Endoscopic ultrasound-guided pancreatic fluid drainage (EUS-PFD) with a lumen-apposing metal stent (LAMS) for pancreatic fluid collections has demonstrated favorable clinical outcomes 1-3. However, for intracavitary bleeding following LAMS placement, conventional hemostatic methods such as clipping or coagulation are often challenging due to tissue fragility and rebleeding risk due to excessive coagulation. Therefore an endoscopic hemostatic agent (PuraStat; 3-D Matrix Medical Technology) might be effective for such bleeding 4, 5. A 66-year-old man with a history of severe acute pancreatitis presented to another hospital with persistent abdominal pain. Computed tomography revealed a 120-mm walled-off necrosis in the pancreatic body and tail with intralesional hematoma (Figure 1a). Thus, he was transferred to our unit for endoscopic treatment. EUS-PFD was performed using a LAMS; a large amount of hematoma was evacuated via the stent (Figure 1b–e). After stent deployment, a nasal cystic tube was placed into the cavity for bleeding monitoring. The pain disappeared afterward, but a small amount of bleeding continued via the tube. Because he had no hematemesis or melena and his vital signs remained stable, endoscopic hemostasis was selected. A standard endoscope was inserted into the stomach, and blood oozing from the LAMS was observed (Figure 2a, Video S1). An endoscope could not be inserted because of insufficient stent expansion. After stent dilation using a balloon catheter, an ultra-slim endoscope was inserted into the cavity (Figure 2b,c). The luminal surface was coated with granulation tissue and hematin was adherent in places (Figure 2d). A bleeding point from a microvessel was identified (Figure 2e), and a total of 1.5 mL of hemostatic agent was applied via an endoscopic retrograde cholangiopancreatography catheter, successfully achieving hemostasis (Figure 2f). This patient was discharged 3 days later and the LAMS was removed 1 month later with no bleeding episodes and no procedure-related adverse events. The authors declare no conflicts of interest. Data sharing not applicable to this article as no datasets were generated or analyzed during the current study. Video S1: A standard endoscope was inserted into the stomach and blood oozing from the stent was observed. Stent dilation was performed using a dilating balloon catheter. An ultra-slim endoscope was inserted into the cavity. The luminal surface was coated with granulation tissue and hematin was adherent in places. A bleeding point from a micro vessel in the granulation tissue was identified. The hemostatic agent was applied via a catheter, successfully achieving hemostasis. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
Kikuchi et al. (Mon,) studied this question.