Shin I.S.1, Moon J.H.1, Lee Y.N.1, Min C.W.1, Lee J.W.1, Lee T.H.2, Yang J.K.2, Cha S.W.3, Cho Y.D.3, Park S.H.2

1Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon, South Korea,  2Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Cheonan, South Korea 3Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Seoul, South Korea

Background/Aims: Endoscopic ultrasound-guided transmural drainage (EUS-TD) using lumen-apposing metal stents (LAMS) is effective, but the procedure requires multiple steps increasing the risks of adverse events. A novel electrocautery system for one-step endoscopic ultrasound-guided drainage using a LAMS was introduced to overcome the complexity. The purpose of this study was to evaluate the effectiveness and safety of the novel electrocautery-enhanced delivery system for one-step endoscopic ultrasound-guided drainage using LAMS.

Methods: A total of 30 patients underwent EUS-TD using LAMS (Niti-S Hot Spaxus, Taewoong Medical, Korea) with one step electrocautery system for pancreatic fluid collections(PFCs), malignant biliary obstruction, and acute cholecystitis. The primary outcome was a technical success. The secondary outcomes were the clinical success and procedure-related adverse events (AEs).

Results: EUS-TD using electrocautery-enhanced LAMS (EC-LAMS) was technically successful in all patients with any tract dilatation procedure. The clinical success was achieved in 29 of 30 (96.7%) patients. AEs were reported in 4 of 30 (13.3%) patients with minor bleeding (n=2), and stent migration (n=2).

Conclusion: One-step EUS-TD using the novel EC-LAMS is effective and safe for indications including PFCs, malignant biliary stricture, and acute cholecystitis in patients requiring transmural drainage.

Keywords: endoscopic ultrasonography, electrocautery-enhanced system, lumen-apposing metal stent