LAMS used in this study (Hot AXIOS stent and electrocautery-enhanced delivery system, Boston Scientific, Natick, Massachusetts, USA) were through-the-scope, fully covered self-expandable metal stents, 15 mm in diameter and 10 mm in length. After directly puncturing the WON using the electrocautery tip (without the use of a guidewire to assist in stent insertion), the delivery catheter was advanced into the fluid collection and the distal flange was deployed under endoscopic ultrasound (EUS) guidance. The proximal flange was then released under EUS guidance or endoscopic view (video 1 ).
Hot axios stent
Manufactured by Boston Scientific
Sourced in United States
The Hot AXIOS stent is a medical device designed for endoscopic drainage procedures. It is a self-expanding, metal stent that is deployed using a delivery system. The stent is intended to create a connection between two hollow organs or structures within the body.
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Lab products found in correlation
6 protocols using hot axios stent
1
Hot AXIOS Stent for Walled-Off Necrosis
2
Endoscopic Ultrasound-Guided Gallbladder Drainage
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We used a slim, linear ultrasound endoscope (EG38-J10EGU, Pentax Medical, Germany) and the Arietta 70 ultrasound system. The transmural EUS-GBD approach involves placing a LAMS from the duodenum or stomach into the GB under EUS guidance (Figure 1 ), allowing, by the adherence of the GB to the gastrointestinal wall, the creation of a permanent fistulous tract (Figure 2 ).
The types of LAMS used were the Hot AXIOS stent (Boston Scientific, USA) or the Hot SPAXUS stent (Taewoong Medical, South Korea). The AXIOS stent sizes used were 15 mm × 10 mm and 10 mm × 10 mm, while the SPAXUS stent size was 16 mm × 20 mm.
The types of LAMS used were the Hot AXIOS stent (Boston Scientific, USA) or the Hot SPAXUS stent (Taewoong Medical, South Korea). The AXIOS stent sizes used were 15 mm × 10 mm and 10 mm × 10 mm, while the SPAXUS stent size was 16 mm × 20 mm.
3
Endoscopic Gastric Bypass Drainage with Antimigration Stents
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EGBD was performed with a variety of LAMS and stents with antimigration designs
2 (link)
19 (link)
20 (link)
. The stents were further divided into single-step or multiple-step devices
5 (link)
6 (link)
7 (link)
8 (link)
19 (link)
21 (link)
22 (link)
23 (link)
24 (link)
25 (link)
. The single-step device allows for single-step delivery of the stent without the need to change instruments for track dilation. This included the HOT AXIOS stent (15 × 10 mm or 10 × 10 mm diameter, Boston Scientific, Marlborough, Massachusetts, United States) (
Fig. 1a ). Multistep devices require track dilation with a cystotome and a 4- to 6-mm biliary balloon. Types of stents used included the SPAXUS stent (10 × 10 mm and 10 × 16 mm, Niti-S, Taewoong Medical, Korea) (
Fig. 1b ), the BONA-AL stent (10 mm × 4 to 7 cm in length with 22-mm external flares to prevent migration, Standard Sci Tech Inc., Seoul, Korea) (
Fig. 1c ) and the Microtech stent (10 × 35 mm length, Nan Jing Co. Ltd., China) (
Fig. 1d ). All procedures were performed by experienced interventional endosonographers.
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EGBD was performed with a variety of LAMS and stents with antimigration designs
2 (link)
19 (link)
20 (link)
. The stents were further divided into single-step or multiple-step devices
5 (link)
6 (link)
7 (link)
8 (link)
19 (link)
21 (link)
22 (link)
23 (link)
24 (link)
25 (link)
. The single-step device allows for single-step delivery of the stent without the need to change instruments for track dilation. This included the HOT AXIOS stent (15 × 10 mm or 10 × 10 mm diameter, Boston Scientific, Marlborough, Massachusetts, United States) (
4
EUS-Guided Gastroenteric Anastomosis Technique
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Using a commercially available LAMS, this step creates an EUS-guided anastomosis between the stomach and small bowel.
A curvilinear echoendoscope was advanced alongside the flexible overtube, and using
fluoroscopy and EUS, the “target segment” of small bowel was identified. After obtaining
an avascular window on Doppler, a 15 × 10mm electrocautery-enhanced LAMS (Hot Axios stent,
Boston Scientific, Marlborough, Massachusetts, United States) was deployed freehand using
standard technique and a gastroenteric anastomosis was created (
Fig. 2 c ). The overtube balloon was then deflated and the
echoendoscope and overtube were withdrawn.
A curvilinear echoendoscope was advanced alongside the flexible overtube, and using
fluoroscopy and EUS, the “target segment” of small bowel was identified. After obtaining
an avascular window on Doppler, a 15 × 10mm electrocautery-enhanced LAMS (Hot Axios stent,
Boston Scientific, Marlborough, Massachusetts, United States) was deployed freehand using
standard technique and a gastroenteric anastomosis was created (
echoendoscope and overtube were withdrawn.
5
Versatile LAMS Placement Outcomes
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This was a retrospective single-center cohort study of consecutive patients who underwent LAMS placement (Hot AXIOS stent, Boston Scientific Corporation, Natick, MA, USA) at our tertiary referral center between June 2020 and June 2022. The study was reviewed and approved by the institutional ethical review board (reference: ONZ-2022-0179).
Patients were divided into categories: A: drainage of peripancreatic collections, B: biliary drainage (CBD), C: gallbladder drainage (GBD), D: gastroenteric anastomosis, E: temporary gastric access for endoscopy (GATE), F: treatment of refractory gastrointestinal (GI) strictures and G: miscellaneous, other indications.
Patients were divided into categories: A: drainage of peripancreatic collections, B: biliary drainage (CBD), C: gallbladder drainage (GBD), D: gastroenteric anastomosis, E: temporary gastric access for endoscopy (GATE), F: treatment of refractory gastrointestinal (GI) strictures and G: miscellaneous, other indications.
6
EUS-guided Lumen-apposing Metal Stent Placement
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The metal stents used in this study will be LAMS (10, 15, or 20 mm in diameter, and 10 mm in length, HotAXIOS stent with an electrocautery-enhanced delivery system, Boston Scientific, Madrid, Spain). This is a self-expanding metal stent totally covered with luminal apposition. After the EUS-guided access into the WON using first a 19-G or directly with the electrocautery tip, the delivery system will be advanced into the cavity and the distal flange will be deployed under EUS guidance. Otherwise, the proximal flange will be released under EUS or endoscopic guidance. The time to stent withdrawal will depend on total resolution by imaging. However, there will be the intention to remove a LAMS no later than 4–6 weeks.
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