Electrocautery-enhanced Delivery System Research Articles

A novel bipolar electrocautery-enhanced delivery system with a lumen-apposing metal stent for EUS-guided drainage: A porcine study.

An electrocautery-enhanced delivery system with a lumen-apposing metal stent (LAMS) is available for one-step endoscopic ultrasound-guided transmural drainage (EUS-TD). Bipolar electrosurgery has several potential clinical advantages, including reduced collateral thermal damage, enhanced hemostasis, and no requirement for a return electrode plate. In this study, we compared the technical feasibility and safety of a newly developed bipolar electrocautery-enhanced delivery system with a conventional delivery system for EUS-TD using a LAMS in a porcine model. Ten days before the study, 12 mini pigs underwent common bile duct ligation for EUS-guided gallbladder drainage. Transenteric puncture was performed, followed by placement of a guidewire. In six pigs, a bipolar electrocautery-enhanced delivery system with LAMS (Hot SPAXUS) was inserted over the guidewire and advanced into the gallbladder, without prior dilation of the tract, by applying a bipolar cut current. In the remaining six pigs, a conventional delivery system with LAMS (Cold SPAXUS) was inserted after tract dilatation using a cystotome. The stent was removed after 4 weeks. In all pigs, the stent was successfully inserted and deployed in the gallbladder without adverse events. The mean procedure time of EUS-TD was significantly lower in the Hot SPAXUS group than that of the Cold SPAXUS group (mean ± standard deviation: 188.7 ± 5.2 vs 449.5 ± 97.5s, P=.0019). Stent migration was not observed, and all stents were removed successfully. Endoscopic ultrasound-guided transmural drainage using a bipolar electrocautery-enhanced LAMS is feasible for reducing the procedure time while maintaining the high success rate and safety of conventional LAMS.

Experimental study of a physician-controlled electrocautery-enhanced delivery system incorporating a newly developed lumen-apposing metal stent for interventional endoscopic ultrasound (with videos).

Although the lumen-apposing metal stent (LAMS) is useful for interventional endoscopic ultrasound (EUS) procedures, there has been some concern about the potential for stent-induced adverse events because of the high lumen-apposing force. A newly designed LAMS with less lumen-apposing force has been developed for use with a physician-controlled electrocautery-enhanced delivery system. The aim of this animal study was to evaluate the feasibility of performing interventional EUS using this newly designed LAMS system. Endoscopic ultrasound-guided cystogastrostomy was performed using the novel LAMS three times in a wet simulation model. EUS-guided gastroenterostomy and EUS-guided gallbladder drainage were then performed using the system in four pigs. The LAMS was successfully placed in all three EUS-guided cystogastrostomy procedures using the wet simulation model and in all four EUS-guided gastroenterostomy and gallbladder drainage procedures in the animal model. In the 3weeks following the procedure, eating behavior was normal in all animals and there were no adverse events. The stents remained patent during this time and were removed without difficulty. The fistula was mature in all cases and a standard upper gastrointestinal endoscope was easily advanced via the fistula to observe the afferent and efferent loops or the lumen of the gallbladder. Necropsy confirmed complete adhesion between the stomach and the wall of the jejunum or gallbladder. Our study findings demonstrate the feasibility of this new LAMS system and its potential clinical value for interventional EUS.

Drainage of pancreatic fluid collections using a lumen-apposing metal stent with an electrocautery-enhanced delivery system.

Our aim was to evaluate the efficacy and safety of a lumen-apposing metal stent with an electrocautery-enhanced delivery system (EDS-LAMS) for endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collections (PFCs) in regular clinical practice. A retrospective and subsequent prospective analysis was undertaken of all patients who underwent EUS-guided drainage of their PFCs using the EDS-LAMS at 17 tertiary therapeutic endoscopy centers. Two hundred eight cases of EDS-LAMS deployment were attempted in 202 patients (mean age 52.9years) at time of evaluation. Ninety-seven patients had pancreatic pseudocysts (PPs), 75 walled-off pancreatic necrosis (WOPN), 10 acute peripancreatic fluid collections (APFCs), 6 acute necrotic collections (ANCs), and 14 postoperative collections (POCs). Procedural technical success was achieved in 202/208 cases (97.1%). Maldeployment occurred in 7/208 cases (3.4%). Clinical success was achieved in 142/160 (88.8%) patients (PP 90%, WOPN 85.2%, APFC 100%, ANC 75%, POC 100%). Delayed adverse events included stent migration in 15/202 (7.4%), stent occlusion and infection in 16/202 (7.9%), major bleeding in 4/202 (2%), and buried EDS-LAMS in 2/202 (1%). PFC recurrence occurred in 13/142 (9.2%) patients; 9/202 (4.5%) required surgical or radiological intervention for PFC management after EDS-LAMS insertion. This large international multicenter study evaluating the EDS-LAMS for drainage of PFCs in routine clinical practice suggests that the EDS-LAMS are safe and effective for drainage of all types of PFCs; however, further endoscopic therapy is often required for WOPN. Major bleeding was a rare complication in our cohort.

New deployment techniques of the lumen-apposing metal stent in walled-off necrosis filled with necrotic tissue: Chick opening its mouth (with video).

The lumen-apposing metal stent (LAMS) on an electrocautery-enhanced delivery system for endoscopic ultrasound-guided transluminal drainage has been widely used for the treatment of walled-off necrosis (WON). However, deployment of the LAMS can be technically difficult in WON, which contains a large amount of necrotic tissue and a low liquid component, owing to insufficient space for expansion of the distal stent flange. It has been recommended that the LAMS is placed in WON containing necrotic tissue, because additional endoscopic necrosectomy can be readily performed via the lumen of the LAMS. Here we introduce two new deployment techniques of the LAMS for WON filled with necrotic tissue, namely, the two-step puncture technique and the back-and-forth technique, which enable the distal stent flange to be expanded like a chick opening its mouth. These techniques are expected to further improve the clinical outcomes of refractory WON.

Endoscopic ultrasound-guided colo-colostomy in a case of acute large bowel obstruction.

Bowel obstruction is one of the most common surgical emergencies and a major cause of morbidity and mortality. Standard supportive measures must be instituted as soon as the diagnosis is confirmed. Anastomotic strictures are a benign etiology of intestinal obstruction, occurring in up to 22 % of patients following colorectal resection. Traditionally, endoscopic balloon dilation (EBD) has been the intervention of choice in such cases; however, it may not be feasible in all settings. We report a novel application of the AXIOS stent and electrocautery-enhanced delivery system (Boston Scientific, Marlborough, Massachusetts, United States) to create a colo-colostomy to bypass a sigmoid colon stricture in a 51-year-old woman who presented with acute intestinal obstruction. Despite stent dislodgment during the procedure, the preexisting tract allowed us to improvise our technique with a second LAMS placement. The patient was discharged well 48 hours after the procedure. However, 4 months later, she required a session of EBD following a presentation for fecal impaction. She is currently asymptomatic and being followed up regularly as an outpatient.

A novel electrocautery-enhanced delivery system for one-step endoscopic ultrasound-guided drainage of the gallbladder and bile duct using a lumen-apposing metal stent: a feasibility study.

The use of a lumen-apposing metal stent (LAMS) capable of one-step endoscopic ultrasound-guided transmural drainage (EUS-TD) can increase the effectiveness of the procedure. We evaluated the newly developed electrocautery-enhanced (EC) delivery system with a LAMS for one-step EUS-guided gallbladder drainage (EUS-GBD) or choledochoduodenostomy (EUS-CDS). In the animal experiment, an EC-LAMS was advanced into the gallbladder without prior tract dilation in four pigs. A conventional LAMS was inserted in another four pigs as a control group. After the animal experiment, 17 patients underwent EUS-TD using the EC-LAMS (EUS-GBD in 10 patients, EUS-CDS in 7). The primary outcome was the technical success rate. In the animal study, the mean procedure time was significantly shorter in the EC-LAMS group than in the conventional LAMS group. In the human study, the overall technical success rate was 94.1 %, with one EUS-GBD failure. The clinical success rate was 100 %. The overall adverse event rate was 17.6 %. One-step EUS-GBD or EUS-CDS using the novel EC-LAMS is a feasible approach that achieves a high success rate and maintains safety.

Effectiveness and safety of EUS-guided choledochoduodenostomy using lumen-apposing metal stents (LAMS): a systematic review and meta-analysis.

Endoscopic ultrasound-guided choledochoduodenostomy (CDD) is emerging as an alternative technique for biliary drainage in patients who fail conventional endoscopic retrograde cholangiopancreatography (ERCP). The lumen-apposing metal stents (LAMS) are being increasingly used for CDD. We performed a systematic review and meta-analysis to evaluate the effectiveness and safety of CDD using LAMS. We performed a systematic search of multiple databases through May 2019 to identify studies on CDD using covered self-expanding metal stents. Pooled rates of technical success, clinical success, adverse events, and recurrent jaundice associated with CDD using LAMS were estimated. A subgroup analysis was performed based on use of LAMS with electrocautery-enhanced delivery system (EC-LAMS). Seven studies on CDD using LAMS (with 284 patients) were included in the meta-analysis. Pooled rates of technical and clinical success (per-protocol analysis) were 95.7% (95% CI 93.2-98.1) and 95.9% (95% CI 92.8-98.9), respectively. Pooled rate of post-procedure adverse events was 5.2% (95% CI 2.6-7.9). Pooled rate of recurrent jaundice was 8.7% (95% CI 4.5-12.8). On subgroup analysis of CDD using EC-LAMS (5 studies with 201 patients), the pooled rates of technical and clinical success (per-protocol analysis) were 93.8% (95% CI 90.4-97.1) and 95.9% (95% CI 91.9-99.9), respectively. Pooled rate of post-procedure adverse events was 5.6% (95% CI 1.7-9.5). Pooled rate of recurrent jaundice was 11.3% (95% CI 6.9-15.7). Heterogeneity (I2) was low to moderate in the analyses. CDD using LAMS/EC-LAMS is an effective and safe technique for biliary decompression in patients who failed ERCP. Further studies are needed to assess CDD using LAMS as primary treatment modality for biliary obstruction.

934 Endoscopic Ultrasound-Guided Drainage of Pancreatic Fluid Collections Using AXIOS Electrocautery Enhanced Delivery System a Retrospective Experience at a Large Quaternary Care Center

INTRODUCTION: Pancreatic fluid collections (PFC) are common complications of acute pancreatitis, surgery, or trauma. Many PFC reabsorb spontaneously but the remainder create cystic structures filled with fluid and/or with necrotic debris. Since the development of lumen apposing metal stents (LAMS) first line treatment of PFCs are with EUS guided drainage. However, despite the high technical and clinical success of the commonly used Electrocautery Enhanced AXIOS LAMS (EEAL), outcome data is still scarce. METHODS: An IRB approved, retrospective chart review, was performed on EUS-guided drainage of PFC using EEAL at a large quaternary care, teaching hospital. Specific procedural data including technical success rate, adverse events, and length of stay were collected. Descriptive statistics were then used to report outcomes. RESULTS: A total of 43 EEAL were used in the treatment of pancreatic pseudocysts (41.9%) and walled off pancreatic necrosis (65.1%). LAMS were placed successfully in 100% of procedures and required revisions in 28.6% of patients. Adverse events occurred in 16.3% of interventions: 2 bleeding events (4.7%), 3 stent migrations (7%), 1 pigtail stent occlusion (2.4%) and 1 spontaneous pancreatic fistula formation (2.4%). Only 2 patients (4.8%) required subsequent surgical resection. The average hospital stay after the procedure was 6.79 days (median of 3 days) and stents were ultimately removed on average at 24.68 days. CONCLUSION: This study demonstrated 100% technical success rate. Of the recorded adverse events after EEAL use in drainage of PFC most were subclinical and minor. Importantly, only two patients required further surgical intervention to obtain desired outcome. Furthermore, length of stay was particularly low with median hospital stay of 3 days. Ultimately, this study highlights how EEAL provides high value care by providing an efficient intervention in a cost-feasible length of time. Further ongoing prospective studies will help determine the utility of EEAL in the practice setting.

2181 Gallbladder Irrigation via Cholecystostomy Tube as a Novel Technique for Improving EUS-Guidance During Placement of Lumen-Apposing Metal Stent (LAMS) for Cholecystoduodenostomy

INTRODUCTION: Cholecystectomy is the preferred treatment of acute cholecystitis, but it may be relatively contraindicated in patients with medical comorbidities or advanced age. Non-surgical approaches include percutaneous transhepatic cholecystostomy tube and endosonographic stent placement. Adequate endosonographic imaging of the gallbladder is essential for correct stent deployment. CASE DESCRIPTION/METHODS: A 55-year-old male was admitted for endoscopic cholecystoduodenostomy for palliation of chronic cholecystitis. He had prior admissions for cholecystitis and choledocholithiasis with cholangitis with prior ERCPs requiring sphincterotomy, sphincteroplasty, stone removal and common bile duct stent placement. He was a poor candidate for cholecystectomy due to multiple medical comorbidities and chronic anticoagulation and was referred for endoscopic therapy. The patient was brought to the endoscopy suite and placed under general anesthesia. The Olympus linear echoendoscope was passed to the second portion of the duodenum. The gallbladder was collapsed due to prior patent sphincterotomy and sphincteroplasty. With IR assistance, the gallbladder was irrigated with normal saline boluses of to a volume of 600 mL. Due to the patent sphincterotomy, the gallbladder would collapse requiring additional irrigation. Maximal size of the gallbladder 30 mm in the long axis and 20 mm in the short axis. The duodenal wall and the gallbladder were punctured under endosonographic guidance using the hot AXIOS electrocautery-enhanced delivery system. A stoma was created and a 15 × 10 mm AXIOS stent was placed with flanges in close approximation to the gallbladder and duodenal wall through the cholecystoduodenostomy. The echoendoscope was then withdrawn. Next, a solution of normal saline and methylene blue was injected through the percutaneous cholecystostomy tube and this solution was seen to flow from the duodenal portion of the AXIOS stent on endoscopic views, confirming adequate location of the AXIOS stent in the gallbladder and duodenum. DISCUSSION: The patient did well in the immediate post-procedural period. Six days post-procedure, he was noted to have melena in the setting of supratherapeutic INR and aPTT. Repeat upper endoscopy showed no evidence of bleeding. The AXIOS stent appeared normal on endoscopic views. Due to the difficulty of stent placement and palliative intent, we left the AXIOS stent in situ. The patient is currently asymptomatic and was referred to IR for removal of percutaneous cholecystostomy tube.

Lumen-apposing metal stents for malignant biliary obstruction: Is this the ultimate horizon of our experience?

In the last years, endoscopic ultrasonography (EUS) has evolved from a purely diagnostic technique to a more and more complex interventional procedure, with the possibility to perform several type of therapeutic interventions. Among these, EUS-guided biliary drainage (BD) is gaining popularity as a therapeutic approach after failed endoscopic retrograde cholangiopancreatography in distal malignant biliary obstruction (MBO), due to the avoidance of external drainage, a lower rate of adverse events and re-interventions, and lower costs compared to percutaneous trans-hepatic BD. Initially, devices created for luminal procedures (e.g., luminal biliary stents) have been adapted to the new trans-luminal EUS-guided interventions, with predictable shortcomings in technical success, outcome and adverse events. More recently, new metal stents specifically designed for transluminal drainage, namely lumen-apposing metal stents (LAMS), have been made available for EUS-guided procedures. An electrocautery enhanced delivery system (EC-LAMS), which allows direct access of the delivery system to the target lumen, has subsequently simplified the classic multi-step procedure of EUS-guided drainages. EUS-BD using LAMS and EC-LAMS has been demonstrated effective and safe, and currently seems one of the most performing techniques for EUS-BD. In this Review, we summarize the evolution of the EUS-BD in distal MBO, focusing on the novelty of LAMS and analyzing the unresolved questions about the possible role of EUS as the first therapeutic option to achieve BD in this setting of patients.

Management of symptomatic pancreatic fluid collections using a lumen-apposing metal stent on an electrocautery-enhanced delivery system - Our preliminary observations of step-up endoscopic treatment

Management of symptomatic pancreatic fluid collections using a lumen-apposing metal stent on an electrocautery-enhanced delivery system - Our preliminary observations of step-up endoscopic treatment

Endoscopic drainage of pancreatic fluid collections by use ofanovel biflanged stent with electrocautery-enhanced deliverysystem.

Endoscopic drainage of pancreatic fluid collections by use ofanovel biflanged stent with electrocautery-enhanced deliverysystem.

Mo1310 CHOLECYSTOENTEROSTOMY AS AN ALTERNATIVE TO CONVENTIONAL TREATMENT FOR CHOELCYSTITIS AND THE ROLE OF SEROTROPIC STENTS

Laparoscopic cholecystectomy for cholecystitis is the standard of care . Percutaneous cholecystostomy is used in patients deemed unfit for surgery . Endoscopic interventions include natural orifice trans-luminal endoscopic surgery (NOTES), per-oral endoscopic trans-papillary drainage and endoscopic ultrasound- guided endoluminal gallbladder drainage. There are a few EUS- specific stents that have shown promise through decreased tissue ingrowth, leakage and migration yet ensure drainage through apposition of lumens. Our index case highlights one stent but autopsy findings did not demonstrate apposition. A 26-year-old female presented with decompensated alcoholic cirrhosis with ascites, abdominal pain and hyperbilirubinemia. After a negative serologic evaluation, we requested a magnetic resonance cholangiopancreatography (MRCP) which demonstrated multiple gallstones and a mildly thickened gallbladder wall. We performed an endoscopic ultrasound which confirmed cholelithiasis, gallbladder distention and estimated the gall bladder wall thickness to be 2.4 mm. We then performed a cholecystoduodenostomy using the AXIOS™ stent and electrocautery enhanced delivery system (AXIOS, Boston Scientific, Natick, MA). Within 24 hours, the patient showed significant improvement in her abdominal pain. Second-look esophagogastroduodenoscopy 48 hours after the initial procedure to evaluate post procedural anemia was unrevealing. Two weeks after gallbladder drainage her hepatic status worsened and she expired. We participated in a limited autopsy to evaluate the effect of the stent invivo and reviewed the histological properties of the lumen. There was evidence of focal adherence of the gallbladder to the duodenum at the site of stent deployment with circumferential serosal formation. Figure 1. The diameter of the tract was 15 mm which was the diameter of the stent used. Histology demonstrated gallbladder serosa continuous with the neo-serosa of the tract and there was no evidence of significant adhesions. Figure 2. The AXIOS™ stent is FDA approved for trans-enteric drainage of pancreatic pseudocysts but recently has been used successfully for gallbladder drainage. Data describing adherence of the gallbladder to the duodenal wall in human subjects using the AXIOS™ stent is limited. Animal model studies have shown serosal adhesion of the stomach to gallbladder at 4 weeks. We observed serosal formation rather than adhesion after two weeks. Studies indicate that adhesions occur after disruption of serosal surfaces and tissue apposition. If tissue apposition does not occur, a new serosal surface will be formed similar to cutaneous wound healing. Trans-luminal stents likely decompress and drain but also are a conduit for serosal formation without direct tissue apposition. We refer to this process as “serotropism.”Figure 2. Histology showing continuation of gallbladder serosa with neo-serosa of the drainage tract created by the stent.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Su1449 EUS-GUIDED GASTROJEJUNOSTOMY USING A LUMEN APPOSING METAL STENT IN PATIENTS WITH SYMPTOMATIC GASTRIC OUTLET OBSTRUCTION

EUS gastrojejunostomy (GJ) is emerging as an alternative novel technique in patients with symptomatic gastric outlet obstructions (GOO) who have advanced malignancy. Recent studies have shown that the EUS-guided approach has less adverse events and is more cost-effective compared to laparoscopic GJ. We share our experience of 5 patients who underwent EUS Guided GJ with favourable outcomes. Five patients with symptomatic gastric outlet obstruction underwent EUS-guided GJ interventions from May 2017 to November 2017. Patients were informed of the potential risks of this novel procedure and informed consent was taken. Technical success was defined as successful deployment of lumen apposing metal stents (LAMS); while clinical success was the ability to tolerate diet. Median age was 61.5 (Range 53-83) years. GOO was secondary to advanced pancreatic malignancy (4) and duodenal malignancy (1). Two patients had altered anatomy from previous post bilroth gastrectomy and Roux-en-Y hepaticojejunostomy. For all five patients with GOO, LAMS 15mm diameter with electrocautery-enhanced delivery system was used to create the GJ anastomosis. Identification of the distal jejunal limb was done with an inflated balloon catheter and this was use as a target for direct puncture with a 19G needle. All five interventions had technical success with median procedure time of 80min (38-163 range). All stents were dilated up to their corresponding diameters. Duration of stay after procedure was 3-7 days and there were no adverse events post procedure such as bleeding or perforation. There were no stent migrations and stents were left in place for the rest of their life expectancy. One patient developed intermittent vomiting four weeks after stent deployment. This was possibly secondary to proximal stomach deployment, as repeated endoscopy showed a patent stent. The rest of the patients had clinical success and could tolerate diet on discharge. Range of follow up time was 1-6 months and at time of analysis GOO did not recur in all 5 patients. Three patients died due to disease progression with no symptoms of GOO prior to terminal event. EUS guided GJ is a novel procedure with favourable outcomes in patients with symptomatic GOO. Further prospective studies with larger number of patients are required to compare this new technique against the gold standard laparoscopic approach.

Current uses and outcomes of lumen-apposing metal stents.

The lumen-apposing metal stent (LAMS) is one of the revolutionary devices recently developed for gastrointestinal endoscopy. This device has a saddle-shaped design and large lumen. It was originally designed for drainage of transmural pancreatic fluid collection and in the last few years it has been used extensively for that indication. More recently, other in- and off-label indications have been proposed. Several types of LAMS are available, with or without an electrocautery-enhanced delivery system. In the current review we discuss the state of the art with regard to LAMS and their indications, usage, and outcomes.

A comparison of outcomes between a lumen-apposing metal stent with electrocautery-enhanced delivery system and a bi-flanged metal stent for drainage of walled-off pancreatic necrosis.

Background and study aims Bi-flanged metal stents (BFMS) have shown promise in the drainage of walled-off pancreatic necrosis (WON), but their placement requires multiple steps and the use of other devices. More recently, a novel device consisting of a combined lumen-apposing metal stent (LAMS) and electrocautery-enhanced delivery system has been introduced. The aim of this study was to compare the placement and outcomes of the two devices. Patients and methods This was a retrospective review of consecutive patients undergoing endoscopic ultrasound-guided placement of BFMS or LAMS for drainage of symptomatic WON. Data from procedures between October 2012 and December 2016 were taken from a prospectively maintained database. We compared technical and clinical success, procedure time, costs, and composite end point of significant events (adverse events, stent migration, additional percutaneous drainage) between BFMS and LAMS. Results 72 consecutive patients underwent placement of BFMS (40 patients, 44 stents) or LAMS (32 patients, 33 stents). Technical success was 91 % for BFMS and 97 % for LAMS. Clinical success was 65 % vs. 78 %, respectively. Median in-room procedure time was significantly shorter in the LAMS group (45 minutes [range 30 – 80]) than in the BFMS group (62.5 minutes [range 35 – 135]; P < 0.001) and fewer direct endoscopic necrosectomies (DEN) were performed (median 1 [0 – 2.0] vs. 2 [0 – 3.7], respectively; P = 0.005). If only inpatients were considered (35 BFMS and 19 LAMS), there was no significant difference in DEN 2 (range 0 – 11) and 2 (range 0 – 8), respectively. The composite end point of 32 % vs. 24 % was not significantly different. Median procedural costs for all patients with successful stent placement for WON treatment was €4427 (range 1630 – 12 926) for BFMS vs. €3500 (range 2509 – 13 393) for LAMS ( P = 0.10). Conclusion LAMS was superior to BFMS in terms of procedure time, with comparable adverse events, success, and costs.

Efficacy and Safety of Self-expandable Lumen-Apposing Fully Covered Metal Stent With an Electrocautery-Enhanced Delivery System in Treatment of Pancreatic Fluid Collections

Efficacy and Safety of Self-expandable Lumen-Apposing Fully Covered Metal Stent With an Electrocautery-Enhanced Delivery System in Treatment of Pancreatic Fluid Collections

Clinical impact of EUS treatment of walled-off pancreatic necrosis with dedicated devices.

Background and study aims Walled-off pancreatic necrosis (WOPN) represents the major risk factor for sepsis-related multiple organ failure. Surgical debridement is an invasive approach associated with high rates of adverse events (AEs) and death. As an alternative, endoscopic ultrasound-guided cysto-gastro-anastomosis has emerged as an effective treatment for WOPNs. Recently a new dedicated-lumen apposing metal stent (LAMS) has been used with satisfactory results in treating peri-pancreatic fluid collections, including WOPNs. The primary outcomes of this study were to evaluate survival and clinical success. Secondary outcomes included: technical success, adverse events and recurrence rate. Patients and methods All consecutive patients with infected WOPN between February 2014 and June 2016 were retrospectively reviewed. Patients underwent placement of a new LAMS incorporated in an electrocautery-enhanced delivery system and direct endoscopic necrosectomy (DEN). DEN was performed immediately after stent deployment and repeated every 3 to 7 days until complete resolution. Results In the study period we treated 20 consecutive patients with infected WOPN using the new LAMS. Technical success was achieved in 95 % of patients. Clinical success was achieved in 73 % and 84.2 % of patients at 1 and 3 months, respectively. Survival rate was 84.2 % and 79 %. Mean length of hospital stay was 19 days (range 3 – 43). No AEs occurred. Patients were followed up after stent retrieval for a mean time of 554,7 days (range 70 – 986) and no recurrence was observed. Conclusions DEN following “1-step, exchange-free” LAMS positioning recorded excellent results. We believe that simplicity of procedure plays a key role in terms of safety.

1107 Two Cases of Afferent Loop Syndrome Treated by Eus-Guided Gastrojejunostomy With Lumen-Apposing Metal Stent Incorporated in an Electrocautery-Enhanced Delivery System

1107 Two Cases of Afferent Loop Syndrome Treated by Eus-Guided Gastrojejunostomy With Lumen-Apposing Metal Stent Incorporated in an Electrocautery-Enhanced Delivery System

A retrospective study evaluating endoscopic ultrasound-guided drainage of pancreatic fluid collections using a novel lumen-apposing metal stent on an electrocautery enhanced delivery system.

Objectives:To report the safety and clinical efficacy with the novel lumen-apposing metal stent (LAMS) with an electrocautery enhanced delivery system for the drainage of pancreatic fluid collections (PFCs).Methods:This was a retrospective analysis of all consecutive patients with PFCs who underwent endoscopic ultrasound (EUS)-guided drainage using the LAMS with an electrocautery enhanced delivery system in 2 US centers.Results:Thirteen patients with PFCs (69% with walled-off necrosis [WON]) underwent drainage using the study device. Successful stent placement was accomplished in all patients. Direct endoscopic necrosectomy was carried out in all nine patients with WON complete resolution of the PFC was obtained in all 13 cases, with no recurrence during follow-up. There was one procedure-related adverse event. In one patient, the LAMS was dislodged immediately after deployment, falling into the stomach where it was removed. A second electrocautery enhanced LAMS was placed in this patient immediately afterward.Conclusions:EUS-guided drainage using the LAMS with the electrocautery-enhanced delivery system is a safe, easily performed, and a highly effective for the drainage of PFCs.