Skip to main content
SpringerLink
Log in

A case of pancreatic walled-off necrosis successfully treated with endoscopic ultrasonography-guided drainage using Hot AXIOS System in a patient with severe hemophilia A

  • Case Report
  • Published:
Clinical Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

Hemophilia A causes a bleeding tendency due to the congenital absence of coagulation factor VIII or the production of antibodies against it. It is challenging to perform invasive procedures in patients with hemophilia A. Walled-off necrosis (WON) is a serious complication of acute pancreatitis. Recently, a new metallic stent has been used to drain WON.

Clinical course

We treated a 32-year-old man who developed WON due to acute pancreatitis and has severe congenital hemophilia A. Since conservative treatment was ineffective, he underwent endoscopic ultrasonography (EUS)-guided transgastric WON drainage using a new metallic stent Hot AXIOS System. The procedure was successful without any severe hemorrhagic complications. Before and after the procedure, his clotting factors were strictly monitored by a hemophilia specialist.

Conclusion

EUS-guided pancreatic cyst drainage can be an effective option for WON in patients with severe congenital hemophilia, under adequate management.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Sakai M, Amano K, Ogawa Y, et al. Guidelines for the management of acquired hemophilia A: 2017 revision. Jpn J Thromb Hemost. 2017;28:715–47.

    Article  Google Scholar 

  2. Sakai M, Taki M, Ieko M, et al. 2013 revised edition: Hemostatic treatment guidelines for inhibitors possess congenital hemophilia patients. Jpn J Thromb Hemost. 2013;24:640–58.

    Article  Google Scholar 

  3. Sugiura R, Kuwatani M, Kawakubo K, et al. Successful endoscopic sphincterotomy for choledocholithiasis in a patient with severe hemophilia A and inhibitors. Clin J Gastroenterol. 2018;11:188–92.

    Article  Google Scholar 

  4. Itoi T, Sofuni A, Itokawa F, et al. Endoscopic transpapillary gallbladder drainage in patients with acute cholecystitis in whom percutaneous transhepatic approach is contraindicated or anatomically impossible (with video). Gastrointest Endosc. 2008;68:455–60.

    Article  Google Scholar 

  5. Mukai S, Itoi T. Technical tips of endoscopic therapy for walled-off necrosis due to severe acute pancreatitis. Gastroenterol Endosc. 2016;58:1453–65.

    Google Scholar 

  6. O’Malley VP, Cannon JP, Postier RG. Pancreatic pseudocysts: cause, therapy, and results’. Am J Surg. 1985;150:680–2.

    Article  Google Scholar 

  7. Harrison S, Kakade M, Varadarajula S, et al. Characteristics and outcomes of patients undergoing debridement of pancreatic necrosis. J Gastrointest Surg. 2010;14:245–51.

    Article  Google Scholar 

  8. Grimm H, Binmoeller K, Soehendra N. Endosonography-guided drainage of a pancreas pseudocyst(with videos). Gastrointest Endosc. 2008;68:1102–11.

    Article  Google Scholar 

  9. Seifert H, Biermer M, Schmitt W, et al. Transluminal endoscopic necrosectomy after acute pancreatitis: a multicenter study with long-term follow-up (the GEPARD Study). Gut. 2009;58:1260–6.

    Article  CAS  Google Scholar 

  10. Bazerbachi F, Sawas T, Vargas EJ, et al. Metal stents versus plastic stents for the management of pancreatic walled-off necrosis: a systematic review and meta-analysis. Gastrointest Endosc. 2018;87:30-42.e15.

    Article  Google Scholar 

  11. Fujii T, Amano K, Atsumi T. 2013 revised edition: hemostatic treatment guidelines for hemophilia patients without inhibitors. Jpn J Thromb Hemost. 2013;24:619–39.

    Article  Google Scholar 

  12. Research and study group on intractable pancreatic diseases as a research project to overcome intractable diseases by the Ministry of Health, Labor and Welfare. Consensus on diagnosis and treatment for local complications of pancreatitis. Panc 2014;29:777–818.

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan

    Ryuichi Morita, Toshifumi Doi, Takeshi Ishikawa, Hiroaki Yasuda, Hideyuki Konishi, Yuji Naito & Yoshito Itoh

  2. Outpatient Oncology Unit, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Takeshi Ishikawa

  3. Department of Gastroenterology and Hepatology, Kyoto City Hospital, Kyoto, Japan

    Taito Fukuma

  4. Department of Gastroenterology and Hepatology, Japanese Red Cross Society Kyoto Daiichi Hospital, Kyoto, Japan

    Hideki Sato

  5. Department of Hematology, Japanese Red Cross Society Kyoto Daiichi Hospital, Kyoto, Japan

    Muneo Ohshiro

Authors
  1. Ryuichi Morita
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Toshifumi Doi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Takeshi Ishikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Taito Fukuma
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hideki Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Muneo Ohshiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hiroaki Yasuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hideyuki Konishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yuji Naito
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Yoshito Itoh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Toshifumi Doi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from the patient for being included in the study.

Human and animal participants

All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Morita, R., Doi, T., Ishikawa, T. et al. A case of pancreatic walled-off necrosis successfully treated with endoscopic ultrasonography-guided drainage using Hot AXIOS System in a patient with severe hemophilia A. Clin J Gastroenterol 15, 216–220 (2022). https://doi.org/10.1007/s12328-021-01528-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12328-021-01528-x

Keywords

Search

Navigation