Endoscopic salvage of errantly deployed lumen-apposing metal stents

Recently, lumen-apposing metal stents (LAMSs) have been introduced to facilitate efficient endoscopic drainage of pancreatic fluid collections, representing an important sustaining innovation in the field. These prostheses offer several conceptual advantages, including a larger lumen diameter that allows seamless introduction of a gastroscope into the cyst cavity. However, their safety profile is still not fully understood, and techniques to mitigate risk and manage adverse events are evolving. We present 3 cases in which LAMSs were errantly deployed distally with the intraluminal flange in the cyst–gastrostomy tract (Fig. 1) or in the cyst cavity. In 2 of the cases, errant deployment occurred because the stent catheter was retracted forcibly after extraluminal flange deployment to pull the cyst cavity toward the stomach wall and shorten a longer-than-usual cyst–gastrostomy tract. This led to desheathing of the stent in a suboptimal position. In the third case, the stent was errantly deployed into the cavity during performance of the entire process under endosonographic guidance, perhaps because of failure to lock the catheter lock before deployment. In all cases, the stents were safely salvaged by dilation of the tract by use of a balloon or a fully covered self-expanding metallic biliary stent to expose the LAMS and allow retrieval with a rat-toothed forceps (Video 1, available online at www.giejournal.org).