Year 2021 / Volume 113 / Number 3
Letter
Lumen-apposing metal stent deployment failure

224-225

DOI: 10.17235/reed.2020.7060/2020

Pedro López Morales, Miguel Ruiz Marín, Antonio Albarracín Marín-Blázquez,

Abstract
Endoscopic ultrasound-guided transmural drainage has become a first-line therapy for pancreatic fluid collections (1). The appearance of lumen-apposing metal stents has resulted in an authentic revolution, due to their efficacy (clinical success rate of 93%) and easy deployment (technical success rate of 98%) (2). They are associated with a shorter procedure time, lower risk of migration and a wider lumen, which could provide a more effective drainage (3). We report the case of a 78-year-old male who developed an infected pancreatic pseudocyst as a late complication of an acalculous severe acute pancreatitis. An endoscopic ultrasound-guided transmural drainage was performed after a failed computed tomography-guided percutaneous drainage with placement of a pig-tail catheter. A gastrocystic fistula was created and an AxiosTM lumen-apposing metal stent (Boston Scientific; Massachusetts, United States) was inserted. Nevertheless, it remained lodged in the pancreatic pseudocyst at the time of deployment. A computed tomography scan confirmed stent placement inside the collection (Figure 1). After endoscopic balloon dilatation of gastrocystic fistulous tract, removal was unsuccessful with proximal traction of the lumen stent flange using biopsy forceps. Surgical treatment was decided and a gastrotomy was performed, the fistula was identified in the posterior gastric wall and the stent was removed. Endoscopic ultrasound-guided transmural drainage of pancreatic fluid collections using lumen-apposing metal stents is a safe procedure. However, it is not exempt of complications such as stent migration, bleeding, gastrointestinal perforation and air embolism (4). Technical failure of lumen-apposing metal stents deployment is a rare complication that may require surgical treatment if endoscopic removal is not possible.
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References
1. Han D, Inamdar S, Lee CW et al. Lumen Apposing Metal Stents (LAMSs) for Drainage of Pancreatic and Gallbladder Collections: A Meta-analysis. J Clin Gastroenterol. 2018;52(9):835–44.
2. Hammad T, Khan MA, Alastal Y et al. Efficacy and Safety of Lumen-Apposing Metal Stents in Management of Pancreatic Fluid Collections: Are They Better Than Plastic Stents? A Systematic Review and Meta-Analysis. Dig Dis Sci. 2018;63(2):289–301.
3. Garcia-Garcia de Paredes A, Lopez-Duran S, Foruny J et al. Management of pancreatic collections: An update. Rev Esp Enferm Dig. Pendiente de publicación.
4. Bang JY, Hawes R, Bartolucci A et al. Efficacy of metal and plastic stents for transmural drainage of pancreatic fluid collections: A systematic review. Dig Endosc. 2015;27(4):486–98.
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López Morales P, Ruiz Marín M, Albarracín Marín-Blázquez A. Lumen-apposing metal stent deployment failure. 7060/2020


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Publication history

Received: 21/03/2020

Accepted: 01/04/2020

Online First: 19/11/2020

Published: 08/03/2021

Article Online First time: 243 days

Article editing time: 352 days


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