Initial Experience of Consecutive EUS-guided Drainage of Peripancreatic Fluid Collections and Walled Off Necrosis Using a Lumen Apposing Metal Stent (with videos)

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Introduction

EUS-guided drainage of peripancreatic fluid collections (PFCs) and
walled off necrosis (WON) utilising fully covered lumen apposing
metal stents (LAMS) has become a viable alternative to surgical
drainage in selected patients. We describe our evolving experience
of clinical outcomes in consecutive patients undergoing EUS-guided
LAMS placement for PFCs and WON using the Hot AXIOS system.

Methods

We conducted a retrospective study of the technical success of EUSguided LAMS stent placement, rate of resolution of PFC/ WON and
incidence of adverse events in all patients with symptomatic PFC/
WON who underwent EUS-guided drainage using the Hot AXIOS
system from May 2016 to September 2017.

Results

LAMS were successfully placed in 13/13 patients (4 WON, 9
pseudocysts). The mean size of collection was 12.8 cm maximal
axial diameter on CT imaging. The median stent in-dwelling time
was 2 months. Endoscopic debridement was performed in the 4
WON patients. Successful endoscopic therapy using the LAMS was
successful in 9, the outcome of two recently placed stent is awaited,
one stent was dislodged during debridement resulting in open
surgical necrosectomy, and one patient died of bronchopneumonia
19 days post procedure. Stent maldeployment occurred in one patient
– the stent was immediately retrieved and a further stent immediately
placed without further difficulty.

Conclusion

EUS guided drainage of PFC/ WON using the Hot AXIOS system is
an effective alternative to surgery with a high technical success rates
and with a relatively low adverse event rate.