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Archive November 2017 XVIII, No. 11

Turn Your Endoscope Into a Therapeutic Device

6 devices that let your GI docs diagnose — and treat — disorders throughout the digestive system.

Douglas Weine

Douglas Weine, MD


Subha Sundararajan

Subha Sundararajan, MD


add-on devices THERAPEUTIC ENDOSCOPY Your GI docs can turn their endoscopes into therapeutic devices with the latest add-on devices.

New devices that attach to endoscopes and let your GI docs not just diagnose but also treat disorders under direct visualization has spawned a new term: therapeutic endoscopy. From mapping tumors to draining cysts, these add-on devices are turning endoscopy into therapeutic care. Here's a look at a few of them.

Pancreatic Cyst Drainage

Pancreatic Cyst Drainage
Axios Stent and Delivery System
Boston Scientific
The Axios system from Boston Scientific provides ideal treatment for patients suffering from pancreatitis, with attention to 2 pancreatic fluid collections in particular: pancreatic pseudocysts and walled-off pancreatic necrosis. The fluid that builds from an inflamed pancreas can lead to enlarged, sometimes life-threatening cysts. Surgical treatments that are available to treat these cysts include cystogastrostomy, by which a surgeon can open a connection between the pancreas and the stomach wall to drain the fluid directly through the GI tract, along with similar procedures through the small intestine or duodenum. These procedures, however, are costly and invasive and they require longer recovery times than endoscopic treatment.

The beauty of the Axios system is that the cautery-enabled catheter and the self-expanding metal stent are both combined into one device on the scope. Under direct visualization via endoscopic ultrasound (EUS), the scope is guided into the stomach and along the lumen until it reaches the target structure — in this case, the pancreas. Once there, the GI provider uses a generator and pump to charge the catheter with a high-density currency that creates a clean and precise cut in the tissue through which the catheter passes. Once the incision is made and the catheter has gained access, the metal stent is planted in the channel and self-expands to hold it open for proper drainage. Ideally, the procedure more or less creates a plumbing system without leakage.

Self-expanding metal stents have recently become more preferable to plastic stents which, although providing the same mechanism, are more limited in diameter and encourage the buildup of bacterial microfilm as a result. Metal stents boast a larger diameter, and they can be left in place for up to 6 months in some cases. The other benefit of being able to leave a metal stent in place for a longer period of time is that it allows for re-entry to treat necrosis with necrosectomy.

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