Successful retrieval of a lumen-apposing metal stent that had completely migrated into the cavity of a walled-off necrosis

Endoscopic ultrasonography (EUS)-guided transgastric drainage of pancreatic fluid collections (PFCs) using a lumen-apposing metal stent (LAMS) is an effective treatment for walled-off necrosis (WON) [1] [2] [3]. However, misdeployment can occur, which is a severe adverse event [4] [5].

EUS-guided transgastric drainage with a LAMS was performed in a 29-year-old woman, for a WON induced by severe idiopathic acute pancreatitis ([Fig. 1]). A convex-type echoendoscope (EG-580UT; Fujifilm, Tokyo, Japan) and a 20-mm LAMS (Hot AXIOS; Boston Scientific, Marlborough, Massachusetts, USA) were used. The delivery system of the LAMS was successfully inserted into the cavity of the WON. However, the LAMS migrated into the WON during deployment: after intrachannel deployment, the LAMS was pushed out from the echoendoscope, but because the distance between the echoendoscope and gastric wall was not recognized, the LAMS moved into the WON cavity. EUS revealed that the LAMS was floating in the WON cavity ([Fig. 2]).

Fig. 1 A walled-off necrosis (WON) developed in a 29-year-old woman after severe idiopathic acute pancreatitis.

Fig. 2 Endoscopic ultrasonography (EUS) shows the migrated lumen-apposing metal stent (LAMS) (yellow arrows) floating in the cavity of the WON.

An additional LAMS was successfully placed in order to remove the migrated LAMS. After balloon dilation (GIGA 14–16-mm; Century Medical Devices, Tokyo, Japan) of the LAMS, a 9.8-mm-diameter forward-viewing endoscope (EG-580RD; Fujifilm) was inserted into the WON cavity through this additional LAMS and the migrated LAMS was observed ([Fig. 3]). The migrated LAMS was successfully retrieved through the scope by using a snare to grasp the center of the saddle part, without any adverse event ([Video 1]).

Fig. 3 The migrated LAMS was found within the WON.

Video 1 Endoscopic retrieval of a migrated lumen-apposing metal stent (LAMS) with a forward-viewing endoscope from a walled-off necrosis cavity, following endoscopic ultrasonography (EUS)-guided placement of an additional LAMS.

The use of an additional LAMS was an effective salvage procedure to endoscopically remove a LAMS that had migrated into a WON cavity during an EUS-guided attempt at transgastric drainage of the WON.

Endoscopy_UCTN_Code_CPL_1AL_2AD

Competing interests

Author H. I. was supported by research grants from Boston Scientific Japan and FUJIFILM Corporation. The funding source has no role in the design, practice, or analysis of this study. The remaining authors have no conflicts of interest to disclose.

• References

• 1 Banks PA, Bollen TL, Dervenis C. et al. Classification of acute pancreatitis-2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013; 62: 102-111
• 2 Arvanitakis M, Dumonceau JM, Albert J. et al. Endoscopic management of acute necrotizing pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) evidence-based multidisciplinary guidelines. Endoscopy 2018; 50: 524-546
• 3 Isayama H, Nakai Y, Rerknimitr R. et al. Asian consensus statements on endoscopic management of walled-off necrosis. Part 2: Endoscopic management. J Gastroenterol Hepatol 2016; 31: 1555-1565
• 4 Garcia-Alonso FJ, Sanchez-Ocana R, Penas-Herrero I. et al. Cumulative risks of stent migration and gastrointestinal bleeding in patients with lumen-apposing metal stents. Endoscopy 2018; 50: 386-395
• 5 Mehta N, Abushahin A, Franco M. et al. Endoscopic retrieval of a lumen-apposing metal stent complicated by inward migration after cystogastrostomy. Endoscopy 2018; 50: E286-E288

Publication History

Article published online:
17 July 2023