CASES OF THE WEEK – “Endoscopic Ultrasound guided drainage of large walled off pancreatic necrosis (Pseudocyst with solid necrosis) with metallic AXIOS stent” by Dr Piyush Somani, Specialist Gastroenterology

Endoscopic Ultrasound guided drainage of large walled off pancreatic necrosis (pseudocyst with solid necrosis) with metallic AXIOS stent

History: A 16 years old male, presented with intermittent abdominal pain with early satiety. There was a recent past history of acute idiopathic severe necrotizing pancreatitis in July, 2020. CT abdomen was suggestive of large (12 cm X 11 cm) walled off peri-pancreatic fluid collection with solid necrosis suggestive of walled off pancreatic necrosis (WOPN). This WOPN was compressing the stomach wall. In view of symptomatic WOPN patient underwent Endoscopic Ultrasound (EUS) which revealed large well circumscribed, encapsulated 11 cm X 10 cm lesion with hyper echoic solid necrotic debris.

Using HOT AXIOS (15 mm diameter X 10 mm length) electrocautery Enhanced metallic stent, the WOPN was punctured with the catheter.

First the distal flange and then the proximal flange of the HOT AXIOS stent was released. The proximal end of stent was visualized in the fundus of stomach with dark brownish yellowish thick fluid with solid necrotic debris coming out from WOPN. The fluid was continuously aspirated.

There was no bleeding or any other complications during drainage and after insertion of stent.

In summary, Endoscopic Ultrasound (EUS) guided drainage of large walled off pancreatic necrosis is a highly advanced endoscopic technique available only in few hospitals in UAE.

It is minimally invasive technique for the drainage of large, symptomatic pancreatic pseudocysts and peripancreatic walled off necrosis.

This is the first case of EUS guided drainage performed in Al Zahra Hospital, Sharjah.