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Create a Free AccountAnatomy - Hepatopancreatobiliary
Transabdominal self-expandable metal stent placement as a rescue therapy for drainage of walled-off necrosis
The current management for intervention in necrotizing pancreatitis consists of a step-up approach with percutaneous drainage as the first choice for infected necrotic collections that are not in contact with the stomach or the duodenum wall.1 However, the presence of large solid necrotic areas often requires direct debridement for complete resolution.A simple method to reposition a dislocated lumen-apposing metal stent during endoscopic necrosectomy
A 62-year-old man presented with epigastric pain 1 year after treatment of severe pancreatitis (Video 1, available online at www.VideoGIE.org ). CT scan showed walled-off necrosis (WON) approximately 10 cm in size (Fig. 1). Laboratory studies revealed an elevated C-reactive protein level of 8.5 mg/dL. The patient underwent EUS-guided drainage of the infected WON using a lumen-apposing metal stent (LAMS) 20 mm in diameter.Start of a new TREnD: TransRemnant Endoscopic Drainage for management of walled-off necrosis in a patient with Roux-en-Y gastric bypass
A 64-year-old woman with a history of Roux-en-Y gastric bypass (RYGB) was admitted to an outside hospital with severe necrotizing pancreatitis. Three weeks after her initial presentation, the patient was transferred to our hospital because of persistent abdominal pain and nausea, along with fever and worsening leukocytosis.EUS-guided stent removal in buried lumen-apposing metal stent syndrome: a case series
Lumen-apposing metal stents (LAMSs) play an increasing role in transgastric and transduodenal drainage of pancreatic fluid collections and allow novel EUS-guided interventions. Alongside the main adverse events of bleeding and occlusion, LAMSs can be overgrown by mucosa, which leads to the inability to visualize the stent in endoscopy.Endoscopic replacement technique for migrated lumen-apposing metal stent during endoscopic pancreatic necrosectomy
A 65-year-old man had experienced severe alcoholic pancreatitis 5 weeks earlier and was treated in another hospital. Although the acute pancreatitis was treated with conservative therapy, the patient had a high fever with abdominal pain for 1 week. The laboratory test showed elevated C-reactive protein (30.5 mg/dL). The CT and EUS findings showed an encapsulated collection, measuring 230 × 76 mm, with debris (Fig. 1). According to the clinical course and image findings, an infected walled-off necrosis (WON) was suspected.Salvage of a misdeployed 20-mm lumen-apposing metal stent by use of a through-the-scope esophageal stent
A 42-year-old woman at 13 weeks of pregnancy with a history of severe alcoholic pancreatitis 9 months earlier was admitted to an outside institution for recurrent abdominal pain. She was found to have a pancreatic walled-off necrosis (WON) abutting the body and tail of the pancreas, measuring 17.2 cm on MRI (Figs. 1 and 2). The patient underwent EUS-guided transgastric drainage of the WON with placement of a 20-mm × 10-mm cautery-enhanced lumen-apposing metal stent ([LAMS] AXIOS; Boston Scientific, Marlborough, Mass, USA) and was discharged home.Pancreatic necrosectomy using an automated mechanical endoscopic tissue extraction device
A 66-year-old man with uncontrolled diabetes mellitus and prior cholecystectomy presented to an outside hospital with symptoms of intractable abdominal pain, nausea, and vomiting. He received a diagnosis of acute pancreatitis and was treated conservatively and eventually discharged. He continued to have persistent symptoms and was admitted again. An abdominal CT scan revealed a pancreatic fluid collection (PFC) with evidence of solid debris. The patient was transferred to our facility for further evaluation and treatment.Endoscopic drainage of pancreatic fluid collections by use of a novel biflanged stent with electrocautery-enhanced delivery system
Endoscopic drainage is currently the preferred modality of drainage for pancreatic fluid collections (PFCs) because of the ease of the procedure, reduced cost, shorter hospital stay, and the reduced morbidity and mortality compared with traditional surgical drainage.1 Plastic stents used for endoscopic drainage may become blocked with the passage of time, leading to adverse events requiring reinterventions, especially in PFCs with significant debris (ie, walled-off necrosis [WON]). Novel large-caliber metal stents (LCMSs) are less prone to spontaneous occlusions and therefore, provide efficient drainage of PFCs.
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