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Retrieval and reuse of a dislodged lumen-apposing metal stent during endoscopic necrosectomy for pancreatic necrosis
VIDEOGIE Todd H. Baron, MD, G. S. Raju, MD, Editors for VideoGIE
Retrieval and reuse of a dislodged lumen-apposing metal stent during endoscopic necrosectomy for pancreatic necrosis
Figure 1. Dislodged lumen-apposing metal stent during necrosectomy.
A 53-year-old man with gallstone pancreatitis complicated by infected walled-off pancreatic necrosis (WOPN) was admitted to our institution. EUS-guided cystgastrostomy was performed with insertion of a 15-mm diameter lumen-apposing metal stent (LAMS). Two weeks later, during direct endoscopic necrosectomy (DEN), a therapeutic gastroscope (10-mm diameter, 3.7-mm working channel) was inserted through the LAMS into the cavity. Hydrogen peroxide lavage and debridement of the necrotic tissue was performed. Upon withdrawal of the gastroscope from the cavity, the LAMS was noted endoscopically and fluoroscopically to have dislodged (Fig. 1A). Necrosectomy was continued through the fistulous tract, and upon completion, the LAMS was retrieved from the stomach using biopsy forceps and was removed through the mouth. The retrieved LAMS was then backloaded into the gastroscope channel using biopsy forceps to grasp one flange of the stent while elongating the stent in a cylindrical fashion and simultaneously applying gentle traction on the biopsy forceps (Video 1, available online at www.giejournal.org). Once the LAMS was backloaded into the channel, the gastroscope was advanced into the cavity, and the biopsy forceps were advanced to deploy
www.giejournal.org
the LAMS with the distal flange in the cavity and the proximal flange within the stomach (Fig. 1B). Dilation of the LAMS to 15 mm was then performed with a controlled radial expansion balloon. Two more sessions of DEN were performed without further dislodgment of the LAMS with complete resolution of the WOPN.
DISCLOSURE M. Kahaleh has acted as a consultant for Boston Scientific, Xlumina, and Maunakea, and has undertaken research for Gore, MI Tech, Pinnacle, and Maunakea. All other authors disclosed no financial relationships relevant to this publication. Nikhil A. Kumta, MD, MS, Rushabh Doshi, Porfirio J. Reinoso Jr, Amy Tyberg, MD, Michel Kahaleh, MD, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA http://dx.doi.org/10.1016/j.gie.2016.02.042
Volume
-,
No.
-
: 2016 GASTROINTESTINAL ENDOSCOPY 1
Retrieval and reuse of a dislodged lumen-apposing metal stent during endoscopic necrosectomy for pancreatic necrosis
Figure 1. Dislodged lumen-apposing metal stent during necrosectomy.
A 53-year-old man with gallstone pancreatitis complicated by infected walled-off pancreatic necrosis (WOPN) was admitted to our institution. EUS-guided cystgastrostomy was performed with insertion of a 15-mm diameter lumen-apposing metal stent (LAMS). Two weeks later, during direct endoscopic necrosectomy (DEN), a therapeutic gastroscope (10-mm diameter, 3.7-mm working channel) was inserted through the LAMS into the cavity. Hydrogen peroxide lavage and debridement of the necrotic tissue was performed. Upon withdrawal of the gastroscope from the cavity, the LAMS was noted endoscopically and fluoroscopically to have dislodged (Fig. 1A). Necrosectomy was continued through the fistulous tract, and upon completion, the LAMS was retrieved from the stomach using biopsy forceps and was removed through the mouth. The retrieved LAMS was then backloaded into the gastroscope channel using biopsy forceps to grasp one flange of the stent while elongating the stent in a cylindrical fashion and simultaneously applying gentle traction on the biopsy forceps (Video 1, available online at www.giejournal.org). Once the LAMS was backloaded into the channel, the gastroscope was advanced into the cavity, and the biopsy forceps were advanced to deploy
www.giejournal.org
the LAMS with the distal flange in the cavity and the proximal flange within the stomach (Fig. 1B). Dilation of the LAMS to 15 mm was then performed with a controlled radial expansion balloon. Two more sessions of DEN were performed without further dislodgment of the LAMS with complete resolution of the WOPN.
DISCLOSURE M. Kahaleh has acted as a consultant for Boston Scientific, Xlumina, and Maunakea, and has undertaken research for Gore, MI Tech, Pinnacle, and Maunakea. All other authors disclosed no financial relationships relevant to this publication. Nikhil A. Kumta, MD, MS, Rushabh Doshi, Porfirio J. Reinoso Jr, Amy Tyberg, MD, Michel Kahaleh, MD, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA http://dx.doi.org/10.1016/j.gie.2016.02.042
Volume
-,
No.
-
: 2016 GASTROINTESTINAL ENDOSCOPY 1