OC-073 The First Multicentre Experience from The UK and Ireland of the Use of the Hot Axios System for Transluminal Drainage of Pancreatic Fluid Collections

Abstract

IntroductionPancreatic fluid collections (PFC) are a common local complication of pancreatitis with incidences of 5–16% and 20–40% in acute and chronic pancreatitis, respectively.1 Classification of PFC includes acute peripancreatic fluid collection, pancreatic pseudocyst, acute necrotic collection and walled-off necrosis (WON). A new lumen-apposing, covered self-expanding metal stent on a catheter-based delivery system (Hot AXIOS, Boston Scientific) may have higher technical success rates, easier deployment and lower migration than plastic stents. We present the first multicentre prospective case series from the UK and Ireland to assess success and complication rates associated with Hot AXIOS stent for the drainage of PFC.MethodsAll adult patients who had Hot AXIOS stent placement for PFC from July 2015-February 2016 were included. Eight centres participated (London, Glasgow, Edinburgh, Newcastle, Cambridge, Manchester, Dublin and Leeds). All patients had CT of the PFC prior to placement. Data including technical success, resolution of collection, complications and stent migration were collected.ResultsForty patients were treated with a single Hot AXIOS stent in each case. The median age was 57 years (range 31–78). 25 were male and 15 female. Indications were WON (24), pseudocyst (15) and abscess.1 The median size of the PFC was 11 cm (4–20 cm). Thirty-eight patients (95%) had trans-gastric stents, 1 had trans-duodenal and 1 had a trans-oesophageal stent. Procedures were technically successful in all patients.Of 22 patients with available follow-up data to date, the collection resolved in 19 (86%) and reduced in size in 3 (14%). The median time to resolution was 36 (7–208) days. Twelve patients (30%) had 33 necrosectomies and/or endoscopic lavage following stent insertion.Stents migrated out in 2 patients and was displaced during necrosectomy in 1. Serious adverse events occurred in 1/40 (2.5%): a small bowel obstruction resulting from stent migration, managed surgically. There was no procedure related or 30 day mortality (data available in 27 patients).ConclusionThis multicentre case series demonstrates that the Hot AXIOS system is safe and effective in draining PFC with a technical success rate of 100% and low serious adverse event rate.Reference1 Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis—2012: Revision of the Atlanta classification and definitions by international consensus. Gut 2013.Disclosure of InterestNone Declared

A comparison of outcomes between a lumen-apposing metal stent with electrocautery-enhanced delivery system and a bi-flanged metal stent for drainage of walled-off pancreatic necrosis

“…A recent study, using the previous generation LAMS (AXIOS; Boston Scientific), showed superiority of LAMS over plastic stents but with more adverse events 8 . In contrast, in our study of the second-generation device, the adverse event rate (utilizing the same definitions of bleeding, perforation, and misplacement) was low (3 %), and other studies of the device have also reported very low procedural adverse events 9 10 . A possible explanation is that placement of the first-generation device requires the same multiple steps and therefore potential for adverse events as other metal and plastic stents.…”

“…Conversely, a recent report from an ongoing randomized controlled trial of the second-generation LAMS and plastic stents for drainage of WON reported a very high rate of stent-related bleeding for LAMS (n = 3/12; 25 %) 124. However, other larger registry-based studies have not reported a similar problem 9 10 25 , and neither did our series, with fewer immediate adverse events. The results of the completed study are awaited.…”

“…This enables a single device to be used when previously multiple devices and steps were required. The literature on the use of this device is limited to a few multicenter registry studies 9 10 . The second-generation LAMS is considerably more expensive than previous devices, and studies comparing BFMS with the new-generation, single-step LAMS are lacking.…”

Adverse events associated with AXIOS stents

“…Small retrospective studies have demonstrated that the AXIOS stent has a higher technical success rate (98.9%) when compared to fully covered self-expanding metal stents and double pigtail stents. [ 2 10 11 12 ] These studies also concluded that the AXIOS stent achieves a PFC clinical resolution rate in 92.5% of cases. [ 2 10 11 12 ] The reported complication rate in these studies ranged from 5% to 9.4%.…”

Advancing the diagnostic and therapeutic role of EUS in pancreaticobiliary disease: Hopkins Lecture 2016

“…Endoscopic necrosectomy is not a procedure in isolation, but part of the repertoire of a specialist pancreatic unit, and specialist multi disciplinary team (MDT) discussion is critical. A new generation of single device lumen apposing metal stents has recently become available; the UK experience of its use for drainage of pancreatic fluid collections21 has recently been presented. We have also demonstrated that it can be used for EUS-guided drainage of the gall bladder 22…”