A kit for eus-guided access and drainage of pancreatic pseudocysts: efficacy in a porcine model

Kenneth F Binmoeller, Ioana Smith, Monica Gaidhane, Michel Kahaleh, Kenneth F Binmoeller, Ioana Smith, Monica Gaidhane, Michel Kahaleh

Abstract

Objective: Transluminal pseudocyst drainage with currently available tools remains technically challenging, time consuming and limited to fluid collections adherent to the GI tract. Multiple tools and steps are still required to achieve pseudocyst drainage. We evaluated a novel kit to facilitate endoscopic ultrasonography (EUS)-guided access, drainage and rapid decompression in a porcine model.

Methods: The kit consists of the NAVIX access device and the AXIOS stent delivery system. The NAVIX contains an inner trocar for puncture and an outer dual balloon catheter for anchorage and dilation. The AXIOS stent is a fully covered dual flanged stent. Both are inserted through the working channel of a curved linear array echoendoscope. In a porcine model, a gallbladder was used as a proxy for a pseudocyst.

Results: Six Yorkshire pigs underwent this procedure successfully without complication and 3 of them were kept alive. After a 4-week implantation period, the AXIOS stents were removed easily using a snare and the 3 animals were observed for an additional 4 weeks. The stents were well-tolerated by the stomach and gallbladder tissues, as confirmed by weekly endoscopic inspection, gross necropsy and histopathology.

Conclusion: EUS-guided transluminal access and drainage of the porcine gallbladder was technical feasible using a novel kit. This kit has the potential to simplify, streamline, and improve the safety of pancreatic pseudocyst drainage.

Keywords: endoscopic ultrasonography; pancreatic fluid collection; pancreatitis; pseudocyst.

Figures

Figure 1
Figure 1
AXIOS Stent.
Figure 2
Figure 2
NAVIX access device.
Figure 3
Figure 3
Fluoroscopic image of cannulation of gallbladder via the stent.
Figure 4
Figure 4
Fluoroscopic image of the AXIOS stent creating a cholecystoenterostomy.
Figure 5
Figure 5
Dual-flanged stent having a 10-mm lumen diameter as seen from the stomach.
Figure 6
Figure 6
Patent stent 7 days post-procedure.
Figure 7
Figure 7
Pig #4509. A: Fibrous tissue pathway; B: Occluded stent pathway.
Figure 8
Figure 8
Pig #4512. A: Tunnel at the stomach end; B: Colon invagination.

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Source: PubMed

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