STENT SELECTION AND TIPS FOR ENDOSCOPIC TREATMENT OF WALLED-OFF NECROSIS

Abstract

Hot AXIOS^TM (Boston Scientific, Marlborough, MA) as a lumen-apposing metal stent (LAMS) can be used when performing endoscopic ultrasound (EUS)-guided transluminal drainage of walled-off necrosis (WON) and pancreatic pseudocysts, and the endoscopic treatment strategy has changed significantly. The larger bore diameter of LAMS compared with that of conventional plastic and metal stents makes it possible to obtain greater drainage volume, and endoscopists can easily perform necrosectomy using LAMS in which the endoscope is directly inserted into the cavity of WON and used to remove necrotic material. If the WON is not so large and the WON lumen is mostly filled with fluid, plastic stent placement can improve WON without necrosectomy. On the other hand, LAMS should be used if there is a wide spread of necrotic tissue and if necrosectomy is expected to be performed. Endoscopic treatment of WON is associated with fatal adverse events, and therefore radiologists and surgeons should be prepared with back-up plans.