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Surgical Endoscopy

, Volume 27, Issue 4, pp 1428–1434 | Cite as

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

  • Joan B. GornalsEmail author
  • Carlos De la Serna-Higuera
  • Andrés Sánchez-Yague
  • Carme Loras
  • Andrés M. Sánchez-Cantos
  • Manolo Pérez-Miranda
Dynamic Manuscript

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.

Keywords

Pseudocyst Transmural drainage Endosonography Pancreatobiliary Endoscopy Therapeutics 

Notes

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.

Supplementary material

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

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Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Joan B. Gornals
    • 1
    • 2
    Email author
  • Carlos De la Serna-Higuera
    • 3
  • Andrés Sánchez-Yague
    • 4
  • Carme Loras
    • 5
  • Andrés M. Sánchez-Cantos
    • 4
  • Manolo Pérez-Miranda
    • 3
  1. 1.Endoscopy Unit, Department of Digestive DiseasesHospital Universitari de Bellvitge - IDIBELL (Bellvitge Biomedical Research Institute), Centro Médico TeknonBarcelonaSpain
  2. 2.Hospital Universitari de BellvitgeBarcelonaSpain
  3. 3.Endoscopy Unit, Department of GastroenterologyRío Hortega HospitalValladolidSpain
  4. 4.Endoscopy Unit, Department of Digestive DiseasesAgencia Sanitaria Costa del SolMarbellaSpain
  5. 5.Endoscopy UnitCentro Médico TeknonBarcelonaSpain

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