Large-caliber metal stent controls significant entry site bleeding during EUS-guided drainage of walled-off necrosis

Abstract

EUS-guided drainage of pancreatic fluid collection (PFC) is currently the accepted standard of care, primarily because of the associated ease, safety, and efficiency of the procedure. Procedure-related bleeding reportedly occurs in 1% to 2% of cases during EUS-guided drainage of PFC. This bleeding can be effectively managed with the deployment of a metal stent. We present a case of significant bleeding that occurred during EUS-guided drainage of walled-off necrosis (WON) that was successfully managed with a dedicated large-caliber self-expandable metal stent (LCMS). A 35-year-old man, who had received a diagnosis of acute necrotizing pancreatitis 7 weeks earlier, presented with abdominal pain and fever for the previous 2 weeks. On evaluation, laboratory test results showed mild anemia (hemoglobin, 12.6 g/dL; leukocytosis, 13,400 white blood cells/mL, elevated serum amylase [386 IU/L], and elevated lipase [288 IU/L] [>3 upper limit of normal]). Contrastenhanced CT and EUS showed WON (78 74 mm) with minimal debris seen in the lesser sac (Figs. 1 and 2). The subject was scheduled for EUS-guided drainage with a plastic stent by the use of a standard therapeutic echo