LAUSR

Endoscopic ultrasound (EUS)-guided gallbladder drainage (EGBD) is gaining popularity as an option for the treatment of acute cholecystitis in patients who would be considered high risk for cholecystectomy [1]. EGBD has been shown to be associated with comparable technical and clinical success rates to percutaneous cholecystostomy, whilst carrying a 4.8%–22% risk of adverse events, including pneumoperitoneum, bile leak, and stent migration [2–5]. Stent-induced bleeding after EGBD is however uncommon. A 95-year-old men on dabigatran with multiple comorbidities suffered from acute cholecystitis. As he was high risk for cholecystectomy, EGBD was performed. A lumen-apposing metal stent (LAMS; Spaxus, Taewoong Medical Corporation, South Korea) and a 3-cm double-pigtail stent were inserted for gallbladder drainage. He was scheduled for cholecystoscopy and stone removal 1 month later. On cholecystoscopy, a 2-cm gallstone was noted at Hartmann’s pouch but could not be removed, so the LAMS was left in situ as a long-term stent. After 4 months, he was admitted with hematemesis and tarry stools; his hemoglobin had dropped to 5.9g/dL. An urgent endoscopy was performed and it was found that his stomach was filled with blood clots (▶Video 1). The LAMS remained in situ at the inferoposterior wall of the first part of the duodenum, E-Videos