A Chinese prospective multicenter cohort study evaluating EUS-guided drainage of pancreatic fluid collections using the Hot AXIOS system

Peng Li; Zheng Zhang; Sheng Wang; Zhendong Jin; Yiqi Du; Aiming Yang; Yunlu Feng; Xiaoping Zou; Lei Wang; Xiaoyan Wang; Li Tian; Pinghong Zhou; Yiqun Zhang; Jun Liu; Zhen Ding; Junwen Zhang; Jian Yang; Siyu Sun; Shutian Zhang

doi:10.4103/EUS-D-22-00058

A Chinese prospective multicenter cohort study evaluating EUS-guided drainage of pancreatic fluid collections using the Hot AXIOS system

Endosc Ultrasound. 2023 Mar-Apr;12(2):259-265. doi: 10.4103/EUS-D-22-00058.

Authors

Peng Li¹, Zheng Zhang¹, Sheng Wang², Zhendong Jin³, Yiqi Du³, Aiming Yang⁴, Yunlu Feng⁴, Xiaoping Zou⁵, Lei Wang⁵, Xiaoyan Wang⁶, Li Tian⁶, Pinghong Zhou⁷, Yiqun Zhang⁷, Jun Liu⁸, Zhen Ding⁸, Junwen Zhang⁹, Jian Yang⁹, Siyu Sun², Shutian Zhang¹

Affiliations

¹ Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
² Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China.
³ Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China.
⁴ Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
⁵ Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China.
⁶ Department of Gastroenterology, Third Xiangya Hospital, Central South University, Changsha, Hunan Province, China.
⁷ Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai, China.
⁸ Department of Gastroenterology, Wuhan Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
⁹ Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.

Abstract

Background and objectives: The Hot AXIOS system, which features a cautery-enhanced lumen-apposing metal stent, facilitates EUS-guided transmural drainage of pancreatic fluid collection (PFC). We aimed to evaluate the safety and efficacy of stents in a multicenter Chinese cohort.

Patients and methods: Thirty patients from nine centers with a single pancreatic pseudocyst (PP) or walled-off necrosis (WON) who underwent EUS-guided transgastric or transduodenal drainage with the novel stent were prospectively enrolled.

Results: We included 15 (50%) patients with PPs and 15 (50%) with WONs. The mean diameter of the PFCs was 11.06 ± 3.56 cm. Stent placement was technically successful in all patients (100%), whereas clinical success was achieved in 93.3% of patients (28/30). Clinical success was defined as the alleviation of clinical symptoms combined with at least a 50% reduction in PFC diameter within 60 days after surgery. 73.3% (22/30) of AXIOS stents were removed after reaching clinical success in the 1^st month of follow-up. A total of 14 (46.7%) PFC-associated infections occurred (4 pre- and 10 postoperation), which recovered within 1 week after treatment. Other complications included three (10%) partially or fully blocked stents and two (6.7%) stent migrations. Regarding the fully opened stent without blocking, complete remission of PFCs within 1 month was independently predicted by a previous pancreatitis attack > 6 months prior (adjusted odds ratio: 11.143; 95% confidence interval: 1.108-112.012; P = 0.041).

Conclusion: EUS-guided drainage of PFCs using the Hot AXIOS system is safe and efficient. Regarding completely patent stents, a previous pancreatitis attack > 6 months prior predicts a greater chance of achieving 100% remission of PFCs within 1 month of AXIOS treatment.

Keywords: EUS; Hot AXIOS system; evaluation; pancreatic fluid collection drainage.