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EUS-guided removal of a buried lumen-apposing metal stent caused by delayed inward migration after cyst-gastrostomy

Published:March 25, 2017DOI:https://doi.org/10.1016/j.gie.2017.03.023
      A 63-year-old man with advanced chronic pancreatitis had a 6-cm pancreatic abscess drained through EUS-guided cyst-gastrostomy with a 15 × 10 mm lumen-apposing metal stent (LAMS). The puncture tract crossed the gastroesophageal junction, so that the intraluminal end of the LAMS lay in the esophagus. No adverse events ensued, and no residual pancreatic fluid collection (PFC) was seen at follow-up CT. The patient, however, was lost to follow-up and was readmitted 8 months later for upper GI bleeding related to nonsteroidal anti-inflammatory drug use. During emergent endoscopy, the intraluminal end of the LAMS was briefly seen among blood clots. However, at elective endoscopy for retrieval 48 hours later, no stent could be found. CT showed the stent lying outside the stomach, close to the aorta, without any residual PFC (Fig. 1A). A new puncture into the retrogastric LAMS was performed under combined guidance by EUS (Fig. 1B) and fluoroscopy (Fig. 1C). The puncture tract was balloon dilated, and the LAMS was uneventfully removed with a rat-tooth forceps (Video 1, available online at www.giejournal.org). No closure devices were deemed necessary. The patient did well.
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      Figure 1A, CT view showing LAMS lying outside the stomach, close to the aorta. B, EUS view combined with fluoroscopic view (C) showing precise location and needle targeting of buried migrated LAMS before creation of a new tract for extraction.
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