Post written by Andrew C. Storm, MD, from the Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA.

We have presented the novel reuse of the electrocautery-enhanced lumen-apposing metal stent deployment catheter to permit transduodenal wire access and stent placement to create a dual AXIOS cystgastrostomy and double pigtail cystduodenostomy.

Management of disconnected pancreatic duct after an episode of acute pancreatitis remains a management dilemma. It is our group’s practice when feasible to place transduodenal stents (cystduodenostomy), sometimes in addition to transgastric stents (when the degree of necrosis is thought to be enough to require necrosectomy). The transduodenal stents are thought to permit a more durable fistula between the collection and the duodenum, potentially preventing recurrence of the collection once the transgastric stent is removed and the tract closes. This technique, and others, need more study to determine the ideal management paradigm for this difficult problem.

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