EUS-GUIDED LOCATION AND REMOVAL OF A BURIED LUMEN-APPOSING METAL STENT WITHIN THE GASTRIC MUCOSA

Introduction:

Endoscopic ultrasound (EUS)-guided lumen-apposing metal stent (LAMS) placement has become the first-line management of pancreatic fluid collections (PFCs) at many centers. LAMs has also shown to be safe and effective for endoscopic transmural drainage of pancreatic pseudocysts (PP) and walled-off pancreatic necrosis (WON). However, its long-term safety profile is not fully established. Our aim was to describe a clinical case of a LAMS buried within the gastric mucosa that was located and removed by EUS.

Endoscopic procedure:

A 65-year-old man with chronic pancreatitis was admitted to the hospital because of PP drainage. PP was located in the body of the pancreas and drainage was performed using EUS-guided LAMS (Hot-Axios 6 × 8 mm, Boston Scientific) placement by “free-hand” technique without early complications. After 66 days, PP resolution was confirmed by an abdominal CTscan. However, during an upper gastrointestinal endoscopy to remove LAMS, inspection of the gastric wall revealed that the gastric mucosa was completely healed at the site of the stent. Then, an EUS was performed and a buried stent within the gastric mucosa was confirmed. Under endoscopic and fluoroscopic guidance, 19-gauge needle was used to puncture inside the stent and a 0.025" guidewire (VisiGlide, Olympus) was passed through the stent. After that, gastric wall was dilated and then the Hot Axios was removed with mouse clamp.

Conclusions:

LAMS are effective for endoscopic transmural drainage of collections, however, buried stent can be a long-term complication. In these cases, buried LAMS can be located and removed by EUS-guided procedure.