A 31-year-old woman with a history of alcohol pancreatitis presented with abdominal
pain. During her initial admission, she developed an 8.2-cm peripancreatic fluid collection.
She underwent successful endoscopic ultrasound-guided drainage of the collection with
a 15 mm lumen-apposing metal stent (LAMS). Though instructed to return, the patient
was lost to follow-up. She returned to an outside hospital 7 months later with recurrent
pancreatitis secondary to alcohol use. Imaging demonstrated resolution of the peripancreatic
collection, with the cyst-gastrostomy stent still in situ. The initial attempt at
stent removal was unsuccessful. She was then transferred to our institution.
During endoscopy the LAMS was seen in the gastric body. Endoscopically, it was evident
that the plastic covering had been eroded ([Video 1]). There was visible tissue ingrowth into the LAMS. The gastric flange was detached
from the gastric mucosa using a snare. However, the distal flange was imbedded in
the tissue. After multiple attempts, the distal flange was successfully removed using
rat tooth forceps after detaching it from tissue. The fistula site had mild oozing
after stent removal. Examination of the removed stent demonstrated obvious tissue
ingrowth through the degraded plastic covering ([Fig. 1]).
Video 1 Lumen-apposing metal cyst-gastrostomy stent with visible tissue ingrowth and erosion
of the plastic covering.
Fig. 1 The lumen-apposing metal stent after endoscopic removal, with evidence of significant
tissue ingrowth through the stent.
After the development of LAMS, endoscopists have created multiple novel anastomoses
between various gastrointestinal lumens. Official recommendation from the manufacturing
company is to remove these stents 60 days after deployment. However, various studies
have demonstrated outcomes beyond 60 days. Examples include pancreatic fluid collections,
benign intestinal tract strictures, gallbladder drainage, choledochoduodenostomy [1]
[2]
[3]
[4]. LAMS have remained in place for longer than 2 months, and reportedly have remained
patent for greater than 6 months. However, degrading of the plastic coating and tissue
ingrowth is a known complication of long-term use of LAMS. Therefore, periodic evaluation
of these patients is necessary to ensure timely removal.
Endoscopy_UCTN_Code_TTT_1AS_2AD
Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques
in gastroenterological endoscopy. All papers include a high quality video and all
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