Post written by Kambiz S. Kadkhodayan, MD, from the Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA.
We describe the use of a helix tack system to anchor the proximal flange of a lumen-apposing metal stent (LAMS) to the gastric pouch during a single-session EUS-directed transgastric ERCP (SS-EDGE).
This video case also describes a reverse Z pattern that was used to fix the LAMS firmly and simplify subsequent removal. The patient described had a history of sleeve gastroplasty that was converted to a Roux-en-Y gastric bypass.
Because of a narrow and fixed excluded stomach in such patients, maneuvering of the duodenoscope can be quite challenging and exposes the LAMS to significant displacement forces during ERCP. The anchoring ability of the helix tack and described reverse Z pattern was able to withstand the excessive forces exerted on the LAMS in this particularly challenging case.
It was important to showcase this video case because displacement of the LAMS during a SS-EDGE procedure can result in perforation and devastating clinical repercussions. Fixing the LAMS to the gastric wall before ERCP significantly reduces the risk of dislodgment.
Endoscopic suturing and over-the-scope clips have been used for this purpose, but they require training, can be cost-prohibitive, and frequently necessitate the use of certain devices for removal. The helix tack system is a relatively inexpensive device that anchors the LAMS well and can be easily removed by cutting the suture at a single location as described in this video case.
In addition, the helix tack may be used to fix the distal flange of the LAMS via retroflexion of the endoscope if needed, and it is a valuable addition to the armamentarium of tools available to the interventional endoscopist.
I would like to thank GIE for the opportunity to share this interesting case.
Endoscopic image after placement of the lumen-apposing metal stent demonstrating a gush of blue dye.
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