A newly designed fully covered metal stent for lumen apposition in EUS-guided drainage and access: a feasibility study (with videos)
- Abstract
- 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.
- All Author(s)
- J. H. Moon
; H. J. Choi
; D. C. Kim
; Y. N. Lee
; H. K. Kim
; S. A. Jeong
; T. H. Lee
; S. W. Cha
; Y. D. Cho
; S. H. Park
; S. Jeong
; D. H. Lee
; H. Isayama
; T. Itoi
- Issued Date
- 2014
- Type
- Article
- Keyword
- Animals; Cholangiopancreatography, Endoscopic Retrograde/*methods; Cholecystitis, Acute/diagnostic imaging/*surgery; Disease Models, Animal; Drainage/*methods; Endosonography/*methods; Feasibility Studies; Female; Follow-Up Studies; Gallbladder/diagnostic imaging/*surgery; Humans; Male; Retrospective Studies; *Stents; Surgery, Computer-Assisted/*methods; Swine
- Publisher
- American Society for Gastrointestinal Endoscopy
- ISSN
- 0016-5107
- Citation Title
- Gastrointestinal Endoscopy
- Citation Volume
- 79
- Citation Number
- 6
- Citation Start Page
- 990
- Citation End Page
- 995
- Language(ISO)
- eng
- DOI
- 10.1016/j.gie.2014.02.015
- URI
- http://schca-ir.schmc.ac.kr/handle/2022.oak/2774
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