Post written by D. Nageshwar Reddy, MD, DM, from the Asian Institute of Gastroenterology, Hyderabad, India.
In this video case series, we described 5 cases with pancreatic fluid collections (4 walled-off necrosis and 1 pseudocyst) that underwent endoscopic ultrasound-guided drainage using a new biflanged metal stent with electrocautery-enhanced delivery system (Hot Nagi, Taewoong Medical, Gyenoggi- do, Korea). The procedure was successfully completed in all the cases. A 19G fine-needle aspiration needle was used to puncture the wall of pancreatic fluid collection in the first 3 cases. In the subsequent 2 cases, the wall was punctured directly with the electrocautery-enabled stent delivery system. As the operator gained familiarity with the delivery system, the number of steps involved in the deployment of the stent reduced. The last case was accomplished in a single step, ie, puncture of the cyst wall with the electrocautery-enabled stent system followed by deployment of the stent. There were no adverse events during or immediately after the procedure. This video highlights that the placement of cystogastric metal stents can be accomplished in a single step.
The electrocautery-enhanced biflanged metal stent is a through-the-scope biflanged metal stent delivery system (10F). The stent is a fully covered metal stent made of nitinol with flared ends and covered with silicone membrane. It is available in 2 lengths (20 and 30 mm) and 4 diameters (10, 12, 14, and 16 mm). The stent flanges measure 26 mm in diameter. The recommended settings on an electrosurgical generator are 80 to 120 watts on pure cut mode. Endoscopic drainage of fluid collections using metal stents is being increasingly utilized. With the use of this device, the drainage procedure is easier and the learning curve shorter for the endoscopists.
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