LAUSR

The lumen-apposing metal stent (LAMS) has been reported to be a useful device for pancreatic fluid collection (PFC) [1]. The technical success rates are generally high, but accidental deployment of a stent flange might happen occasionally. This is a case of a real-time salvage of a maldeployed LAMS in PFC drainage (▶Video 1). A 54-year-old woman was admitted to our center with intermittent epigastric pain. Computed tomography revealed a large pancreatic pseudocyst (PPC), possibly associated with acute pancreatitis 3 months previous. The PPC lesion was about 11.4×11.0 cm in size on endoscopic ultrasound (EUS) imaging (▶Fig. 1 a). After obtaining the patient’s informed consent, EUS-guided transmural drainage was performed. Following the successful puncture with a 19-gauge needle, a 20×10-mm fully covered LAMS (Micro-Tech, Nanjing, China) was inserted through the guidewire. The distal flange was deployed appropriately, however the proximal flange of the LAMS was unintentionally released in the PPC (▶Fig. 1b). A 12-mm balloon (Boston Scientific, Marlborough, Massachusetts, USA) was then introduced over the retained guidewire to dilate the fistulous tract (▶Fig. 2 a). Owing to the appropriate choice of cystogastrostomy site, the wall of PPC did not move far away from the gastric body. A therapeutic endoscope easily passed into the cyst and located the LAMS through the enlarged orifice. The proximal flange of the LAMS was remodeled and pulled out into the gastric side by a retrieval hook (▶Fig. 2b). Follow-up endoscopy 1 week later confirmed the LAMS was still at the desired position (▶Fig. 3). To the best of our knowledge, this is the first report of successful retrieval and repositioning of a biflanged LAMS in real time. Particularly, unlike the previous strategy in published literature, no repeated cystogastrostomy was performed and no second stent was used in the present trial [2, 3]. This case would provide further experience to manage LAMS misplacement.