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Gastroenterology pioneers at KU Wichita minimize hospital stays with new stent

Gastroenterologists from KU School of Medicine-Wichita are pioneering regional use of a new endoscopic stent in patients suffering from painful and potentially life-threatening pancreatic pseudocysts.

Gastroenterologists from KU School of Medicine-Wichita are pioneering regional use of a new endoscopic stent in patients suffering from painful and potentially life-threatening pancreatic pseudocysts.

A pseudocyst is a fluid-filled sac in the abdomen. They develop most often from acute pancreatitis (sudden swelling or inflammation of the pancreas) but also from chronic pancreatitis or injury. Traditionally, they have been treated by surgically creating a channel to drain them through the digestive system. 

These complications can hospitalize a patient for weeks or even months, but the covered-metal AXIOS stents can vastly reduce hospital stays with a minimally invasive alternative to open surgical procedures. Because stents can typically be installed in less than a half hour, the risks that accompany anesthesia are also reduced.

"Our ability to safely manage very large pseudocysts with minimal complications compared to some of the older techniques has increased a great deal," said Dr. William Salyers, Jr., an assistant professor who is program director of the internal medicine residency program and division chief of the gastrointestinal division.

The older endoscopic techniques with plastic stents would be a seven-day stay in the hospital with IV antibiotics," he said. "If it's only a pseudocyst I do it now as a 48-hour extended recovery outpatient procedure."

Salyers first used the AXIOS stents in February, and he and Dr. Nathan Tofteland, assistant professor, have since performed a number of the endoscopic procedures at Wesley Medical Center. The hospital is just one of 80 sites across the country where the stents' use has been allowed so far. "My hope is that it will become something that I can offer wherever the patient needs it," Salyers said of expanding their use to other hospitals.

Salyers' practice has a focus on advanced therapeutic endoscopy. That focus includes work in diagnosis and staging of pancreatic and esophageal cancer, severe pancreatitis, and esophageal disorders. He sees patients at the VA Medical Center and at KU Wichita Gastroenterology and has used stents in patients in both locations. 

The covered, metal mesh stents are placed and expanded with a balloon. Dead or infected tissue is removed if present. If all goes well, the patient can eat normally the next day - far shorter than with the traditional surgical procedure - and leave the hospital within two days. Two weeks later the stent is removed endoscopically.

"I initiated this because I felt it would make a huge impact on patient care after seeing some of the patients with pancreatic necrosis and how long of a course of recovery they had and how difficult it could be for some of them to recover," Salyers said. "You are looking at a recovery period that still may be weeks or months, but we can be cutting months off that and having them be very functional at the end." 

"When I was trying to get the stent, a representative of the company flew out to meet with me and interview me on whether I was qualified to use their product," Salyers said. "Working for the university was a huge help in getting it done."


KU School of Medicine-Wichita