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EUS-guided RFA Master Course Program (Seoul, Marseille)
EUS-guided procedures are no longer the future of EUS but rather the present! Nowadays EUS has emerged as an essential field in diagnostic and therapeutic endoscopy. Our EUS-guided RFA master course is not only to provide the opportunities to understand mechanism of EUS-guided RFA, but also to learn the essential technical tips for successful RFA applications through comprehensive lectures and hands-on courses including patient’s case observation and animal test, phantom hands-on. We are convinced that our comprehensive and intensive 2 days course will guide all of attendees to EUS-guided RFA program practice as well as introduce our EUS-RFA novel device. We are completed twice of EUS-guided RFA master course successfully until now in Seoul, Korea and Marseille, France.Let’s share the program inside story together from now.EUS-guided RFA Master Course Program is primarily focused on the following training courses and lectures. First program was held in Seoul, Korea Asan Medical Center directed by Prof. Seo, Dong Wan and second program was held in Marseille, France Nord Hospital directed by Prof. Marc Barthet. Both training program were consisted of EUS lectures by director and EUS-RFA case observation, and hands-on with phantom model and porcine model. EUS lectures are open to questions from the participant’s review of case observation and hands-on training in a preliminary session.This one-to-one interaction training program will hopefully build up links and long term relationships helpful for personal development and a greatest integration of future procedure.Most of the participants hope that EUSRA™ can be applied to a variety of indication not only pancreas tumor but also, gradually predict increase these EUS treatment in the future.
16.12.05 -
Taewoong Medical Research Center Open
Taewoong Medical Research Center has newly-organized a preclinical team to provide preclinical evaluation service for medical devices ‘Build a foundation for systematic research to support R&D and provide histological analysis.’ Taewoong Medical has been continuously investing in product development since its foundation in 1999 and engaged in organic research cooperation with many research institutions at home and abroad, making efforts to diversify and improve the functionality of the product. This year in March, a preclinical team has been established in Taewoong Medical’s Osong research center.Preclinical Studies are executed to test a medical device in animals before conducting any clinical trials in the patient to verify biological safety and effectiveness of the medical device. Biocompatibility testing and risk assessment for marketing approval of medical devices necessarily entails accurate analysis of data from biological evaluation and animal testing. Therefore, the newly-organized preclinical team is attracting expectations to enhance the competitiveness of the product while improving the safety in medical procedures.The new preclinical team provides expert research support services to various medical personnel and researchers, not to mention supporting Taewoong’s own products in development. The team has already been entrusted with animal tissue with biomaterial implant from several universities and research institutions and has embarked on the histological analysis service.For those researchers who require animal experiments will benefit from a laboratory animal center of Osong Medical device development center (Department of evaluation Bio Compatibility assessment team; www.kiobhealth.kr). A researcher-centered ‘One-way system’ embracing from the whole process of animal testing to histological analysis will be introduced in the near future. In addition, to aid the safe and correct use of commercial products, the domestic and international sales divisions are preparing to implement training programs using experimental animals targeted for medical specialists.With the installation of the new preclinical team, Taewoong Medical can internally evaluate cell testing and animal testing from early stages of development to the point of completing a new product, which will enable Taewoong to introduce mature products to the market in a much shorter period of time. Also, offering targeted training programs to medical specialists and histological analysis service will enhance efficiency and research achievements of medical devices.
16.12.05 -
Niti-S™ SPAXUS™_Preliminary report_EUS-Guided Drainage of Pseudocyst_Korea
Preliminary report on a EUS guided pseudocyst drainage with a new lumen apposing metal stent (SPAXUS™); single center, 9 months experience Background and AimsEndoscopic ultrasound (EUS)-guided drainage has become a mainstay for treating peripancreatic fluid collection and fully covered metal stent provided more efficient drainage than plastic stent. Recently, wide-flanged fully covered metal stent is introduced in EUS-guided pseudocyst drainage and showed promising results. The aim of this study was to evaluate the feasibility and efficacy of EUS-guided pseudocyst drainage with a new lumen apposing metal stent (Niti-S™ SPAXUS™ Stent; Taewoong Medical, Seoul, Korea).MethodA prospective, single-arm, multicenter feasibility study of EUS-guide pseudocyst drainage with SPAXUS™ is now enrolling patients at 6 tertiary hospital in Korea. This preliminary report describes single center, 9 months experiences of the multicenter study. Between January and September 2016, a total of 11 patients were treated with EUS-guided pseudocyst drainage with SPAXUS™ in our institute. Baseline characteristics and outcomes including technical/clinical success rate, adverse event, and recurrence rate were evaluated.ResultThe median age of 11 patients was 57 (42-76) and male was 10 of 11 patients. The median size of PFC was 80 mm (60-160 mm). SPAXUS™ was successfully placed all patients and PFC resolution was achieved in all 11 patients at median of 35 days after stent placement. The median procedure time was 7 min (5-10 min). Three cases of fever were developed during immediate post-procedure period and all of them were successfully treated with intravenous antibiotics. No other immediate post-procedure adverse events were seen. One case of stent occlusion was developed 40 days after procedure and endoscopic stent cleaning with retrieval balloon was conducted. Until now, no case of PFC recurrence was observed.ConclusionEUS-guided pseudocyst drainage with SPAXUS™ was conducted effectively and safely in our institute until now. Further multicenter experience would be helpful to clarify the role of this procedure.-----
16.12.05 -
CONNECT GLOBAL issue 7, OCT 2016 16.10.07
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IDEN 2016 (International Digestive Endoscopy Network) Seoul, Korea
IDEN 2016 (International Digestive Endoscopy Network) Seoul, Korea International Digestive Endoscopy Network (IDEN) 2016 was held in Seoul, Korea from June 24 to June 26, 2016. At IDEN congress, many physicians and researchers from all over the world would participated to present and discuss the latest advances in the field of upper GI, lower GI and pancreatobiliary endoscopy. During IDEN congress period, we invited key opinion leaders and our partners to the Taewoong Medical factory to introduce our production process. Stent production tour was arranged to look all around the each production rooms, in addition we had Endoscopic RFA hands-on experience.“It was first time to see how to make hand-made metal stent and impressive the many steps for producing the one stent.” said one of participants.We also prepared Korean traditional dinner and had a great time with all of them.We have invited KOLs and partners to Korea twice an annual event on June and October during IDEN and SGI domestic congresses. Upcoming next official factory tour will be held on October 6 before the day of SGI congress. To learn more about SGI and factory tour, please contact your territory manager.
16.07.05 -
Niti-S™ SPAXUS™ Stent won the excellent patent award
[2016 상반기 우수특허 대상]태웅메디칼‘자가 팽창 스텐트’, 두 장기를 연결한국일보 : [2016 상반기 우수특허 대상] 태웅메디칼태웅메디칼(대표 신경민, www.stent.net)은 1991년 설립된 의료기기 제조 및 수출기업이다. 태웅메디칼은 약 60여개 국가에 연간 3,000만달러 이상의 수출을 하고 있으며 2014년 미국지사를 설립해 적극적인 해외투자에 나서고 있다. 특히 세계적으로 품질의 우수성을 인정받고 있는 스텐트(인체내강 확장용 의료기기)의 지속적인 제품 개발을 위해 많은 투자를 하고 있다.태웅메디칼이 이번에 개발한 ‘Niti-S SPAXUS 스텐트’는 형상기억합금인 나이티놀 와이어를 사용해 제작된 자가 팽창형 금속 스텐트이다. 두 장기를 연결할 수 있도록 스텐트의 양쪽 끝 단에 두 장기를 연결하고 고정할 수 있는 기술이 적용됐다.이 스텐트의 특징은 형상기억합금 와이어를 교차되게 엮어 제작한 몸통 부위와 날개 부위로 이뤄져 있으며 스텐트는 실리콘 피막으로 코팅돼 있다. 스텐트의 날개부위는 인접된 두 장기 사이에 밀착해 연결할 수 있으며, 몸통부위는 내경을 확보해 배수 및 이동경로 변경의 통로를 만들어준다.태웅메디칼은 소화기내과용 스텐트에 머무르지 않고 비뇨기과용, 뇌혈관, 약물방출 등의 스텐트를 지속적으로 개발할 계획이다.http://hankookilbo.com/v/e665b273a5c945efb86984caacdc9bcf
16.06.10 -
DDW 2016 (Digestive Disease Week), San Diego, USA
DDW 2016 (Digestive Disease Week), San Diego, USA Taewoong Medical participated DDW 2016 with a huge attention of attendees in San Diego, USA. Exhibition booth consisted of SPAXUS™ Stent section, Endoscopic RFA area, Stent area and extended meeting rooms. Design concept was simple and modern, which emphasized full exposure of our company identity. Especially we prepared to demonstrate SPAXUS™ user friendly delivery system so that visitors could try easy deployment. The day before DDW, Taewoong Medical organized partner’s day with global distributor at Holiday Inn, Bayside. We had SPAXUS Hands on class with special dummy model and a lively discussion time about EUSRA & ELRA, Endoscopic RFA products. In particular, Euromedical, Italy presented their sales strategy and current state of RFA business, and this invaluable sharing would stand partners in good stead when it comes to meeting customers. Mr. Shin, CEO, Taewoong Medical, expressed thanks to the all partners regarding their effort and cooperation in closing remark. 2nd day of DDW congress, the valued customers and friends from all of the world were invited to SeaWorld, attraction of San Diego. Taewoong Medical prepared special show with killer whales and dinner buffet beside the pool. All attendees seem to return to the innocence of childhood during the show, and they had a great time even though some of them were dripping wet by whales.Upcoming next DDW 2017 is going to be held at Chicago. Hope we can get together again!
16.06.07 -
Website Renewal to become more easily to access even if you can access mobile device
Website Renewal to become more easily to access even if you can access mobile device Have you visited our website lately?You can see optimize pages whichever way you look at it. PC Screen Shot We have finished website renewal to become more easily to access and use even if you can access mobile device and also renewed the entire design and the structure of previous website in order to make easier to use and more convenience for obtaining necessary information with regard to our business activities and products for valuable customers and business partners through brand new website. We aim to proactively and effectively deliver updated valuable information regarding our business activities, products and services to customers and we also utilize our website as a part of sales and marketing tools for global users. As you know we have also opened Facebook webpage and we always aim to have a better communication with partners and customers! Please visit the updated TaeWoong Website and send us the sincere feedback! Mobile Screen Shot Through recent update, following new pages and products been added into the website.Customer Service: You can find General product information which is frequently asked like MRI Information, Storage.Meet Us At: Find congress and TW event informationProduct:M Biliary StentEndoscopic Accessory OPTIMOS™
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Niti-S™ NAGI™ Stent_Author Discussion Series : Natsuyo Yamamoto
Natsuyo Yamamoto, MD, PhD, from The University of Tokyo writes about her article“Preliminary report on a new, fully covered, metal stent designed for the treatment of pancreatic fluid collections.” Although efficacy of endoscopic cystogastrostomy for pancreatic fluid collections is reported, few stents dedicated for this purpose are commercially available. We evaluated a newly developed, short metal stent with wide lumen diameter customized for cystogastrostomy in 9 cases. Technical success rate was 100% without early adverse events. Direct endoscopic necrosectomy through the stent was successful in all 3 attempted cases. Stent removal was achieved without difficulties in all 6 cases. THE NEW FULLY COVERED METAL STENT (NAGI STENT, TAEWOONG-MEDICAL CO, LTD, YEONGGI-DO, KOREA) The placement of this metal stent in the treatment of pancreatic fluid collection may prevent complications such as migration and peritonitis. A wide stent lumen enables direct endoscopic necrosectomy through the stent.A plastic stent has been commonly used for enterocystostomy. Endoscopic treatment for pancreatic fluid collection including necrosectomy is technically feasible using this new metal stent. The safety, efficacy, and indication should be evaluated in larger prospective studies.Read the abstract for this article here.The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.
16.03.19 -
Niti-S™ KAFFES™ Stent_ Author Discussion Series: Ken Liu
Ken Liu, Faculty of Medicine at the University of Sydney in Camperdown, New South Wales, Australia, reports on his Review Article“Fully covered self-expandable metal stents for treatment of benign biliary strictures.” The focus of this paper was the use of fully covered self-expandable metal stents (FCSEMS) in the treatment of benign biliary strictures (BBSs). There has been an explosion of recent research on the use of FCSEMSs in BBSs with suggestions of a paradigm shift from using plastic stents. Due to their growing popularity, we felt it was important to review the available literature on the efficacy, safety, and cost-effectiveness of FCSEMSs in BBSs.FCSEMSs have been shown to achieve excellent success rates in both transplant and non-transplant BBSs (>90% in some studies). This success is sustained for over 12 months in most studies. The efficacy of FCSEMSs is unchanged when used as first-line or as second-line therapy (after balloon dilation and plastic stenting). The subset of patients with BBSs secondary to chronic pancreatitis remains a challenge (46-75% success). Results of FCSEMSs in BBSs are similar to studies of plastic stents, in particular, studies using multiple plastic stents. Fewer ERCP sessions are required for treatment of BBSs with FCSEMSs which may result in cost savings, although published data are lacking. Figure 1. A, An example of the classic stent type (Bonastent; Standard Sci-Tech). B, An example of a new stent type (Niti-S Kaffes; Taewoong). The stent sits entirely within the biliary tree with a long removal string that rests in the duodenum. The antimigration feature in this stent is the gradual tapering in the middle of the stent FCSEMSs are safe to use. Adverse events such as pancreatitis, cholangitis, secondary strictures, and pain are infrequent and usually respond to conservative management. Spontaneous stent migration rates are variable; however, several anti-migration modifications have demonstrated efficacy in reducing this adverse event.There is still a need for further studies, in particular, randomized controlled trials comparing FCSEMSs vs. plastic stents. Data are also lacking regarding optimal duration of stent placement, and the cost effectiveness and long term safety of FCSEMSs.Read this article on pages 13-21 of the print Journal or find it online.The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.
16.03.19 -
UVENTA™_2nd Meeting of the EAU Section of Urolithiasis stent procedure Live
한덕현 교수, 유럽서 요관스텐트 라이브수술 시연덴마크 코펜하겐 학회에서 유벤타 스텐트 주제로 시연 및 강의기사입력시간 : 2013-09-26 11:08:39최종편집시간 : 2013-09-26 11:08:39이혜선 기자 [청년의사 신문 이혜선]성균관의대 삼성서울병원 비뇨기과 한덕현 교수가 지난 3~7일 5일간 덴마크 코펜하겐에서 열린 EAU(유럽비뇨기과학회) 주관, 요로결석학회 및 수술 워크숍(2nd Meeting of the EAU Section of Urolithiasis(EULIS))에서 유벤타 스텐트(Uventa stent)라는 주제로 라이브수술 및 강의를 시행했다.3일 열린 수술 워크숍(surgical workshop)에서는 네 종류의 요관용 금속스텐트에 대한 강의 및 라이브 수술이 시연됐다.한덕현 교수는 라이브 수술자로 참석하여 새로 개발된 이중금속커버스텐트에 대한 논문(Efficacy and safety of a novel, double-layered, coated, self-expandable metallic mesh stent (Uventa™) in malignant ureteral obstructions) 및 임상경험을 소개했으며 악성종양으로 인한 요관폐색 환자에게 성공적으로 수술을 시연해 참가 의료진들로부터 주목을 받았다.한덕현 교수는 “요관협착은 타장기에 비해 금속스텐트의 적용이 늦게 시작된 분야로서, 기구의 발전과 임상경험의 축적이 절실한 상태”라며 “삼성서울병원에서는 이미 보편화된 수술 경험이, 이제 시작하는 유럽의 의사들에게는 많은 관심을 유발한 것 같다”고 소감을 밝혔다.EULIS는 유럽비뇨기과학회(EAU)에서 결석 및 비뇨내시경 관련 학술모임을 활성화하고자 만든 세부학회로 올해로 2회째를 맞고 있다. 금번 학회는 유럽의 요로결석 전문가 300여 명이 참석한 가운데 개최됐다.http://www.docdocdoc.co.kr/news/newsview.php?newscd=2013092600007
16.03.19 -
UVENTA™ EAU Report_The future of metal stenting at EULIS Pre-meeting Symposium
Leading off the 2nd EULIS Meeting in Copenhagen was a special pre-conference symposium on metal stenting of the ureter on September 4th. This special event took place in the Copenhagen University Hospital, the Rigshospitalet, and featured live surgery demonstrations. Mr. Noor Buchholz was key in bringing together all four companies producing metal stents for the first time. “About two years ago, I had a vision for bringing together the four companies involved in the development and production of metal stents. As the EULIS Section meeting was approaching, we decided to piggy-back the stent workshop as a pre-meeting symposium,” Buchholz explained.“Metal stents are very much a niche market, so I think it’s more important for the companies to work together to spread awareness of these products, rather than compete for a small target audience. I’m trying to raise awareness of the use of metal stents in urology, because I think they are very useful for the “right” patients.”Mr. Buchholz points out two major problems of preconceptions about metal stenting. “We’ve seen metal stents in the past that simply didn’t work, so older urologists won’t touch them. The second problem is related: younger urologists aren’t being taught about them, and might not even be familiar with them.”According to Buchholz, this newer generation of stents, as developed in the past ten years has one key advantage over the older models: they are much easier to place and remove, which can be done through minimally invasive surgery. The biggest advantage compared to contemporary competitors like the double-J stent is their longevity:“The initial purchase price is considerably higher, but because the stents do not have to be replaced two or three times per year like plastic stents, the patient requires less surgery, making it cost-neutral in the first year. From the second year onward, it’s an annual saving of some €5000 per patient. And the patient won’t have to undergo regular surgery, with all of the disadvantages thereof. It’s a great solution for patients who need long-term stenting. One of my patients has had a stent for 80 months now.”The four companies involved in the symposium were PNN Medical with its Memokath thermolabile nitinol stent, Cook Medical with its grooved metal double-J Resonance stent, Allium with its self-expanding polyurethane stent, and Taewoong with its Uventa Ureteral Stent, another self-expanding stent. The live surgery demonstrations were given for each of the four companies’ stents.Other presentations at the symposium showed the current state of developments, techniques for placement and maintenance, as well as a look into the future of metal stents. Biocompatibility and biodegradability are two important properties for improved treatment of patients. Other innovations are the antibody-coated stents, nanotube coating and radioactive stents for internal treatment. An absorbable magnesium metal stent is to combine the inertness of biomaterial with the stability of a metal.
16.03.19 -
Niti-S™ SPAXUS™ Stent_Metal stents for lumen apposition for EUS-guided drainage
Metal stents for lumen apposition for EUS-guided drainageJong Ho Moon, MD from the Digestive Disease Center and Research Institute at SoonChunHyang University School of Medicine in Bucheon/Seoul, South Korea discusses this New Methods article “A newly designed fully covered metal stent for lumen apposition in EUS-guided drainage and access: a feasibility study (with videos)” from the June issue. EUS-guided transenteric drainage by using a newly developed fully covered metal stent that is capable of lumen apposition was successfully performed in animal study and small sized clinical experiences. This stent is equipped in conventional delivery system, and preventive for migration and leak because of backwardly folded flanges in both ends and full covering of stent.As EUS-guided therapeutic interventions have evolved, development of metal stents for safe and effective procedures is needed.The EUS-guided drainage was successfully performed by using the new stent. There were no adverse events such as migration or leakage. Endoscopic interventions through the stent was immediately possible, and the stents were easily removed after 4 weeks in patients with pancreatic pseudocyst. Large scaled clinical studies are warranted.Additional expected usage of this new stent is choledochoduodenostomy or temporary insertion into the gallbladder for formation of an access route to perform endoscopic interventions.Read the article abstract here. Figure 1. A, A new fully covered metal stent having folding-back wide anchoring flanges for lumen apposition. B, A 10F conventional delivery system with a constrained stent The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.
16.03.19 -
Niti-S™ NAGI™ Stent_Management of pancreatic collections with novel stent
Dr. Sujievvan Chandran from the Department of Gastroenterology, Austin Health Melbourne in Victoria, Australia discusses his Original Article“Management of pancreatic collections with a novel endoscopically placed fully covered self-expandable metal stent: a national experience (with videos).” The purpose of this study was to evaluate a recently developed lumen-apposing, fully covered self-expandable metal stent (FCSEMS) in the management of pancreatic fluid collections (PFCs).The recent literature indicates that endoscopically inserted FCSEMSs may be superior to traditional plastic stenting in the management of PFCs. However, the current literature is limited by small case series undertaken by single operators, across expert centers, and by the use of tubular stents not specifically designed for the management of PFCs. We therefore undertook a multicenter study to address the deficiencies in the current literature. Figure 1. The novel lumen-apposing stent with flared ends to prevent migration and drawstring attachment located at the gastric end to aid extraction We recruited 54 stent cases across 13 centers throughout Australia. Successful insertion occurred in 53/53 (98.1%) with the majority (88.9%, 48/54) being described as easier to insert by the operator in comparison to plastic stenting.This relates to the fact that multiple plastic stenting can be technically more demanding with the associated increased procedural time compared to a single FCSEMS insertion. Stent extraction was also described as superior to plastic stent extraction in the majority of cases (88.6%, 31/35), which can be attributed to the stent design where a draw string at the gastric flange end facilitates rapid collapse and extraction of the stent. The PFC resolution rate in our cohort (76.6%) corresponds to the lower end of what is published in the available literature. We feel that this reflects a real-world experience given the number of centers involved in addition to a larger subgroup of patients with walled of pancreatic necrosis and infected pseudocysts which traditionally have lower resolution rates.Direct endoscopic necrosectomy, while not universally successful across our cohort, did provide a bridge to surgery in a substantial proportion of our patients who were stabilized from a sepsis point of view post FCSEMS insertion which resulted in improvements in the clinical state prior to surgical intervention. Commonly observed adverse events included stent migration (spontaneous and during direct endoscopic necrosectomy [DEN]), recurrent stent occlusion and tissue ingrowth/overgrowth. Stent migration was likely due to the fact that rapid cyst decompression may overcome the anchoring flared ends. Similarly, during DEN the force placed on the stent via the movement of the endoscope overcame the flared end resulting in dis-lodgement into the stomach. Long term stent placement resulted in cases of stent ingrowth related to loss of the silicone coating and overgrowth which indicate that it may not be suitable for the management of PFCs that require long term stenting (eg, disconnected pancreatic tail syndrome).While we have shown a real world experience of PFC management with this novel FCSEMS, randomized control studies are required to further evaluate the benefit of FCSEMS over pigtail stents.Read the abstract for this article online.The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.
16.03.19 -
Niti-S™ NAGI™ Stent_EUS-guided drainage using metal stents
Ryosuke Tonozuka, MD, from the Depatment of Gastroenterology and Hepatology at Tokyo Medical University in Tokyo, Japan discusses this New Methods article“EUS-guided drainage of hepatic abscess and infected biloma using short and long metal stents (with videos).” Refractory hepatic abscess (HA) and infected biloma (IBL), in which inflammation does not improve only by the dosage of the antibiotic agent, often require percutaneous drainage (PCD) and surgical interventions. Recently, the usefulness of EUS-guided hepatic abscess drainage (EUS-HAD) and US-guided biloma drainage (EUS-BLD) has been described. However, there has been only 1 report of a case in which a fully covered self-expandable metal stent (FCSEMS) was used. In this study, we evaluated the safety and efficacy of EUS-HAD and EUS-BLD using a FCSEMS retrospectively.We used 2 types of FCSEMSs for the drainage. If the target lesion was close to the digestive tract (≤2 cm), a short biflanged FCSEMS (short stent; 16 mm in diameter, 2 or 3 cm in length) was used. If the target lesion was far (≥3 cm), a conventional biliary FCSEMS (long stent; 8 or 10 mm in diameter, 6 or 8 cm in length) was used. Figure 1. Schema of EUS-guided drainage of HA using a short and large diameter biflanged self-expandable metal stent (short SEMS) The technical success rate was 100% and the clinical success rates of EUS-HAD and EUS-BLD at the first session were 71.4% and 83.3%, respectively. In 2 cases, they needed necrosectomy (endoscopic necrotic tissue removal) as an additional therapy. The final clinical success rate was 100%. There were no procedure-related adverse events and no cases of recurrence during the follow-up period (median, 83.5 days).We think EUS-guided drainage has several advantages over PCD as follows: 1) one-step internal drainage is suitable for patients not only for cosmetic reasons but also for physiologic liquid flow; 2) there is no risk of self-removal of the external drain, which causes peritonitis; 3) possible drainage of the lesion around the caudate lobe where puncture may be difficult. Furthermore, a 10-mm-diameter fully covered or 16-mm-diameter fully covered self-expandable metal stent (SEMS) may have several advantages compared with 1 or more conventional PS for treatment by EUS-HAD and EUSBLD as follows: 1) only 1 stent is required because of the large diameter; thus, FCSEMS placement may allow fewer sessions and reduce the procedure time; 2) minimum leakage of liquid in the cavity; 3) upon FCSEMS placement, sufficient drainage is expected, leading to rapid improvement; 4) DEN can be easily performed through the large-bore stent, as was seen in this study, as DEN was easily performed through the FCSEMS in 2 cases; and 5) FCSEMSs may be helpful for hemostasis when unexpected bleeding from the tract occurs during the procedure. Figure 2. Schema of EUS-guided drainage of biloma using a usual long biliary self-expandable metal stent (long SEMS) The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.
16.03.19 -
Niti-S™ NAGI™ Stent_Pulsating pseudoaneurysm in a walled-off necrosis
Shuntaro Mukai from the Department of Gastroenterology and Hepatology at Tokyo Medical University in Tokyo, Japan describes this VideoGIE case “Pulsating pseudoaneurysm in a walled-off necrosis.” Our video case describes a pulsating pseudoaneurysm in the cavity of a walled-off necrosis (WON) diagnosed by endoscopy through a fully-covered biflanged metal stent (BFMS). Subsequently, the pseudoaneurysm was successfully treated. A 38-year-old man developed an infected WON after severe necrotizing pancreatitis. A novel BFMS (16 mm in diameter and 20 mm in length) was placed under EUS guidance. Then, direct endoscopic necrosectomy (DEN) was performed through the BFMS. Seven days after DEN, he vomited blood; we suspected bleeding from the cavity. Emergency angiography was not able to detect any obvious bleeding point. After seven days of conservative therapy, an endoscope was advanced to examine the condition within the cavity. Surprisingly, a pulsating pseudoaneurysm was found. Subsequently, the pseudoaneurysm was treated by coil embolization. Interestingly, a “second-look” endoscopy determined that the pseudoaneurysm completely resolved after use of the embolization coil.To the best of our knowledge, this is the first video which shows a pulsating pseudoaneurysm detected by direct endoscopic imaging and subsequently successfully treated by coil embolization. Bleeding from the cavity due to the rupture of a pseudoaneurysm is a fatal complication in patients with WON. Thus, the management of bleeding is mandatory for treatment success.BFMS is useful for the treatment of WON also in that observation in the cavity of WON by endoscopy can be easily performed during the treatment course.Find more VideoGIEs available online. Figure 1. Endoscopic imaging revealed a pulsating pseudoaneurysm (A). A “second-look” endoscopy demonstrated that the pseudoaneurysm completely resolved after use of the embolization coil (B). Angiography revealed a pseudoaneurysm (C), which was subsequently treated by coil embolization (D). The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.
16.03.19