Post written by Tae Jun Song, MD, PhD, Sang Soo Lee, MD, PhD, Jong Ho Moon, MD, PhD, from the Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, and the Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon, Republic of Korea.

We investigated the effectiveness and safety of a newly designed lumen-apposing metal stent (LAMS) with a conventional delivery system for endoscopic ultrasound (EUS)-guided drainage of symptomatic pancreatic pseudocysts.

Traditionally, EUS-guided drainage of pancreatic pseudocysts has been performed using double-pigtail plastic stents or covered biliary metal stents due to the lack of specialized stents. Developments of new dedicated devices for EUS-guided drainage can help endosonographers expand the applications of EUS-guided drainage. Recently, LAMSs (AXIOS stents) were developed that are large in diameter, short in length, and bi-flanged at the ends to bind and hold 2 separate structures together. The early results of EUS-guided drainage with LAMSs were promising. However, only 1 type of LAMS has been used for EUS-guided drainage of pancreatic pseudocysts. So, new LAMSs (SPAXUS stents), which have a conventional delivery system, accommodative apposition, and relatively longer length (2 cm) compared with previous LAMSs, were recently designed and have demonstrated favorable results in a small case series study. We would like to prospectively evaluate the usefulness of EUS-guided drainage of pseudocysts using this new LAMS.

Figure 2. EUS-guided drainage of acute peripancreatic fluid collections with a Niti-S SPAXUS stent. A, CT of a large pseudocyst. B, EUS-guided transgastric puncture of the pseudocyst. C, Fluoroscopic imaging of the coiling of the guidewire within the pseudocyst. D, EUS-guided placement of a SPAXUS stent. E, Fluoroscopic imaging of the placement of a stent. F, Endoscopic image of an inserted stent. G, Follow-up CT of an improved pseudocyst after stent insertion. H, Follow-up endoscopy of a well-maintained stent. I, Easy removal of the stent by endoscopy.

This novel LAMS is made of nitinol wire and is fully covered with a silicone membrane. The available diameters of the stents are 8, 10, and 16 mm, and the length of the stents is 2 cm. They have 25 mm of big flanges at both ends for anchoring and approximation of 2 luminal structures. The margin of the flanges are rounded to minimize damage to the walls of the fluid collection. This study showed that EUS-guided drainage using the newly designed LAMS is technically feasible and effective for the treatment of symptomatic pancreatic pseudocysts. The stent was placed successfully in 33/34 patients (97.1%), and clinical success was achieved in 32/33 patients (97.0%). Procedure-related adverse events, including pseudocyst infection (n=3) and stent maldeployment (n=1), occurred in 4 patients. All stents could be endoscopically removed with ease after confirming complete resolution of the pseudocyst on CT. A prospective study to compare the outcomes between different types of LAMSs or other specialized tubular metal stents is necessary soon.

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