Pancreatic Necrosectomy Through a Novel Double-flange Lumen-apposing Covered Metal Stent

We present a 60 year old patient admitted to the intensive care unit for severe acute pancreatitis that developed WON with superinfection. The intensivists and surgeons indicated endoscopic cystgastrostomy to evacuate the collection. Using the echoendoscope we found a large collection adherent to the gastric wall. The collection was accessed under EUS-guidance using the Hot AXIOS™ catheter that features a cautery tip, then a 15mm AXIOS™ stent was deployed through the cystgastrostomy orifice to keep it patent. The patient required two necrosectomy sessions to clean the cavity. The WON resolved in 6 weeks and the stent was removed unevently. The patient was discharged. A double flange lumen apposing FC-SEMS used as a port for necrosectomy significantly improves management of walled-off pancreatic necrosis. Placement of this stents should be considered when multiple necrosectomy sessions are anticipated. Procedure time can be significantly decreased using a catheter that combines a cautery tip and stent delivery system.
Source: Video Journal and Encyclopedia of GI Endoscopy - Category: Gastroenterology Source Type: research