A Kit for EUS-Guided Access and Drainage of Pancreatic Pseudocysts: Efficacy in a Porcine Model

Objective: Transluminal pseudocyst drainage with currently available tools remains technically challenging, time consuming andlimited to fluid collections adherent to the GI tract. Multiple tools and steps are still required to achieve pseudocyst drainage. Weevaluated a novel kit to facilitate endoscopic ultrasonography (EUS)-guided access, drainage and rapid decompression in a porcinemodel.Methods: The kit consists of the NAVIX access device and the AXIOS stent delivery system. The NAVIX contains an inner trocarfor puncture and an outer dual balloon catheter for anchorage and dilation. The AXIOS stent is a fully covered dual flanged stent.Both are inserted through the working channel of a curved linear array echoendoscope. In a porcine model, a gallbladder was usedas a proxy for a pseudocyst.Results: Six Yorkshire pigs underwent this procedure successfully without complication and 3 of them were kept alive. After a4-week implantation period, the AXIOS stents were removed easily using a snare and the 3 animals were observed for an additional4 weeks. The stents were well-tolerated by the stomach and gallbladder tissues, as confirmed by weekly endoscopic inspection, grossnecropsy and histopathology.Conclusion: EUS-guided transluminal access and drainage of the porcine gallbladder was technical feasible using a novel kit. Thiskit has the potential to simplify, streamline, and improve the safety of pancreatic pseudocyst drainage.