Endoscopic management of a long-term distal LAMS migration after endoscopic ultrasound-guided gallbladder drainage

Abstract Text An 84-year-old woman was admitted for severe sepsis due to biliary acute cholecystitis and cholangitis. Due to the high surgical risk, concomitant EUS-GBD with transduodenal 10x10 mm LAMS and ERCP were performed. A double pig-tail plastic stent (DPPS) was placed through the LAMS. Fifteen months later, the patient experienced right-upper abdominal pain and abdominal imaging showed LAMS distal migration into the gallbladder. Upper endoscopy was performed and the DPPS loop was identified protruding from the fistula, while the LAMS was not visible. After ballon fistula dilation, gallbladder access with the gastroscope was obtained and both stents were retrieved with forceps. Cystic duct was then cannulated and a trans-papillary DPPS was placed. Gallbladder stones were finally removed using a net, until complete gallbladder clearance.

Video  http://data.process.y-congress.com/ScientificProcess/Data//106/570/1428/1d9d9d60-deb8-4fe0-8d00-6e4a345ff8ec/Uploads/16849_Migrated_LAMS.mp4