Endoscopy 2019; 51(04): S47
DOI: 10.1055/s-0039-1681308
ESGE Days 2019 oral presentations
Friday, April 5, 2019 11:00 – 13:00: Video EUS 2 South Hall 1A
Georg Thieme Verlag KG Stuttgart · New York

ENDOSCOPIC ULTRASOUND (EUS)-GUIDED SINGLE-STEP MULTIPLE GATEWAY DRAINAGE OF COMPLEX WALLED-OFF NECROSIS (WON) WITH LUMEN APPOSING METAL STENT (LAMS): A PRELIMINARY EXPERIENCE

C Fabbri
1   Unit of Gastroenterology and Digestive Endoscopy, Forlì-Cesena, AUSL Romagna, Forlì-Cesena, Italy
,
C Binda
2   Internal Medicine, Gastroenterology and Liver Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
,
E Dabizzi
3   Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna Bellaria-Maggiore Hospital, Bologna, Italy
,
M Fiscaletti
4   Department of Radiology, AUSL Bologna Bellaria-Maggiore Hospital, Bologna, Italy
,
E Jovine
5   Department of Surgery, AUSL Bologna Bellaria-Maggiore Hospital, University of Bologna, Bologna, Italy
,
A Gasbarrini
2   Internal Medicine, Gastroenterology and Liver Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
,
V Cennamo
6   Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna Bellaria-Maggiore Hospital, Bologna, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 

Background:

EUS-guided drainage is suggested as the first approach in the management of symptomatic, complicated WON. A step-up approach is proposed in case of either refractory or complex collections. Recently, a new LAMS with an integrated electrocautery delivery system have been developed, facilitating drainage, reducing procedural timing and hospital stay. Although a single transluminal access is preferred, multiple step-up gateway technique is proposed in case of multiple, large or low-responding WON.

Methods:

We present our preliminary experience on patients with symptomatic complex WON, defined as large (> 12 mm), septated or multiple, drained with a single-step, multiple gateway technique using EC-LAMS. All procedures were performed after 4 weeks from the onset and conservative treatment failure. Patients demographic, technical and clinical success, procedure time, necrosectomy sessions, further treatment needed, adverse events and post-procedure hospitalization were recorded and statistically analyzed.

Results:

This is a retrospective analysis of prospective collected data of five consecutive patients with symptomatic complex WON. WON were single with septa in 3 patients, multiple in 2 patients. 10 EC-LAMS were deployed with both transgastric and transduodenal approach. Technical success was 100%. The mean time for procedure was 29 min. Necrosectomy was completed in up to 3 sessions, achieving clinical success in 3 cases (80%), with no recurrence in all the patients. One patient required a concomitant percutaneous drainage. We reported one moderate bleeding, in the first post-operative day (POD) treated endoscopically and one severe bleeding, on 10th POD, requiring embolization and surgery with concomitant necrosectomy.

Conclusion:

Patients affected by multiple, septated, large WON can be considered “hard-to-treat-patients” and a single gateway could represent an insufficient treatment. Our case series showed that a single-step multiple gateway technique using EC-LAMS is safe and feasible.

However further prospective, randomized, controlled studies are needed to define the long-term outcomes of this approach.