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
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