‘OVER THE SCOPE TECHNIQUE’ (OTS) FOR PARTIALLY COVERED SELF-EXPANDABLE METAL STENT (PC-SEMS) PLACEMENT TO TREAT DUODENAL PERFORATION (DP) OCCURRED DURING EUS: CASE SERIES

Aims Adverse events during EUS are rare. According to the literature, DP occurs in about 0,09% of patients and is associated with a high mortality rate. Surgical approach has been the main treatment for years. According to current version of the ESGE position statement, new endoscopic approaches to treat DP have been developed.

Aim of this study assessing the feasibility of use of PC-SEMS with the “OTS technique placement” as an endoscopic approach to treat large (> 1 cm) DPs occurred during EUS.

Methods Between June 2016 and May 2019 we collected data from 6 patients (4/2; M/F, median age: 66) treated for DP during EUS in 3 different endoscopic centers. We treated them according to the size and type of the perforation by placing 6 cm PC-SEMS implanted with OTS technique in order to achieve a large perforation closure and avoid stent migration. Moreover ‘OTS technique’ allowed us to preserve the Vater papilla thanks to the direct endoscopic view, without fluoroscopic guide during the placement of the SEMS.

Results Indications for EUS evaluation were: study of a pancreatic cyst in 1/6 patients, biliary pancreatitis assessment in 5/6 patients. Perforation occurred in the inferior wall of the duodenum knee in all patients. The mean size was 20 mm, range 15–25 mm). All stents were placed successfully. After 4 weeks the PC-SEMS were removed with foreign-body forceps; in 3/6 patients APC had to be used on the overgrowth tissue on the distal uncovered part of the stent. 4 weeks later endoscopic and radiological control confirmed the healing of the DPs in all patients.

Conclusions The use of PC-SEMS in skilled hands is feasible, safe and allows to treat large perforation; “OTS technique” allows the correct stent placement also in the case of radiological guide absence.