Abstract
Background Recently, a novel lumen-apposing fully covered self-expanding metal stent (LA-FCSEMS)
mounted on an electrocautery-enhanced delivery system has been developed to perform
endoscopic ultrasound (EUS)-guided transluminal drainage. From early experience, however,
release of the proximal flange of the stent has mostly been done using endoscopic
view guidance to ensure proper positioning.
Aim We describe a new technique that we have named the Intra-Channel Stent Release Technique
(ICSRT) to perform stent placement under complete EUS control, without the use of
either fluoroscopic or endoscopic views.
Material and methods Data on all consecutive patients who underwent EUS-guided drainage using the new
ICSRT between June 2014 and April 2016 were retrospectively retrieved from two institution
databases. All EUS procedures were performed by experienced endoscopists with the
patient under conscious or deep sedation. The total procedure and stent deployment
time, and adverse events related to stent positioning with the ICSRT were evaluated.
Results One hundred consecutive patients (51 women; mean age ± SD, 66 ± 15.2 years, range
34 – 95) underwent EUS-guided transluminal drainage with the Hot AXIOS™ device using
the new ICSRT. The procedure was technically successful in all but one patient (1 %).
The mean total procedural time was 21.9 minutes (range 7 – 50), while the mean time
for stent placement was 3.2 minutes (range 1 – 15). No major adverse events occurred.
Discussion The ICSRT has been used to deploy the newly developed lumen-apposing FCSEMS under
complete EUS guidance without fluoroscopic and/or endoscopic assistance. The technique
appears to be safe and highly effective and should be learned by all interventional
endosonographers in order to be able to perform drainage in all clinical scenarios.
