TY - JOUR AU - Rajesh Paramasivam AU - Shiaw-Hooi Ho AU - Basri Abdullah AU - Khean-Lee Goh AU - Ida Hilmi PY - 2014/09/28 Y2 - 2024/03/29 TI - Novel Use of a Self-Expandable Metal Stent with an Anti-Migration System for Palliative Drainage of a Pancreatic Cystic Neoplasm JF - JOP. Journal of the Pancreas JA - JOP VL - 15 IS - 5 SE - CASE REPORTS DO - 10.6092/1590-8577/2802 UR - http://www.serena.unina.it/index.php/jop/article/view/2802 AB - Context There is scanty data on endoscopic palliative management of pancreatic cystic lesions that cause gastric outlet obstruction (GOO). This is the first case report that illustrates the use of a covered self-expandable metal stent (CSEMS) with an anti-migration system in the management of a symptomatic neoplastic cystic pancreatic lesion. Case report A 92-year-old Chinese female presented with partial GOO for 3 months. Examination revealed a non-tender epigastric mass with moderate abdominal distension. Esophagogastroduodenoscopy (EGD) showed a significant bulge at the posterior wall of the gastric antrum and food residue in the stomach. A CT scan of the abdomen showed a large pancreatic tail cystic lesion. Endoscopic ultrasound (EUS) showed a clear, non-septated cystic lesion measuring 9.7x10 cm arising from the pancreatic tail. Analysis of the aspirate revealed the following: Amylase: 3,200 units/L, CEA: 411 ng/mL, CA 19-9 812 U/mL and no malignancy. A Niti-STM Biliary Stent (NAGITM) was used for a cystogastrostomy. This procedure was complicated by a self-limiting intra-abdominal leak, stent migration and bleeding from a splenic artery pseudoaneurysm which was arrested with coil embolization. She progressed well after that with significant symptom improvement and no further complications. Conclusion This is the first case of a CSEMS with an anti-migration system that was used for decompression of a pancreatic cystic neoplasm (PCN). Novel use of this stent is a viable option as palliative management of a PCN in those not fit for surgery but caution needs to be exercised as there can be significant complications.Image: CT abdomen showing stent in-situ. ER -