ASGE Endoscopy Live: Interventional EUS and Endo-Hepatology | July 2023-7-13-23 Endoscopy Live Case Demonstration 1

Video Transcription

Video Summary

Dr. Ji Young Bang (Orlando Health) demonstrates EUS-guided drainage of a symptomatic pancreatic fluid collection in a 70-year-old with prior gallstone pancreatitis (2020) and cholecystectomy. The collection is ~10 cm, compressing the stomach, mostly fluid with minimal debris and well apposed to the gastric wall. After Doppler confirms no intervening vessels and a short wall distance (~3 mm), she places a 20 mm × 10 mm lumen-apposing metal stent (AXIOS), favoring 20 mm for faster resolution and easier access if necrosectomy were needed (though not indicated here). She uses prophylactic antibiotics (ceftriaxone) and prefers intubation for procedural control and aspiration prevention. Panelists discuss stent choice (metal vs plastic, individualized; plastic favored for disconnected/obstructed duct), managing maldeployment, and when to perform necrosectomy (same-session for infected necrosis, otherwise often drainage alone). Follow-up: 7 days antibiotics, CT at 3–4 weeks, remove LAMS at 3–4 weeks, and consider ERCP then to assess duct leak/disconnection and possibly place plastic stents.

Asset Subtitle

EUS-guided pancreatic fluid collection drainage
Endoscopist: Dr. Ji Bang

Keywords

EUS-guided drainage

pancreatic fluid collection

lumen-apposing metal stent (AXIOS)

gallstone pancreatitis

necrosectomy decision-making

ERCP for pancreatic duct disconnection