LAUSR

Endoscopic ultrasound (EUS)-guided drainage is well known as an established technique for the treatment of pancreatic pseudocysts [1, 2]. New covered metal stents, known as lumen-apposing metal stents (LAMS), have been designed. Despite their superior antimigration features, these LAMS can migrate inwardly [3, 4]. We report a case of successful endoscopic retrieval of a LAMS with inward migration after cystogastrostomy. A 50-year-old man with a history of alcohol-induced chronic pancreatitis complicated by a large pancreatic pseudocysts at the head of the pancreas (▶Fig. 1), presented with severe abdominal pain and gastric outlet obstruction. EUS-guided cystogastrostomy was successfully performed with a 15-mm LAMS (▶Fig. 2). The patient returned for stent removal 2 months later, and the follow-up computed tomography (CT) scan revealed resolution of the cyst. However, during the esophagogastroduodenoscopy to remove the stent, we observed a small orifice at the location of the previously applied stent (▶Fig. 3 a). Fluoroscopic images confirmed stent migration into the fistulous lumen of the remaining pseudocyst (▶Fig. 3 b). We proceeded with endoscopic retrieval of LAMS (▶Video1). The retrieval procedure was performed under general anesthesia. Carbon diox▶ Fig. 1 Computed tomography scan demonstrating a large pancreatic pseudocyst (circled) at the head of the pancreas, requiring endoscopic ultrasound-guided drainage.