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Utilization of Lumen-Apposing Metallic Stent for the Drainage of Peri-Digestive Fluid Collections in Pediatric Population: A Case Series


Javed, Safeera MD1; Rivas, Yolanda MD2; Novak, Inna MD2; Ho, Sammy MD, FASGE, FACG, NYSGEF3

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American Journal of Gastroenterology: October 2016 - Volume 111 - Issue - p S705-S706
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Introduction: Lumen-apposing self-expandable metallic stent (LASEMS) has gained wide popularity because of its increased use for various indications such as drainage of pancreatic fluid collections (PFCs), gallbladders and peri-digestive collections. Several studies have looked at the efficacy of LASEMS in adult population. To our knowledge this is the first case series that describes the use of LASEMS in pediatric population.

Cases: An 18-year-old boy developed perirectal abscess as complication of perforated appendicitis. Under endosonographic guidance, a 15mm LASEMS was deployed into the abscess cavity. Interval imaging in one month showed resolution of the abscess and the stent was removed through sigmoidoscopy. An 11-year-old boy with gallstone pancreatitis was admitted for drainage of pancreatic cyst. MRCP revealed a complex 12 x 7.3 cm, peri-pancreatic collection, consistent with walled off necrosis. Patient had EUS-guided cyst-gastrostomy, during which a 15 mm LASEMS was deployed into the cyst cavity. Interval imaging in one month showed reduction in the size of the cyst, but continued internal debris. Patient subsequently had successful endoscopic debridement of the necrotic cavity through the stent. An 11-year-old girl presented with abdominal pain and vomiting, and was found to have 10 x 10cm peri-pancreatic fluid collection, consistent with pseudocyst. Under endosonographic guidance a 15 mm LASEMS was deployed into the cyst cavity. A subsequent MRCP showed interval decrease in size of the pseudocyst.

Discussion: Drainage of peri-digestive fluid collections has historically been technically challenging. Traditional endoscopic management of PFCs included the use of pig-tail catheters and biliary metal stents. These stents had several limitations as they were not specifically designed for transluminal drainage. The LASEMS tends to overcome these limitations. This stent has a dumbbell configuration which enables anchorage and prevents stent migration. Upon full expansion, the stent has a large diameter, which allows for apposition of the two lumens and prevents leakage. The lumen of the stent is large enough to accommodate passage of an endoscope, which in turn enables therapeutic maneuvers such as endoscopic necrosectomy. Treatment success rates exceeding 90% have been reported for PFCs in elderly population. This series demonstrates the safety and efficacy of LASEMS for treating PFCs and peri-digestive abscesses in pediatric population.

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