. Endoscopy Unit, Department of Gastroenterology, Río Hortega Hospital, Valladolid, Spain

    Carlos De la Serna-Higuera & Manolo Pérez-Miranda

  4. Endoscopy Unit, Department of Digestive Diseases, Agencia Sanitaria Costa del Sol, Marbella, Spain

    Andrés Sánchez-Yague & Andrés M. Sánchez-Cantos

  5. Endoscopy Unit, Centro Médico Teknon, Barcelona, Spain

    Carme Loras

Authors
  1. Joan B. Gornals
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  2. Carlos De la Serna-Higuera
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  3. Andrés Sánchez-Yague
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  4. Carme Loras
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  5. Andrés M. Sánchez-Cantos
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  6. Manolo Pérez-Miranda
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Corresponding author

Correspondence to Joan B. Gornals.

Electronic supplementary material

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Video Endosonography-guided transgastric drainage of a pancreatic pseudocyst using a lumen-apposing metallic covered stent (WMV 22657 kb)

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Gornals, J.B., De la Serna-Higuera, C., Sánchez-Yague, A. et al. Endosonography-guided drainage of pancreatic fluid collections with a novel lumen-apposing stent. Surg Endosc 27, 1428–1434 (2013). https://doi.org/10.1007/s00464-012-2591-y

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  • DOI: https://doi.org/10.1007/s00464-012-2591-y

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