Endoscopic ultrasound-guided transluminal drainage with a lumen-apposing metal stent
(LAMS) is the favored initial approach to manage a symptomatic pancreatic fluid collection
(PFC) [1]. The recurrence rate of PFCs was significantly lower when the LAMS was replaced
with a double-pigtail plastic stent (DPPS), particularly for disconnected pancreatic
duct syndrome [1]
[2]. However, replacing the LAMS with a DPPS can be challenging when the PFC cavity
has shrunk, leaving insufficient space for the DPPS. The optimal strategy involves
placing a coaxial DPPS within the LAMS concurrently during initial treatment and removing
the LAMS afterward, leaving the DPPS in place to prevent PFC recurrence [3]
[4]. However, during LAMS removal, the DPPS may sometimes be unintentionally dislodged
as well. To address this issue, we demonstrate an innovative coaxial plastic stent
designed to facilitate the removal of only the LAMS while leaving the plastic stent
in place.
A 43-year-old man was diagnosed with severe acute pancreatitis caused by alcohol
consumption. Contrast-enhanced computed tomography revealed necrosis of the pancreatic
body
([Fig. 1]
a). Although the pancreatitis resolved, an infected PFC
developed due to disconnected pancreatic duct syndrome ([Fig. 1]
b). Endoscopic ultrasound-guided drainage was performed using a
LAMS with an electrocautery-enhanced delivery system (Hot Axios; Boston Scientific,
MA, USA)
(fluid amylase, 93,185 IU/L). Concurrently, an innovative
5-Fr-diameter multi-loop, half-pigtail coaxial plastic stent (Gadelius Medical, Tokyo,
Japan)
was deployed within the LAMS ([Fig. 2]). Two weeks after placement of the stents, the LAMS alone was removed, leaving the
coaxial plastic stent in place. The removal procedure involved grasping the flange
of the LAMS
with forceps and passing the plastic stent through its lumen, with the proximal half-pigtail
shape of the plastic stent preventing it from catching on the LAMS and ensuring it
remained in
place ([Fig. 3], [Video 1]).
Fig. 1 Contrast-enhanced computed tomographic images: a necrosis of the pancreatic body (arrowheads); b pancreatic fluid collection.
Fig. 2
a The innovative plastic stent with a 5-Fr diameter multi-loop (blue arrowheads) and
half-pigtail (green arrowheads). b Fluoroscopic X-ray image (red arrow: lumen-apposing metal stent, LAMS).
Fig. 3 When a double-pigtail plastic stent (DPPS) has been placed coaxially within a LAMS
during initial treatment, the DPPS may sometimes be unintentionally dislodged as well
when the LAMS is removed. The proximal half-pigtail shape of the innovative plastic
stent prevents it from catching on the LAMS and ensures it remains in place.
An innovative coaxial plastic stent facilitated the removal of the LAMS alone, leaving
the plastic stent in place.Video 1
This innovative coaxial plastic stent within a LAMS may effectively prevent PFC recurrence,
by remaining in place after LAMS removal.
Endoscopy_UCTN_Code_TTT_1AS_2AJ
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