A newly designed fully covered metal stent for lumen apposition in EUS-guided drainage and access: a feasibility study (with videos)

Jong Ho Moon, Hyun Jong Choi, Dong Choon Kim, Yun Nah Lee, Hee Kyung Kim, Song Ah Jeong, Tae Hoon Lee, Sang-Woo Cha, Young Deok Cho, Sang Heum Park, Seok Jeong, Don Haeng Lee, Hiroyuki Isayama, Takao Itoi
Gastrointestinal Endoscopy 2014, 79 (6): 990-5

BACKGROUND: A lumen-apposing stent can be used effectively under endosonographic guidance.

OBJECTIVE: To evaluate a newly designed, fully covered self-expandable metal stent with folding anchoring flanges for lumen apposition assembled on a conventional delivery system.

DESIGN: Retrospective case series and animal study.

SETTING: Tertiary care academic medical centers.

SUBJECTS: Six pigs for animal study and 7 patients, 3 of whom underwent endoscopic drainage for acute cholecystitis (AC) and 4 for pancreatic fluid collection (PFC).

INTERVENTION: Stent deployment under EUS guidance after puncturing, passage of an endoscope through the stent into the gallbladder (GB), or PFC with conventional endoscopic procedures.

MAIN OUTCOME MEASUREMENTS: Technical and clinical success, adverse events, and removability.

RESULTS: In the animal study, the stent was successfully inserted and deployed in the GB via a transgastric approach under EUS guidance without adverse events in all 6 pigs. Contrast injection demonstrated the absence of leakage. Cholecystoscopy with enhanced endoscopy was performed successfully in all animals after stent placement. All stents were intact and were removed successfully at 4 weeks. GB firmly adhered to the stomach with an intact cholecystogastric tract on necropsy and histopathology. The stents were successfully deployed without adverse effects in 7 patients. AC or PFC was resolved after stent placement in all patients. Endoscopic procedures were possible through the stent. Stent migration was not observed. The stent was successfully removed from the 4 patients with PFC after complete resolution.

LIMITATIONS: Small sample size, retrospective study.

CONCLUSIONS: Transenteric drainage and endoscopic intervention by using a novel fully covered self-expandable metal stent for lumen apposition under EUS guidance is feasible for the management of AC and PFC. Further study is warranted.

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