1071 the Use of Novel Modified Endoscopic Vacuum Therapies in the Management of a Transmural Rectal Wall Defect

Abstract

recanalization and remodeling sequentially performed. EUS-PG and transpapillary pseudocyst drainage by ERCP with dual fully covered SEMS are performed in a single-session at Stage-1. Early inward migration of PG-SEMS requires distal repositioning through another EUS-guided puncture of the migrated SEMS one week after initial placement. At 2-months from the index procedure and after pseudocyst resolution is confirmed by CT, SEMS removal, antegrade rendezvous recanalization of DPDS with retrograde through-and-through double-pigtail stent placement across the papilla, the disconnected PD and the PG fistula are performed at Stage-2. Eventually, 9-months after the index procedure, the transpapillary-transgastric double-pigtail stent is exchanged for a transpapillary intraductal 10F-plastic stent across the DPDS at Stage-3, pending definitive stent removal. The patient remains asymptomatic since successful PG drainage 19-months later. The disconnected PD is now succesfully bridged and the disruption partially remodeled (reconnected PD). Conclusions: DPDS recognition requires attention to history, symptoms and imaging. Initially failed endoscopic recanalization may be overcome at a second attempt following drainage of an intervening pseudocyst. This treatment strategy is labor-intensive and not without risks, but it appears to be more physiological and less invasive than pancreatectomy and it also avoids the inconvenience of percutaneous drainage catheters over a prolonged time span.