ASGE Endoscopy Live: Interventional EUS and Endo-Hepatology (On-Demand) | 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 (post-cholecystectomy). Endoscopy shows gastric compression from a ~10 cm collection involving the body/tail; EUS confirms mostly fluid with minimal debris and close adherence to the gastric wall. After Doppler confirms no intervening vessels and wall distance is minimal, she selects a 20 mm × 10 mm lumen-apposing metal stent (AXIOS), favoring larger diameter for rapid resolution and potential future necrosectomy access (though necrosectomy is not indicated here). She intubates for procedural control and aspiration prevention and gives antibiotics (ceftriaxone, then oral course). Deployment steps and positioning landmarks (black marks) are reviewed, emphasizing the assistant’s role. Panel discussion covers stent choice (metal vs plastic), when to use double-pigtail stents, maldeployment rescue strategies, and necrosectomy timing evidence. Follow-up: CT at 3–4 weeks, remove LAMS to reduce adverse events, and consider ERCP then to assess duct leak/disconnection and place plastic stents if needed.

Asset Subtitle

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

Keywords

EUS-guided pancreatic fluid collection drainage

lumen-apposing metal stent (AXIOS) placement

walled-off pancreatic necrosis vs pseudocyst management

Doppler assessment for intervening vessels

LAMS maldeployment rescue strategies

follow-up CT and stent removal with ERCP for pancreatic duct leak