Joan B. Gornals, MD, PhD at the Endoscopy Unit, Department of Digestive Diseases at the Hospital Universitari de Bellvitge-IDIBELL in Barcelona, Spain presents this VideoGIE case, “EUS-guided transesophageal drainage of a mediastinal abscess using a diabolo-shaped lumen-apposing metal stent.”

In this video, we demonstrate the successful use of a self-expanding metal stent specifically designed for EUS-guided transmural drainage of collections in a mediastinal abscess case drained transesophageally with a favorable outcome in only one session. There was total resolution of the lesion without complications, avoiding surgical intervention.

Recently, some case series have reported initial experiences with this kind of stent, named as lumen-apposing metal stents, with satisfactory results in abdominals collections (pseudocysts, walled-off pancreatic necrosis, or gallbladder). EUS-guided transmural drainage of mediastinal collections is not common, and previous experiences have used plastic stents.

With improvement of the available devices and development of new metallic stents, EUS transmural drainage techniques have become easier and less time-consuming. In our experience, these new kind of stents are more specific for endoscopic internal drainage, and a good example of innovation on EUS specific therapeutic devices.

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