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EUS-guided Transgastric Drainage of a Post-pancreatectomy Abdominal Fluid Collection Using a Lumen-apposing Metal Stent

Trindade, Arvind Julius*,†; Rahman, Merajur*; Inamdar, Sumant*; Bitton, Samuel

Journal of Pediatric Gastroenterology and Nutrition: October 2017 - Volume 65 - Issue 4 - p e95
doi: 10.1097/MPG.0000000000001575
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*Division of Gastroenterology, Hofstra Northwell School of Medicine, Long Island Jewish Medical Center

Department of Pediatric Gastroenterology, Hofstra Northwell School of Medicine, Cohen Children's Medical Center Northwell Health System, New Hyde Park, NY.

Address correspondence and reprint requests to Dr Arvind Julius Trindade, MD, Division of Gastroenterology, Long Island Jewish Medical Center, 270-05 76th Ave, New Hyde Park, NY 11040 (e-mail:

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (

The authors report no conflicts of interest.

Submissions for the Image of the Month should include high-quality TIF endoscopic images of unusual or informative findings. In addition, 1 or 2 other associated photographs, such as radiological or pathological images, can be submitted. A brief description of no more than 200 words should accompany the images. Submissions are to be made online at, and will undergo peer review by members of the NASPGHAN Endoscopy and Procedures Committee, as well as by the Journal.

Although percutaneous drainage was traditionally the standard for drainage of post- pancreatectomy abdominal fluid collections (AFCs), endoscopic ultrasound (EUS)–guided drainage of AFC is now standard (1,2). No literature exists on EUS-guided drainage of AFCs using lumen-apposing metal stents (LAMS). Successful application of LAMS has been described for drainage of pseudocysts and walled off pancreas necrosis in adult (3) and pediatric gastroenterology (4,5). We report the use of a LAMS, in a pediatric patient, to successfully drain a persistent postsurgical AFC that failed percutaneous drainage by interventional radiology (Supplemental Digital Content 1, Video, and Supplemental Digital Content 2, Video notes, A 16-year-old girl underwent a distal pancreatectomy for a solid pseudopapillary tumor of the pancreas with a resulting AFC. Figure 1 shows the post-pancreatectomy AFC after 2-failed percutaneous drainage procedures. A 10 mm × 10 mm lumen-apposing stent with an electrocautery delivery system was placed under EUS guidance. Figure 2 demonstrates the endoscopic and radiologic views of the LAMS. On 5-weeks of follow-up, the patient is doing well without symptoms. This case demonstrates that LAMS can be successfully used to drain AFCs that have mature walls and abuts the stomach. To our knowledge, this is the first reported case of use of LAMS for drainage of post-pancreatectomy AFC.





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5. Trindade AJ, Inamdar S, Bitton S. Pediatric application of a lumen-apposing metal stent for transgastric pancreatic abscess drainage and subsequent necrosectomy. Endoscopy 2016; 48 (suppl 1):E204–E205.

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© 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,