INTRODUCTION

Endoscopic ultrasound (EUS)-guided drainage of peripancreatic collections has become the standard approach following the development of lumen-apposing metal stents (LAMS). Until now, only a single "free-hands" deployment model of this type of stent was available; the Z-EUS IT model by Hanarostent® has been recently commercialized. 

CASE REPORT

We present the case of a 60-year-old male with an episode of severe necrotizing acute pancreatitis and subsequent development of an 80 x 100 mm peripancreatic pseudocyst in the body of the pancreas, which was communicating with the main pancreatic duct. A cholangio-MRI also showed compression of the splenic vein and ductal disconnection syndrome. 

ENDOSCOPY

EUS was performed, confirming the well-defined wall of the pseudocyst and the absence of interposed vessels along the needle path. EUS-guided cystogastrostomy was performed using a 14 x 20 mm Z-EUS IT lumen-apposing metal stent via a "free-hands" technique, under endoscopic ultrasound and fluoroscopic guidance, confirming its successful deployment. Abundant liquid content was observed draining into the stomach. Subsequently, a 7 Fr x 5 cm double pigtail plastic stent was telescopically placed inside the LAMS without complications, and the patient was discharged 24 hours later. 

A control MRI performed at 4 weeks showed complete resolution of the pseudocyst, and the LAMS was removed using the stent retrieval thread with forceps, without incidents. Three months later, we confirmed no pseudocyst recurrence performing a CT scan.

COMMENT

The new "free-hands" Z-EUS IT lumen-apposing metal stent is easy to use and effective for EUS-guided drainage of peripancreatic collections. Different sizes are available than those previously commercialized, what can be useful in selected patients. Additionally, it has a retrieval thread to make easier its removal.