Detailed Description
This prospective, single-center observational study aims to evaluate the safety and effectiveness of the HANAROSTEN HOT Plumber with Z-EUSIT for pancreatic pseudocyst drainage. The study will assess clinical success, defined as a reduction of at least 50% in pseudocyst size accompanied by symptom improvement, as well as technical success, device retention, lumen patency, and adverse events. Follow-up will continue until one month after stent removal.
### Study Rationale
- Pancreatic pseudocysts develop due to pancreatic duct obstruction or damage caused by inflammation, resulting in fluid accumulation. Symptoms may include abdominal pain, gastric outlet obstruction, early satiety, and weight loss. Drainage is required when pseudocysts become symptomatic, infected, or increase in size.
- Endoscopic ultrasound-guided transgastric or transduodenal drainage is the standard treatment for accessible pseudocysts. Compared to surgical or percutaneous methods, this approach is less invasive and promotes faster recovery.
- The HANAROSTEN HOT Plumber with Z-EUSIT features an electrocautery-enhanced delivery system, eliminating the need for guidewire exchanges and tract dilation. The stent is made of nitinol wire with silicone coating and anti-migration bi-flanges, designed for easy placement and removal.
Study Design
- Type: Prospective, single-center, observational study
- Device: HANAROSTEN HOT Plumber with Z-EUSIT
- Target Enrollment: 20 adults aged 18 years or older
- Procedure: Endoscopic ultrasound-guided transgastric or transduodenal drainage of pancreatic pseudocysts
- Follow-Up: Until one month after stent removal
Procedure Overview
- Prior to the procedure, cross-sectional imaging (CT or MRI) will determine pseudocyst size and proximity to the gastrointestinal lumen, guiding stent selection.
- Patients will receive prophylactic antibiotics and sedation with midazolam and pethidine according to institutional protocols.
- Under EUS guidance, the pseudocyst will be punctured using the electrocautery-enhanced delivery system. The stent will be deployed to create a connection between the pseudocyst and the gastrointestinal lumen, allowing fluid drainage.
- If direct puncture is not feasible, a 19-gauge needle will be used to access the pseudocyst, followed by guidewire placement and stent deployment.
- Stent removal will occur after pseudocyst resolution, confirmed by follow-up imaging, and will be performed using forceps or a snare.
Follow-Up and Safety Monitoring
- Participants will be monitored for adverse events, including bleeding, infection, perforation, stent migration, tissue injury, and other complications.
- Follow-up visits will occur within 30 or 60 days after the procedure, and one month after stent removal.
- Safety monitoring will include clinical assessments, laboratory tests, and imaging studies as required.
Data Collection and Statistical Analysis
- Data will be summarized using descriptive statistics. Continuous variables will be reported as mean ± standard deviation or median (interquartile range), and categorical variables as frequencies and percentages.
- Technical success rates will be calculated as the percentage of successful stent placements and removals. Clinical success rates will be reported as the percentage of participants with ≥50% pseudocyst size reduction and symptom improvement.
- Adverse events will be classified according to severity and relationship to the device. The incidence of stent migration, retention, and lumen patency will also be reported.
- Missing data will be handled using the last observation carried forward (LOCF) method.
Ethical Considerations
- The study will be conducted in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines.
- All participants will provide written informed consent before enrollment.
- Personal data will be anonymized and securely stored, accessible only to authorized study personnel.
This study aims to provide clinical evidence supporting the safety and effectiveness of the HANAROSTEN HOT Plumber with Z-EUSIT for pancreatic pseudocyst drainage, potentially improving outcomes for patients with this condition.