HOT AXIOS STENT FOR LARGE PANCREATIC PSEUDOCYST/ WON скачать в хорошем качестве

HOT AXIOS STENT FOR LARGE PANCREATIC PSEUDOCYST/ WON

A 35 year old lady presented 4 months ago with a history of abdominal pain and jaundice. She was a smoker but alcohol intake was minimal. Blood tests showed abnormal liver chemistry with a bilirubin of 133 umol/L and raised ALT and alkaline phosphatase. The abdominal ultrasound 3 weeks after the onset of symptoms showed stones in the gall bladder, a dilated CBD and a normal pancreas. She was referred for an out patient ERCP but by the time of the ERCP 6 weeks ago, the jaundice had resolved and the liver chemistry had improved. Hence, instead of an ERCP she had an EUS which showed stones in the gall bladder and a walled off necrosis (WON) with inflammation of the body and tail of the pancreas. The CBD did not contain stones and so an ERCP was not performed. It was thought that she had had gallstone pancreatitis with subsequent WON/pseudocyst formation. An MRCP was requested and was performed 3 weeks ago showing a 12cm pseudocyst with some solid components within. She was reviewed in the GI clinic a week ago by which time she had started to vomit, had upper abdominal pain and had lost a lot of weight. A tender epigastric mass was palpable. A same day CT scan with contrast confirmed a large pseudocyst compressing the mid and lower portions of the stomach. There was no pseudo-aneurysm. She now attends for an EUS and drainage of the cyst using a Hot AXIOS stent (see video). The video has audio and describe the case and a review of the Hot AXIOS system and its deployment sequence. My colleague Dr Shafqat Mehmood performed the EUS with Dr Vanja Giljaca assisting.