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首页> 外文期刊>Endoscopy International Open >Intra-channel stent release technique for fluoroless endoscopic ultrasound-guided lumen-apposing metal stent placement: changing the paradigm
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Intra-channel stent release technique for fluoroless endoscopic ultrasound-guided lumen-apposing metal stent placement: changing the paradigm

机译：通道内支架释放技术用于无荧光内镜超声引导管腔并置金属支架的放置：改变范例

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Background?Recently, a novel lumen-apposing fully covered self-expanding metal stent (LA-FCSEMS) mounted on an electrocautery-enhanced delivery system has been developed to perform endoscopic ultrasound (EUS)-guided transluminal drainage. From early experience, however, release of the proximal flange of the stent has mostly been done using endoscopic view guidance to ensure proper positioning. Aim?We describe a new technique that we have named the Intra-Channel Stent Release Technique (ICSRT) to perform stent placement under complete EUS control, without the use of either fluoroscopic or endoscopic views. Material and methods?Data on all consecutive patients who underwent EUS-guided drainage using the new ICSRT between June 2014 and April 2016 were retrospectively retrieved from two institution databases. All EUS procedures were performed by experienced endoscopists with the patient under conscious or deep sedation. The total procedure and stent deployment time, and adverse events related to stent positioning with the ICSRT were evaluated. Results?One hundred consecutive patients (51 women; mean age ± SD, 66 ± 15.2 years, range 34?–?95) underwent EUS-guided transluminal drainage with the Hot AXIOS? device using the new ICSRT. The procedure was technically successful in all but one patient (1?%). The mean total procedural time was 21.9 minutes (range 7?–?50), while the mean time for stent placement was 3.2 minutes (range 1?–?15). No major adverse events occurred. Discussion?The ICSRT has been used to deploy the newly developed lumen-apposing FCSEMS under complete EUS guidance without fluoroscopic and/or endoscopic assistance. The technique appears to be safe and highly effective and should be learned by all interventional endosonographers in order to be able to perform drainage in all clinical scenarios.
机译：背景技术最近，已经开发出一种新型的可在腔内放置的完全覆盖的自膨胀金属支架（LA-FCSEMS），该支架安装在电灼增强的输送系统上，以进行内窥镜超声（EUS）引导的腔内引流。但是，从早期的经验来看，大多数使用内窥镜观察引导来释放支架的近端凸缘以确保正确定位。目的：我们描述了一种被称为通道内支架释放技术（ICSRT）的新技术，该技术可在完全EUS的控制下进行支架置入，而无需使用透视镜或内窥镜。材料和方法：回顾性地从两个机构数据库中检索2014年6月至2016年4月期间使用新ICSRT进行EUS引导引流的所有连续患者的数据。所有EUS程序均由经验丰富的内镜医师对患者进行清醒或深度镇静。评估了总程序和支架展开时间，以及与使用ICSRT进行支架定位相关的不良事件。结果：连续一百例患者（51名女性;平均年龄±SD，66±15.2岁，范围34-？95）接受了EUS引导的热AXIOS腔内引流术。设备使用新的ICSRT。从技术上讲，该手术除一名患者外（1％）均成功。平均总手术时间为21.9分钟（范围为7-5？50），而平均放置支架的时间为3.2分钟（范围为1-15？15）。没有发生重大不良事件。讨论：ICSRT已用于在完全EUS指导下部署新开发的具有腔的FCSEMS，而无需使用荧光镜和/或内窥镜辅助。该技术似乎是安全且高效的，所有介入式超声检查者都应学习该技术，以便能够在所有临床情况下进行引流。

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