A Game Changing new metal stent (Hot Axios) for eus- guided drainage and necrosectomy of pancreatic fluid collections
V.Parihar, P.Maheshwari, R.Stack, A.Alakkari, L.Kumar, F.Carville, BM Ryan
Department of Gastroenterology Tallaght Hospital
Endoscopic ultrasound (EUS)-guided drainage of Pancreatic Fluid Collections (PFCs) has been carried out for almost two decades. Methods involving placement of plastic pigtail stents have been the mainstay of treatment until recently. we previously presented our experience of PFC drainage with plastic stents (ISG November 13). Recently, a new lumen-apposing, covered self-expanding metal stent (LAMS) has become available (Hot AXIOS, Boston Scientific) which may have some advantages over plastic stents.
The aim of this prospective study was to evaluate the success and complication rates associated with Hot Axios System in our institution to date and to compare with our experience with pigtail plastic stents preprocess
All adult patients who had EUS-guided Hot AXIOS stent placement for PFC since December 2015 were included. Results were compared with historic data for EUS-guided plastic stent insertion at our institution. The primary endpoint was the technical success of the procedure, with secondary outcomes being complication and reintervention rates. Serious Complications specifically checked were bleeding, perforation, superinfection and stent migration.
Four patients (2 males and 2 females), mean age 55 years (range 49-60) underwent Hot AXIOS stent insertion. The indication was symptomatic Walled off Necrosis, WON (n=1) or Pseudocyst (n=3). The mean size of the PFC on EUS was 9 cm (6-12 cm). 3 had trans-gastric and 1 trans-duodenal stent insertion. 1 patient underwent complete necrosectomy at the index procedure. Procedures were technically successful in all patients. However, one stent (25%) required reintervention at 7 days due to blockage. Procedures were done under conscious sedation and 2 were day cases. There were no serious complications and no cases of stent migration. The average duration of the procedure was 45 minutes.
Hot AXIOS system is safe and effective in draining PFC with a technical success rate of 100% and low serious adverse event rate. The procedure was on average 1.5 hours shorter duration than EUS-guided plastic stent insertion and with significantly less sedation. preprocess