Endoscopic ultrasound-guided placement of AXIOS stent for drainage of pancreatic fluid collections

Abstract

Pancreatic fluid collections (PFCs) have conventionally been treated with surgery, percutaneous drainage, or with the more recently established endoscopic ultrasound (EUS)-guided drainage modality. Currently, endoscopic plastic or metallic stents are used for PFC drainage. Plastic stents present issues with stent migration and premature occlusion requiring frequent stent exchanges or placement of additional stents. Metallic stents are tubular and may migrate, resulting in inefficient drainage, content leakage, retrieval and replacement, and possible mucosal injury. The aim of this review was to summarize and evaluate the clinical and technical effectiveness of EUS-guided placement of the recently developed AXIOS stent, a lumen-apposing self-expandable metallic stent (LASEMS)for PFC drainage. A literature review was performed to identify the studies describing this technique. In this review article we have summarized case series or reports describing EUS-guided LASEMS placement. The indications, techniques, limitations and complications reported are discussed. A total of 298 patients were included across all studies described thus far in the literature. Overall, a 97% technical success rate and a 96% clinical success rate have been reported. Early and late complications related to the placement or removal of LASEMS have been reported, however few cases have presented life-threatening results. EUS-guided PFC drainage and LASEMS placement can be a safe and effective alternative approach in the management of selected patients.

Rare Esophageal Migration of AXIOS Stent Used for Walled-off Pancreatic Necrosis Drainage

“…When indicated, WON drainage can be done surgically, percutaneously, or endoscopically 1. Endoscopic ultrasound (EUS)-guided transmural drainage of WON is an efficacious, safe, and widely used therapeutic modality 1.…”

PWE-072 EUS Fork-tip biopsy versus EUS FNA in the diagnosis of solid pancreatic masses

“…Endoscopic necrosectomy is the primary intervention in the management of walled-off pancreatic necrosis (WOPN) 1 . After insertion of a lumen-apposing self-expanding metal stent (LASEMS), necrosis is removed using tools such as snares and forceps.…”

PWE-073 EUS-guided drainage of peripancreatic fluid collections: hot axios experience from a tertiary referral centre

“…1 The Hot-Axios (Boston Scientific) device offers a one-step combined diathermy-enabled access and deployment of a lumen-apposing self-expanding metal stent (LASEM). The aim of this study was to investigate the efficacy and safety of the Hot-Axios device for the management of patients with PFCs referred to a regional tertiary centre.…”