Biflanged Metal Stent Research Articles

Pulsating pseudoaneurysm in a walled-off necrosis

Bleeding from the cavity caused by the rupture of a pseudoaneurysm is a fatal adverse event in patients with walled-off necrosis (WON). Thus, the management of bleeding is mandatory for treatment success. Herein, we describe a pulsating pseudoaneurysm in the cavity of a WON diagnosed by endoscopy through a fully covered biflanged metal stent (BFMS). Subsequently, the pseudoaneurysm was successfully treated. A 38-year-old man experienced an infected WON after a severe necrotizing pancreatitis. A novel BFMS (16 mm in diameter and 20 mm in length) was placed under EUS guidance. Then, direct endoscopic necrosectomy was performed through the BFMS. Seven days afterward, the patient vomited blood; we suspected bleeding from the cavity. Emergency angiography was not able to detect any obvious bleeding point. After 7 days of conservative

Current status and perspective of endoscopic ultrasonography-guided gastrojejunostomy: endoscopic ultrasonography-guided double-balloon-occluded gastrojejunostomy (with videos).

Surgical intervention and, more recently, endoscopic intervention have been performed for the treatment of malignant gastric outlet obstruction. Recently, endoscopic ultrasonography (EUS)-guided gastrojejunostomy using special devices has been established. In line with this, we have developed a novel EUS-guided double-balloon-occluded gastrojejunostomy (EBOG) using a lumen-apposing biflanged metal stent. Herein, we describe the technique and outcome of EBOG.

Mo1391 Comparing the Performance of EUS-Fine Needle Aspiration and EUS-Fine Needle Biopsy: a Multicenter, Randomized Clinical Trial

using plastic stent (nZ9) or biflanged metal stent (nZ3) and seventy patients with walled-off pancreatic necrosis (WON) treated using one and more plastic stents (nZ27) or biflanged metal stent (nZ43) under EUS guidance. Technical and clinical success and adverse event were evaluated. In addition, we assessed re-intervention after the initial drainage and total cost of treatment tools. Result: In terms of PC, there was no statistical significant difference between PS group and BFMS group. The outcome of EUS-guided drainage for PC was technical and clinical success rate (each 100%), early adverse event (0% vs 33%, pZ0.07), and mortality rate(each 0%) . However, total cost was higher in BFMS group than PS group (159$ vs 325$, p! 0.001). In terms of WON, there was not also statistically significant difference: technical success rate (each 100%) and clinical success rate (92.6% vs 97.7%,pZ0.31), early adverse event rate (18.5% vs 7.0%, pZ0.14), mortality rate (7.4% vs 2.3%, pZ0.85), re-intervention rate (30% vs 46.5%, pZ0.16), and the mean number of sessions of additional procedure (4.1 vs 2.7, pZ0.14). Total cost was almost the same (286$ vs 359$,pZ0.14). However, total cost in re-intervention case was statistically higher in PS group than BFMS group (611$ vs 393$,pZ0.03). Conclusions: EUS-guided drainage using a plastic stent versus a novel biflanged metal stent placement for PC and WON were equally effective although there was tendency of decrease of early adverse event rate (especially bleeding from the cavity, severe adverse event) and mortality rate in BFMS group. In terms of cost-effectiveness, PS is more beneficial for the treatment of PC. However, BFMS is more beneficial for the treatment of complicated WON. Since there are several limitations because there was no control group and this was retrospective manner, randomized controlled studies including the cost analysis and hospital stay are warranted.

Mo1389 Plastic Stent Versus Biflanged Metal Stent Placement Under EUS Guidance for the Treatment of Pancreatic Pseudocysts and Walled-off Necrosis

Endoscopic ultrasonography (EUS)-guided drainage of pancreatic fluid collections (PFCs) using single or multiple plastic stents (PS) with or without nasocystic catheter is common. Recently, EUS-guided drainage using a novel self-expandable biflanged metal stent (BFMS) has been reported for satisfactory drainage and sequential direct endoscopic necrosectomy. However, its safety and efficacy is still controversial. In the present study, we retrospectively assessed its safety, efficacy and cost-effectiveness of EUS-guided drainage for PCFs using BFMS compared to PS.