EUS guided drainages with novel electrocautery-enhanced apposing metal stents (stent Hot AXIOS) in a cohort of 20 patients
Jiřina Pintová Orcid.org 1, Robert Procházka Orcid.org 2, Vladimír Nosek Orcid.org 2
+ Affiliation
Summary
Introduction: In the last decade the indications for endosonographic (EUS) guided drainages have significantly broadened mainly due to the advent of novel lumen apposing metal stents (LAMS). Method: The aim of this retrospective, consecutive review (November 2016–May 2018) was to evaluate technical safety, clinical success, and the number of procedure-related and late complications of EUS guided drainage using the Hot AXIOS stent. Among a cohort of 20 patients, 9 had a malignant diagnosis and 11 had a benign diagnosis. Seven patients underwent pathological fluid drainage, six patients underwent transluminal cholecystostomy, six patients were treated with LAMS to gain access to the bile duct, and one patient underwent gastro-enterostomy. Results: The technical success rate was 100 % and the clinical success rate was 95 %. There were two procedure-related complications (10 %), stent malposition and mild bleeding. There was one late complication of clogging of the LAMS with emanating cholangoitis, which was solved by endoscopic re-intervention. The average follow-up period for malignant diagnoses was 103 days. Conclusion: Evaluation of the cohort confirmed the high technical and clinical success of EUS guided drainage using Hot AXIOS stents and the low percentage of complications of this procedure.
Keywords
biliary drainage, endoscopic ultrasound-guided transmural drainage, enteroenterostomy, lumen-apposing metal stent, pancreatic fluid collectionsTo read this article in full, please register for free on this website.
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Literature
1. Stier MW, Waxman I. Lumen-apposing metal stents: which one and why? Gastrointest Endosc Clin N Am 2018; 28 (2): 207–217. doi: 10.1016/j.giec.2017.11.008.
2. Bank JS, Adler DG. Lumen apposing metal stents: A review of current uses and outcomes. Gastrointestinal Intervention 2017; 6 (1): 9–14. doi: 10.18528/gii160033.
3. Bang JY, Varadarajulu S. How the experts do it: step-by-step guide. Gastrointest Endosc Clin N Am 2018; 28 (2): 251–260. doi: 10.1016/j.giec.2017.11.011.
4. Amateau SK, Freeman ML. Avoidance, recog-nition, and management of complications associated with lumen-apposing metal stents. Gastrointest Endosc Clin N Am 2018; 28 (2): 219–231. doi: 10.1016/j.giec.2017.11.009.
5. Binmoeller KF, Nett A. The evolution of endoscopic cystgastrostomy. Gastrointest Endosc Clin N Am 2018; 28 (2): 143–156. doi: 10.1016/j.giec.2017.11.003.
6. Giovannini M. Endoscopic ultrasound-guided drainage of pancreatic fluid collections. Gastrointest Endosc Clin N Am 2018; 28 (2): 157–169. doi: 10.1016/j.giec.2017.11.004.
7. Brimhall B, Han S, Tatman PD et al. Increased incidence of pseudoaneurysm bleeding with lumen-apposing metal stents compared to double pigtail plastic stents in patients with peripancreatic fluid collections. Clin Gastroenterol Hepatol 2018. In press. doi: 10.1016/j.cgh.2018.02.021.
8. Rinninella E, Kunda R, Dollhopf M et al. EUS-guided drainage of pancreatic fluid collections using a novel lumen-apposing metal stent on an electrocautery-enhanced delivery system: a large retrospective study (with video). Gastrointest Endosc 2015; 82 (6): 1039–1046. doi: 10.1016/j.gie.2015.04.006.
9. Siddiqui AA, Kowalski TE, Loren DE et al. Fully covered self-expanding metal stents versus lumen-apposing fully covered self-expanding metal stent versus plastic stents for endoscopic drainage of pancreatic walled-off necrosis: clinical outcomes and success. Gastrointest Endosc 2017; 85 (4): 758–765. doi: 10.1016/j.gie.2016.08.014.
10. Bang JY, Hasan M, Navaneethan U et al. Lumen-apposing metal stents (LAMS) for pancreatic fluid collection (PFC) drainage: may not be business as usual. Gut 2017; 66 (12): 2054–2056. doi: 10.1136/gutjnl-2016-312812.
11. Lang GD, Fritz C, Bhat T et al. EUS-guided drainage of peripancreatic fluid collections with lumen-apposing metal stents and plastic double-pigtail stents: comparison of efficacy and adverse event rates. Gastrointest Endosc 2018; 87 (1): 150–157. doi: 10.1016/j.gie.2017.06.029.
12. Arvanitakis M, Dumoceau JM, Albert J et al. Endoscopic management of acute necrotizing pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) evidence-based multidisciplinary guidelines. Endoscopy 2018; 50 (5): 524–546. doi: 10.1055/a-0588-5365.
13. Puga M, Consiglieri CF, Busquets J et al. Safety of lumen-apposing stent with or without coaxial plastic stent for endoscopic ultrasound-guided drainage of pancreatic fluid collections: a retrospective study. Endoscopy 2018. In press. doi: 10.1055/a-0582-9127.
14. Mudireddy PR, Sethi A, Siddiqui AA et al. EUS-guided drainage of postsurgical fluid collections using lumen-apposing metal stents: a multicenter study. Gastrointest Endosc 2018; 87 (5): 1256–1262. doi: 10.1016/j.gie.2017.08.011.
15. Boulay BR, Lo SK. Endoscopic ultrasound-guided biliary drainage. Gastrointest Endosc Clin N Am 2018; 28 (2): 171–185. doi: 10.1016/j.giec.2017.11.00.
16. Khashab MA, Levy MJ, Itoi T et al. EUS guided biliary drainage. Gastrointest Endosc 2015; 82 (6): 993–1001. doi: 10.1016/j.gie.2015.06.043.
17. Kunda R, Pérez-Miranda M, Will U et al. EUS-guided choledochoduodenostomy for malignant distal biliary obstruction using a lumen-apposing fully covered metal stent after failed ERCP. Surg Endosc 2016; 30 (11): 5002–5008. doi: 10.1007/s00464-016-4845-6.
18. Tsuchiya T, Teoh AYB, Itoi T et al. Long-term outcomes of EUS-guided choledochoduodenostomy using a lumen-apposing metal stent for malignant distal biliary obstruction: a prospective multicenter study. Gastrointest Endosc 2018; 87 (4): 1138–1146. doi: 10.1016/j.gie.2017.08.017.
19. Law R, Baron TH. Endoscopic ultrasound-guided gallbladder drainage. Gastrointest Endosc Clin N Am 2018; 28 (2): 187–195. doi: 10.1016/j.giec.2017.11.006.
20. Dollhopf M, Larghi A, Will U et al. EUS-guided gallbladder drainage in patients with acute cholecystitis and high surgical risk using an electrocautery-enhanced lumen-apposing metal stent device. Gastrointest Endosc 2017; 86 (4): 636–643. doi: 1016/j.gie.2017.02.027.
21. Chen YI, Kunda R, Storm AC et al. EUS-guided gastroenterostomy: a multicenter study comparing the direct and balloon-assisted techniques. Gastrointest Endosc 2018; 87 (5): 1215–1221. doi: 10.1016/j.gie.2017.07.030.