EUS-guided transgastric drainage of walled-off paramalignant ascites

Czech version

Authors: M. Števove ¹; J. Rajec ^1-3; R. Husťak ^1-3
Authors‘ workplace: Gastroenterologické oddelenie, Klinika vnútorného lekárstva, FN Trnava ¹; Trnavská univerzita, Trnava ²; Slovenská zdravotnícka univerzita v Bratislave ³
Published in: Gastroent Hepatol 2025; 79(6): 469-472
Category: Clinical and Experimental Gastroenterology: Review Article

Overview

Malignant and paramalignant ascites significantly reduce the quality of life of oncology patients and are primarily managed with palliative care. A rare but clinically challenging variant includes encapsulated paramalignant fluid collections that are not amenable to standard percutaneous drainage. We present the case of a 65-year-old woman with advanced pancreatic cancer and peritoneal carcinomatosis who developed a large encapsulated collection causing gastric outlet obstruction. To relieve her symptoms, we performed transgastric drainage of the collection using endoscopic ultrasound guidance with the placement of a lumen-apposing metal stent. The procedure was carried out without complications and led to rapid clinical improvement. The patient was subsequently discharged for home palliative care. The aim of this case report is to highlight the usability of LAMS in uncommon indications in oncologic patients.

Keywords:

EUS-drainage – malignant ascites – pancreatic cancer – encapsulated collection

Sources

1. Jung M, Pützer S, Gevensleben H et al. Diagnostic and prognostic value of SHOX2 and SEPT9 DNA methylation and cytology in benign, paramalignant, and malignant ascites. Clin Epigenetics 2016; 8 : 24. doi: 10.1186/s13148-016-0192-

2. Berger JM, Alany A, Puhr R et al. Clinical risk factors for ascites in metastatic pancreatic cancer. ESMO Open 2023; 8 (2): 101200. doi: 10.1016/j.esmoop.2023.101200.

3. Sangisetty SL, Miner TJ. Malignant ascites: a review of prognostic factors, pathophysiology and therapeutic measures. World J Gastrointest Surg 2012; 4 (4): 87–95. doi: 10.4240/wjgs.v4.i4.87.

4. Yamamoto N, Isayama H, Kawakami H et al. Preliminary report on a new, fully covered, metal stent designed for the treatment of pancreatic fluid collections. Gastrointest Endosc 2013; 77 (5): 809–814. doi: 10.1016/j.gie.2013.01.009.

5. Itoi T, Binmoeller KF, Shah J et al. Clinical evaluation of a novel lumen-apposing metal stent for endosonography-guided pancreatic pseudocyst and gallbladder drainage (with videos). Gastrointest Endosc 2012; 75 (4): 870–876. doi: 10.1016/j.gie.2011.10.020.

6. Poc K, Mačinga P, Stirand P et al. Endosonographically-guided drainage of pancreatic collections –⁠ personal experience. Gastroent Hepatol 2017; 71 (5): 401–408. doi: 10.14735/amgh 2017401.

7. Musumba C, Tutticci N, Nanda K et al. Endosonography-guided drainage of malignant fluid collections using lumen-apposing, fully covered self-expanding metal stents. Endoscopy 2014; 46 (8): 690–692. doi: 10.1055/s-0034-13 65424.

8. Köck R, Jürgensen C, Fischer-Lampsatis R. Endosonography-guided drainage of loculated malignant ascites using double-pigtail plastic stents. Endosc Int Open 2018; 6 (7): E902–E906. doi: 10.1055/a-0605-3587.

9. Reuangrith J, Scott SA, Kohansal A. Endoscopic ultrasound-guided placement of lumen-apposing metal stent for transgastric drainage of loculated malignant ascites. Ther Adv Gastrointest Endosc 2024; 17 : 26317745241289238. doi: 10.1177/26317745241289238.