Case Report
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World J Gastrointest Endosc. Apr 16, 2012; 4(4): 148-150
Published online Apr 16, 2012. doi: 10.4253/wjge.v4.i4.148
Covered self expandable metallic stent with flared plastic one inside for pancreatic pseudocyst avoiding stent dislodgement
Ilaria Tarantino, M Di Pisa, Luca Barresi, Gabriele Curcio, Antonino Granata, Mario Traina
Ilaria Tarantino, Luca Barresi, Gabriele Curcio, Antonino Granata, Mario Traina, Marta Di Pisa, Department of Gastroenterology and Digestive Endoscopy, Mediterranean Institute for Transplantation and Advanced Specialized Therapies ISMETT/University of Pittsburgh Medical Center, 90100 Palermo, Italy
Author contributions: Tarantino I wrote the paper; Di Pisa M, Barresi L, Curcio G, and Granata A reviewed the literature; Traina M critically revised the manuscript.
Correspondence to: Ilaria Tarantino, MD, Gastroenterology Mediterranean Institute for Transplantation and Advanced Specialized Therapies ISMETT/University of Pittsburgh Medical Center, 90100 Palermo, Italy. itarantino@ismett.edu
Telephone: +39-3357357728 Fax: +39-3357357728
Received: April 15, 2011
Revised: January 10, 2012
Accepted: March 30, 2012
Published online: April 16, 2012
Abstract

Endoscopic ultrasound-guided drainage has recently been recommended for increasing the drainage rate of endoscopically managed pancreatic fluid collections and decreasing the morbidity associated with conventional endoscopic trans-mural drainage. The type of stent used for endoscopic drainage is currently a major area of interest. A covered self expandable metallic stent (CSEMS) is an alternative to conventional drainage with plastic stents because it offers the option of providing a larger-diameter access fistula for drainage, and may increase the final success rate. One problem with CSEMS is dislodgement, so a metallic stent with flared or looped ends at both extremities may be the best option. An 85-year-old woman with severe co-morbidity was treated with percutaneous approach for a large (20 cm) pancreatic pseudocyst with corpuscolated material inside. This approach failed. The patient was transferred to our institute for EUS-guided transmural drainage. EUS confirmed a large, anechoic cyst with hyperechoic material inside. Because the cyst was large and contained mixed and corpusculated fluid, we used a metallic stent for drainage. To avoid migration of the stent and potential mucosal growth above the stent, a plastic prosthesis (7 cm, 10 Fr) with flaps at the tips was inserted inside the CSEMS. Two months later an esophagogastroduodenoscopy was done, and showed patency of the SEMS and plastic stents, which were then removed with a polypectomy snare. The patient experienced no further problems.

Keywords: Pancreatic pseudocyst; Self expandable metallic stent