A 94-year-old woman presented with a 2-month history of dysphagia to solids and a 6.8-kg weight loss. EGD revealed extrinsic compression of the cardia of the stomach (Fig. 1A). Anteroposterior CT demonstrated a large cystic lesion arising from the body of the pancreas, causing extrinsic compression on the stomach (Fig. 1B). EUS with FNA was then done (Figs. 1C and D), and the results of fluid studies were consistent with a mucinous cyst. The patient was considered a poor surgical candidate; therefore, cystgastrostomy by an electrocautery-enhanced lumen-apposing metal stent (LAMS) delivery system was deemed the best approach for palliative decompression (Video 1, available online at www.VideoGIE.org). Large mucinous cysts have been historically treated with surgery or cyst ablation with ethanol and/or paclitaxel. The recently developed electrocautery-enhanced delivery system uses an all-in-one cautery and LAMS delivery system to create a durable anastomosis between the GI tract and a target structure (Figs. 1D-I). Previous therapies can be technically challenging and have been related to higher rates of morbidity and mortality and to adverse events such as infections and fistula formation. This case demonstrates the use of the electrocautery-enhanced LAMS delivery system as a feasible and safe alternative for palliative decompression of a symptomatic pancreatic cystic neoplasm in a patient who was not a candidate for surgical treatment.
Figure 1.
A, Endoscopic view revealing extrinsic gastric compression on the cardia of the stomach. B, Coronal CT revealing a large pancreatic cystic lesion with extrinsic compression on the lesser curvature. C, Linear EUS view of the mucinous cyst with solid debris. D, Additional ultrasound view of the large cystic lesion with mucinous debris. E, Endoscopic view of LAMS 1 month post-procedure. F, Endosonographic view of ceramic-tipped cautery catheter. G, Endosonographic view of LAMS deployment within the cystic lesion. H, Gastric view of the cystgastrostomy created via LAMS. I, Mucin expression noted from LAMS.
Disclosure
Dr Das and Dr Sachdev are consultants for Boston Scientific. All other authors disclosed no financial relationships relevant to this publication.
Footnotes
Written transcript of the video audio is available online at www.VideoGIE.org.
Supplementary data
This video reveals the use of an all-in-one cautery and LAMS delivery system in a large, symptomatic mucinous cystic lesion.
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
This video reveals the use of an all-in-one cautery and LAMS delivery system in a large, symptomatic mucinous cystic lesion.