Strategic International Session2(JGES・JSGE・JSGS)
Fri. November 3rd   9:00 - 12:00   Room 11: Portopia Hotel South Wing Topaz
ST2-13_E
 Techniques for HOT AXIOS Placement in Walled-Off Necrosis: WONDERFUL study group
Sho Takahashi1, Takuji Iwashita2, Hiroyuki Isayama1
1Department of Gastroenterology, Juntendo University, 2First Department of Internal Medicine, Gifu University Hospital
Background: EUS-guided pancreatic fluid drainage(PFD) with HOT AXIOS effectively treats WON. However, necrotic tissue as the main component requires various techniques for diagnosis/placement, yet these are not fully understood.
Method:This study analyzed 352 cases of pancreatic fluid collection treated with EUS-PFD using AXIOS between 2010 and 2023 at 11 facilities in the WONDERFUL study group. Successful AXIOS placement for WON was achieved in 58 cases (16.5%), and placement techniques were evaluated.
Result:In 18(31.0%) cases, additional techniques were required during placement. Contrast-enhanced EUS was used to confirm the presence and extent of WON in 5 cases. Three techniques were used to create a space for AXIOS placement. Injection of saline via a pre-placed external drainage tube, was used in 2 cases. The two-step puncture technique involving puncturing with an FNA needle and then injecting saline to create a space, was used in 5 cases. The trans-delivery injection method involving injecting liquid from the guidewire lumen using the AXIOS Delivery System to confirm the drainage space was performed in 2 cases. In cases of poor deployment of AXIOS, the Back-and-forth technique or Torquing method, which involve shaking the main body or scope to deploy the flange, were used in 4 cases. Among 9 AEs, each group had one migration immediately after AXIOS placement.
Conclusion:Various techniques enabled successful AXIOS placement with minimal AEs. Understanding these techniques may increase technical success rate.
Index Term 1: Walled-off necrosis
Index Term 2: Lumen apposing metal stent
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