Endoscopy 2018; 50(09): E233-E234
DOI: 10.1055/a-0624-1576
E-Videos
© Georg Thieme Verlag KG Stuttgart · New York

Re-deployment of a dislodged lumen-apposing metal stent (LAMS): avoiding the sacrificial LAMS

Vinay Chandrasekhara
Gastroenterology and Hepatology, Mayo Clinic, Rochester, United States
,
Mark Topazian
Gastroenterology and Hepatology, Mayo Clinic, Rochester, United States
,
Barham K. Abu Dayyeh
Gastroenterology and Hepatology, Mayo Clinic, Rochester, United States
,
Michael J. Levy
Gastroenterology and Hepatology, Mayo Clinic, Rochester, United States
› Author Affiliations
Further Information

Publication History

Publication Date:
19 June 2018 (eFirst)

Lumen-apposing metal stents, or LAMS, have been increasingly used for endoscopic drainage of walled-off pancreatic necrosis (WON). However, these can become dislodged during endoscopic necrosectomy and are expensive to replace. This video highlights a technique to reuse a LAMS after it has become dislodged ([Video 1]).

Video 1 Re-deployment of a lumen-apposing metal stent after dislodgment during endoscopic necrosectomy.

Georg Thieme Verlag. Please enable Java Script to watch the video.

A 63-year-old man with necrotizing pancreatitis underwent endoscopic ultrasound-guided drainage with placement of a 15 × 10 mm LAMS (AXIOS; Boston Scientific, Marlborough, Massachusetts, USA) for an 18-cm area of WON. The patient returned for endoscopic necrosectomy 4 weeks after initial placement. A large amount of necrosis was noted to be obstructing the LAMS ([Fig. 1]). During initial debridement, the stent became dislodged and could not be replaced, and was therefore removed from the patient ([Fig. 2]). Necrosectomy was performed using a snare and rat tooth forceps. Although the majority of the necrosis was removed, a small amount of thick adherent material could not be extracted. Therefore the decision was made to replace the LAMS.

Zoom Image
Fig. 1 Necrotic material occluding the lumen-apposing metal stent.
Zoom Image
Fig. 2 Cystgastrostomy tract after removal of the lumen-apposing metal stent.

The LAMS was thoroughly washed in sterile water. By squeezing and elongating the LAMS, it was back loaded into the channel of the therapeutic upper endoscope. A short portion of the distal aspect of the LAMS was intentionally left outside the channel in case it needed to be recovered ([Fig. 3]). A 5 – 10 Fr Soehendra biliary dilation catheter (Cook Medical, Winston-Salem, North Carolina, USA) was modified by cutting off the graded portion so that the distal tip was 10 Fr in diameter, and the modified catheter was advanced down the channel to the level of the stent. The endoscope was then advanced into the cavity, and under endoscopic and fluoroscopic guidance the distal flange was deployed by advancing the dilation catheter. The endoscope was then withdrawn across the cystgastrostomy tract, and when in the gastric lumen, the proximal flange was deployed ([Fig. 4]). The endoscope was then advanced through the stent to confirm successful deployment.

Zoom Image
Fig. 3 Fully collapsed lumen-apposing metal stent loaded in the channel of the therapeutic upper endoscope.
Zoom Image
Fig. 4 Successful re-deployment of the lumen-apposing metal stent through the cystgastrostomy tract.

Endoscopy_UCTN_Code_CPL_1AK_2AG

Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high quality video and all contributions are freely accessible online.
This section has its own submission website at https://mc.manuscriptcentral.com/e-videos