Commentary

Endoscopic ultrasound (EUS)-guided transgastric drainage is a cornerstone in the treatment of symptomatic pancreatic walled-off necrosis (WON). The easiest access method is placement of a lumen-apposing metal stent (LAMS). However, in patients with disconnected tail syndrome, indwelling plastic stents are often placed to reduce the risk of recurrence after resolution of the WON. In this case presentation, Kato et al. describe a newly developed double-pigtail plastic stent where the end proximal to the operator is only half-pigtail in shape, thereby facilitating safe removal of the LAMS without dislodgment of the already placed coaxial plastic stent. Of note, the evidence supporting the use of indwelling plastic stents to reduce the risk of recurrence remains controversial, as do the optimal number, size, and duration before removal.

Publication History

Article published online:
28 August 2025