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Re: A novel salvage method to recapture the maldeployed distal flange of a lumen-apposing metal stent
We congratulate Prawiradiradja et al. on their novel method to successfully recapture a maldeployed distal flange of a lumen-apposing metal stent (LAMS) . Current literature indicates that maldeployment can occur in 2 %–9 % of cases, even in expert hands  .
We have two concerns regarding the proposed solution (cutting the plastic safety latch to recapture the distal flange). First, maldeployment of a stent is a stressful situation and, if the endoscopist attempts to cut the safety latch, this poses an additional sharps-related injury risk. Studies have shown that, during stressful situations, fine motor skills are impaired more than gross motor skills  . Moreover, removing the safety latch effectively removes the intended brake designed into step 2 of device insertion, which may impact reattempted LAMS deployment, with the step 2 safety latch no longer available to prevent inadvertent distal flange recapture. Instead, we propose a safer alternative (off label) method to help recapture the distal flange, simply by using one’s index finger to push in the lock and recapture the distal flange ([Fig. 1]). This preserves the safety lock, as designed, for any further redeployment attempt.
Second, we note that recapture may not work in all situations. In our bench-top model using a 15 × 10-mm LAMS, despite successful reversal of the deployment mechanism, the distal flange could not be fully recaptured. We recognize that a smaller LAMS could possibly be recaptured more easily, as demonstrated by the authors when using a 6 × 8-mm LAMS. We hope to raise awareness of this phenomenon and emphasize the importance of optimal initial deployment technique.
Article published online:
26 October 2023
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