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Revista Española de Enfermedades Digestivas
versão impressa ISSN 1130-0108
Rev. esp. enferm. dig. vol.110 no.4 Madrid Abr. 2018
https://dx.doi.org/10.17235/reed.2018.5411/2017
LETTERS TO THE EDITOR
Late migration of a metal stent after EUS-drainage of a pancreatic pseudocyst abscess
1Unidad de Gestión Clínica de Aparato Digestivo. Hospital Universitario Virgen Macarena. Sevilla, España
Key words: Drainage; Endoscopic ultrasound; Self-expanding metal stent; Migration
Dear Editor,
Endoscopic ultrasound (EUS)-guided drainage of pancreatic collections has replaced surgery as the first line of treatment due to its accuracy and safety profile 1,2. A higher success rate and fewer adverse events have been observed using fully covered metal stents for drainage 3,4. However, complications of EUS-guided drainage can occur in 1-18% of cases, the most frequent being acute bleeding, perforation, post-procedure infection and stent migration 5.
Case report
A 61-year-old female patient with a history of hypertension and obesity was admitted due to acute biliary pancreatitis. Abdominal computed tomography (CT) on admission showed necrosis greater than 75% and peripancreatic collections. The evolution was torpid, with an abscess collection in the tail of the pancreas. An EUS-guided drainage was performed and a fully covered lumen-apposing metal stent (Hanarosten(r); 12 mm diameter/4 cm length) was deployed with a 10F plastic double pigtail (Cook Medical(r), Baeswiler; Germany) inserted alongside.
Another 10F plastic double pigtail was inserted during another endoscopic session 19 days later (Fig. 1A). The patient underwent a progressive clinical, analytical and radiological improvement and was eventually discharged. Eight weeks later, an abdominal magnetic resonance imaging (MRI) showed complete resolution of the collection. Gastroscopy was performed to remove the stents, without visualizing them. An abdominal CT showed that the stents had lodged in the descending colon lumen, producing an increase in the pericolic fat (Fig. 1B), without signs of perforation. A colonoscopy with a pneumatic dilation up to 13.5 mm was required for their successful removal.
Bibliografía
1. Fusaroli P, Jenssen C, Hocke M, et al. EFSUMB Guidelines on Interventional Ultrasound (INVUS). Part V - EUS-Guided Therapeutic Interventions (short version). Ultraschall Med 2016;37(4):412-20. DOI: 10.1055/s-0035-1553742 [ Links ]
2. Itoi T, Binmoeller KF, Shah J, et al. Clinical evaluation of a novel lumen-apposing metal stent for endosonography-guided pancreatic pseudocyst and gallbladder drainage (with videos). Gastrointest Endosc 2012;75(4):870-6. DOI: 10.1016/j.gie.2011.10.020 [ Links ]
3. Tyberg A, Karia K, Gabr M, et al. Management of pancreatic fluid collections: a comprehensive review of the literature. World J Gastroenterol 2016;22(7):2256-70. DOI: 10.3748/wjg.v22.i7.2256 [ Links ]
4. Weilert F, Binmoeller KF, Shah JN, et al. Endoscopic ultrasound-guided drainage of pancreatic fluid collections with indeterminate adherence using temporary covered metal stents. Endoscopy 2012;44(8):780-3. DOI: 10.1055/s-0032-1309839 [ Links ]
5. Vilmann AS, Menachery J, Tang S-J, et al. Endosonography guided management of pancreatic fluid collections. World J Gastroenterol 2015;21(41):11842-53. DOI: 10.3748/wjg.v21.i41.11842 [ Links ]