Invasive endoscopic ultrasound

Endoscopic drainage of a symptomatic peripancreatic collection was successfully treated using the Boston Scientific HOT AXIOS® device guided by endoscopic ultrasound. Endoscopic ultrasound is a device that allows us to identify and target structures around the stomach and small/colon and HOT AXIOS® is a (one in all device) device that allows us to deploy a special metal stent that can communicate and contrast cystic collections with the lumen of a hollow viscera (bowel-stomach).

The patient was admitted to the Clinic with a moderately severe pancreatitis as a complication of which, 4 weeks later, a walled off necrosis developed. This effusion had a maximum diameter of 9cm, occupied the retroperitoneal space from the level of the stomach to the pelvis and caused severe abdominal discomfort, nausea with vomiting and due to the above significant weight loss. A 20x10mm HOT AXIOS® was placed endoscopically in the patient under the guidance of endoscopic ultrasound and the collection was successfully drained into the body of the stomach. At re-examination, 6 weeks later, the effusion had almost disappeared.

Images 1a:
Walled off necrosis (WON) in the head region of the pancreas which compresses the stomachImages 2a:
Drainage of the collection in the stomach. Stomach full of contrast media. CT 4 weeks after drainage.

Historically, these collections were initially treated surgically with open laparotomy and drainage of the collection either into the stomach (cysto-gastric anastomosis) or externally into the skin, while later drainage of these collections was performed percutaneously by interventional radiologists, creating the need for either a multi-day hospital stay or the presence of a drainage in the skin. Today, with the use of this innovative device via endoscopic ultrasound, these collections can be treated endoscopically without the need for hospitalization, without the need for post-operative recovery of the patient and therefore lower costs and greater safety, and the device allows for future endoscopic visit and cleaning of the cystic collection.

Figures 1b:
Tail extension of WONFigures 2b:
Complete elimination of the collection 4 weeks later

Endoscopic ultrasound and this device have revolutionized endoscopy in recent years, as their applications have been increasing, many of which are highly innovative, such as the creation of endoscopic choledocho-gastric anastomosis, biliary-cysto-gastric anastomosis and gastro-enteroanastomosis, removing the need for surgical interventions and enabling even patients who are not surgical candidates, either due to co-morbidities or age, to be treated with less risk and corresponding efficacy.

Images 1c, 1d:
Tail extension of WONImages 2c, 2d:
Complete elimination of the collection 4 weeks later