A newly designed fully covered metal stent for lumen apposition in EUS-guided drainage and access: a feasibility study (with videos).
BACKGROUND
A lumen-apposing stent can be used effectively under endosonographic guidance.


OBJECTIVE
To evaluate a newly designed, fully covered self-expandable metal stent with folding anchoring flanges for lumen apposition assembled on a conventional delivery system.


METHODS
Retrospective case series and animal study.


METHODS
Tertiary care academic medical centers.


METHODS
Six pigs for animal study and 7 patients, 3 of whom underwent endoscopic drainage for acute cholecystitis (AC) and 4 for pancreatic fluid collection (PFC).


METHODS
Stent deployment under EUS guidance after puncturing, passage of an endoscope through the stent into the gallbladder (GB), or PFC with conventional endoscopic procedures.


METHODS
Technical and clinical success, adverse events, and removability.


RESULTS
In the animal study, the stent was successfully inserted and deployed in the GB via a transgastric approach under EUS guidance without adverse events in all 6 pigs. Contrast injection demonstrated the absence of leakage. Cholecystoscopy with enhanced endoscopy was performed successfully in all animals after stent placement. All stents were intact and were removed successfully at 4 weeks. GB firmly adhered to the stomach with an intact cholecystogastric tract on necropsy and histopathology. The stents were successfully deployed without adverse effects in 7 patients. AC or PFC was resolved after stent placement in all patients. Endoscopic procedures were possible through the stent. Stent migration was not observed. The stent was successfully removed from the 4 patients with PFC after complete resolution.


CONCLUSIONS
Small sample size, retrospective study.


CONCLUSIONS
Transenteric drainage and endoscopic intervention by using a novel fully covered self-expandable metal stent for lumen apposition under EUS guidance is feasible for the management of AC and PFC. Further study is warranted.
Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon/Seoul, South Korea.
Jong Ho
JH
Moon
Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon/Seoul, South Korea.
Hyun Jong
HJ
Choi
Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon/Seoul, South Korea.
Dong Choon
DC
Kim
Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon/Seoul, South Korea.
Yun Nah
YN
Lee
Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon/Seoul, South Korea.
Hee Kyung
HK
Kim
Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon/Seoul, South Korea.
Song Ah
SA
Jeong
Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon/Seoul, South Korea.
Tae Hoon
TH
Lee
Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon/Seoul, South Korea.
Sang-Woo
SW
Cha
Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon/Seoul, South Korea.
Young Deok
YD
Cho
Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon/Seoul, South Korea.
Sang Heum
SH
Park
Department of Internal Medicine, Inha University School of Medicine, Incheon, South Korea.
Seok
S
Jeong
Department of Internal Medicine, Inha University School of Medicine, Incheon, South Korea.
Don Haeng
DH
Lee
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Hiroyuki
H
Isayama
Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
Takao
T
Itoi
D000818:Animals; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D041881:Cholecystitis, Acute / Q000000981:diagnostic imaging / Q000601:surgery*; D004195:Disease Models, Animal; D004322:Drainage / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005704:Gallbladder / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D015607:Stents; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013552:Swine