EUS-guided drainage of pancreatic fluid collection with a Hot AXIOS stent in a patient with pancreatitis following distal pancreatectomy (with video).

The Hot AXIOS lumen-apposing stent (Xlumena Inc., Mountain View, CA, USA) is a novel double-flanged or “barbell-shaped,” covered, self-expanding metal stent that can be an efficient tool for the drainage of pancreatic fluid collection (PFC), which is mostly caused by gallstone disease, or alcoholic, idiopathic, or chronic pancreatitis.[12345] Herein, we present a case of successful PFC drainage in a patient with pancreatitis following distal pancreatectomy [Video 1].

A 59-year-old woman presented with epigastric pain and nausea. She was diagnosed with pancreatitis 4 months after undergoing a distal pancreatectomy and splenectomy because of pancreatic cancer. An upper ultrasound revealed a normal esophagus. An extrinsic compression was found in the body of the stomach and antrum, along with hypertensive portal gastropathy throughout the stomach. A very careful examination performed with a 7.5 MHz linear echoendoscope revealed a large oval pseudocyst in the body of the pancreas. The pseudocyst measured 120 mm along the long axis and was anechoic on ultrasound. A small amount of layering debris was observed near the bottom of the cyst. Cystogastrostomy was performed with a 15 mm × 10 mm cautery-enhanced lumen-apposing metal stent. Immediately after stent deployment, a copious amount of dark fluid, approximately 1000 ml, drained from the cyst. The stent remained in an excellent position along the posterior wall of the body of the stomach. No unexpected events occurred. Sixty days later, the metal stent was removed using a snare, without difficulty. The pre- and post-drainage computed tomography images are shown in Figure 1.

Figure 1

Computed tomography images obtained before and after drainage. (a) Large cyst before cystogastrostomy. (b) Stent is still in place, and the cyst size is decreased. (c) Stent was removed after cyst resolution

The findings of this case indicate that EUS-guided cystogastrostomy with a Hot AXIOS stent is safe and effective in the setting of pancreatitis associated with pancreatic surgery.

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The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has provided consent for submission of her images and other clinical information required for publication in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal her identity but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.