New stent expands treatment options for critically ill patients

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By Kelly O’Brien

Gastroenterologists at St. Michael’s Hospital were the first in Ontario to use a new type of stent to treat complicated cases of pancreatitis and severe infection in the bile ducts or gallbladder.

The stent also allows gastroenterologists to treat patients at the bedside using an endoscopic ultrasound, expanding treatment options for those in the intensive care unit who are too sick to be moved or to have major surgery.

The stent, known as a Hot-AXIOS stent, is used in the United States and Europe, but is not yet approved for use in Canada. St. Michael’s was the first hospital in Ontario to get “batch approval” from Health Canada for eight stents, to be used where doctors otherwise wouldn’t have been able to treat the patient.

Dr. Jeff Mosko performed the first procedure using the stent in January, alongside Dr. Gary May, division head of gastroenterology at St. Michael’s. Both participated in specific training before being granted the batch approval.

“This stent allows us to expand the number of patients we treat and reduces the number that need major surgery because we can operate through the scope on patients who we wouldn’t have been able to before,” says Dr. May.

Pancreatitis is a condition in which the pancreas becomes inflamed, and in severe cases, can cause fluid and dead tissue to collect in the form of cysts near the stomach. The fluid and tissue are relatively easy to remove using a traditional plastic stent and a scope, so long as the cyst and stomach are stuck together.

The Hot-AXIOS stent is a lumen-apposing metal stent, or LAMS, made of a coated woven metal alloy instead of plastic. Its shape, similar to that of a dumbbell, allows it to be deployed through an ultrasound scope. It brings the stomach and cyst together to prevent dead tissue from leaking into the body when draining the cyst, which reduces complications.

Dr. May says there were some huge advantages to using the new stent. “It facilitates further treatment, and allows for the procedure to be performed in one step,” he says. “When extra steps are eliminated, it reduces the time for the procedure, and it can be done without the need for X-ray, which opens up the options of where we can treat the patients.”

But there are disadvantages, the main one being the cost. The Hot-AXIOS stent is significantly more expensive than other stents.

“It’s not something we’re going to start using in every case, but certainly we can use it when we can’t proceed with our standard techniques, or using this stent would significantly minimize the risks for the patient,” says Dr. May.

Kelly O’Brien works in communications at St. Michael’s Hospital.