A CASE OF AN IMPRISONED HOT-AXIOS STENT

Aims:

Hot-Axios stent are indicated to facilitate transgastric or transduodenal endoscopic drainage of pancreatic pesudocystys. The removal of the stent is programmed after 4 – 6 weeks. Up to now, no case of imprisoned Hot-Axios has been reported.

Methods:

We describe the case of a patient who came back to our attention 6 months after being lost at follow-up for an Hot-Axios stent placement for transgastric drainage of a pancreatic pseudocyst.

Results:

At first examination, the 50 years old patient presented with hyporexia, abdominal pain and hyperamylasemia due to an increasing pseudocyst, result of a previous haemorrahagic acute pancreatitis the year before. A first EUS showed a voluminous cyst (100 × 60 mm) with liquid content and minimal debris. We decided to perform EUS-guided drainage with an Hot-Axios stent (15 × 10 mm) obtaining immediate emptying of the pseudocyst. The day after the procedure, a transabdominal US confirmed the correct placement of the stent and a decrease in cystic volume (from 100 to 48 mm). The stent removal was scheduled after 4 weeks but we lost the patient for 6 months when an attempt to remove Hot Axios has been made. With a pre-cut needle we excised the gastric mucosa grown over the gastric edge of the stent and we tried, unsuccessfully, to remove it with a biopsy forceps then with a polipectomy snare. All attempts failed because of granulation tissue growth over the pseudocyst edge of the stent, as confirmed by a subsequent CT. After multidisciplinary evaluation with abdominal surgeons and radiologists, the surgical removal of the stent was rejected due to the young age of the patient and the absence of symptoms. A close follow-up was scheduled.

Conclusions:

The patients has no symptoms, normal blood tests and no pseudocyst left, along with the imprisoned Hot-Axios with no worrisome signs on a recent MRI.