PWE-073 EUS-guided drainage of peripancreatic fluid collections: hot axios experience from a tertiary referral centre

• Published in: Gut Vol. 68; no. Suppl 2; p. A161
• Main Authors: Peerally, Mohammad Farhad, Goldie, Fraser, Savva, Sophia, Khan, Farooq, Kadri, Sudarshan
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.06.2019
• Subjects: Data collection; Disease management; Electronic medical records; Endoscopy; Fentanyl; Gastroenterology; Implants; Midazolam; Migration; Mortality; Pancreas; Stents; Success; Ultrasound; Wound drainage
• ISSN: 0017-5749; 1468-3288
• DOI: 10.1136/gutjnl-2019-BSGAbstracts.304

IntroductionEndoscopic management of peripancreatic fluid collections (PFCs) has a high success rate and low mortality rate but plastic stents may be associated with high rates of blockage (18%) while stent migration (15%) remains an issue for tubular self-expanding metallic stents.1 The Hot-Axios (Boston Scientific) device offers a one-step combined diathermy-enabled access and deployment of a lumen-apposing self-expanding metal stent (LASEM). The aim of this study was to investigate the efficacy and safety of the Hot-Axios device for the management of patients with PFCs referred to a regional tertiary centre.MethodsThis was a single-centre retrospective database study involving 27 consecutive patients who underwent drainage of PFCs using the Hot Axios device between 1stJanuary 2018 and 1st of January 2019. Data was obtained by interrogating GI reporting tool (Unisoft) and electronic health record systems, and is reported using simple descriptive statistics.Results28 procedures were performed in 27 patients (20 males (74%), average age 57). 27 stents(96%) were successfully placed. Clinical success rate was 89% (25 procedures, 2 increased in size due to complications, 1 had no change in size). 27(96%) procedures were performed under conscious sedation (median doses: 3 mg (range:1–6) Midazolam and 50 mcg of Fentanyl (range 25–100)). Stents remained in situ for an average of 55 days. 71% (20 procedures) required further washout (mean 1.4(1–5)). There was 1 perforation (4%), 2 blocked stents (7%), 2 migration (7%). 30 day mortality was 7% (2 patients- due to pseudoaneursymal bleed unrelated to the procedure).ConclusionEUS-guided management of PFCs using the Hot-Axios device offers high technical and clinical success rates, and low adverse event rates. Long term efficacy and safety data comparing plastic, conventional metal stents and LASEMs in a randomised controlled trial is required.ReferencesPatil R, Ona MA, Papafragkakis C, Anand S, Duddempudi S. Endoscopic ultrasound-guided placement of AXIOS stent for drainage of pancreatic fluid collections. Annals of Gastroenterology: Quarterly Publication of the Hellenic Society of Gastroenterology. 2016;29(2):168.