title: Novel use of a self-expandable metal stent with an anti-migration system for palliative drainage of a pancreatic cystic neoplasm.
abstract: BACKGROUND
  There is scanty data on endoscopic palliative management of pancreatic cystic lesions that cause gastric outlet obstruction (GOO). This is the first case report that illustrates the use of a covered self-expandable metal stent (CSEMS) with an anti-migration system in the management of a symptomatic neoplastic cystic pancreatic lesion.
  
  
  METHODS
  A 92-year-old Chinese female presented with partial GOO for 3 months. Examination revealed a non-tender epigastric mass with moderate abdominal distension. Esophagogastroduodenoscopy (EGD) showed a significant bulge at the posterior wall of the gastric antrum and food residue in the stomach. A CT scan of the abdomen showed a large pancreatic tail cystic lesion. Endoscopic ultrasound (EUS) showed a clear, non-septated cystic lesion measuring 9.7x10 cm arising from the pancreatic tail. Analysis of the aspirate revealed the following: Amylase: 3,200 units/L, CEA: 411 ng/mL, CA 19-9 812 U/mL and no malignancy. A Niti-S™ Biliary Stent (NAGI™) was used for a cystogastrostomy. This procedure was complicated by a self-limiting intra-abdominal leak, stent migration and bleeding from a splenic artery pseudoaneurysm which was arrested with coil embolization. She progressed well after that with significant symptom improvement and no further complications.
  
  
  CONCLUSIONS
  This is the first case of a CSEMS with an anti-migration system that was used for decompression of a pancreatic cystic neoplasm (PCN). Novel use of this stent is a viable option as palliative management of a PCN in those not fit for surgery but caution needs to be exercised as there can be significant complications.
authors.affiliation: Department of Medicine, University Putra Malaysia. Seri Kembangan (Serdang), Selangor, Malaysia. jeshmar74@yahoo.co.uk.
authors.forename: Rajesh Kumar
authors.initials: RK
authors.lastname: Paramasivam
authors.forename: Shiaw-Hooi
authors.initials: SH
authors.lastname: Ho
authors.forename: Basri Jeet
authors.initials: BJ
authors.lastname: Abdullah
authors.forename: Khean-Lee
authors.initials: KL
authors.lastname: Goh
authors.forename: Ida
authors.initials: I
authors.lastname: Hilmi