RSS-Feed abonnieren
DOI: 10.1055/s-0042-124505
The buried stent: a rare complication of endoscopic ultrasound-guided pancreatic necrosectomy using a lumen-apposing metal stent
Corresponding author
Publikationsverlauf
Publikationsdatum:
31. Januar 2017 (online)
A 51-year-old man was referred to our facility for endoscopic ultrasound-guided drainage of walled-off pancreatic necrosis. The cyst was first punctured with a 19-gauge needle ([Fig. 1]). A NAGI stent (Taewoong Medical, Seoul, South Korea) was then deployed under ultrasonographic and fluoroscopic guidance without difficulty ([Fig. 2], [Video 1]). A computed tomography (CT) scan 6 weeks later revealed significant reduction in the cyst size with residual necrotic debris. Upper endoscopy showed an orifice in the middle of a small bulge of gastric mucosa and the stent could not be seen. The cystogastrostomy tract was cannulated and dilated with a 15-mm pneumatic balloon ([Fig. 3]). The extremity of the lumen-apposing metal stent (LAMS) embedded in the gastric wall was identified, and the stent was removed using rat-tooth forceps ([Fig. 4]). The endoscope was then passed into the cyst cavity and the residual necrotic debris was irrigated and removed with a snare. A follow-up CT scan after 3 months revealed an almost totally collapsed cyst cavity, consistent with drainage of the collection.
![](https://www.thieme-connect.de/media/endoscopy/2017S01/thumbnails/10-1055-s-0042-124505-i14919cl1.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
![](https://www.thieme-connect.de/media/endoscopy/2017S01/thumbnails/10-1055-s-0042-124505-i14919cl2.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
Qualität:
![](https://www.thieme-connect.de/media/endoscopy/2017S01/thumbnails/10-1055-s-0042-124505-i14919cl3.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
![](https://www.thieme-connect.de/media/endoscopy/2017S01/thumbnails/10-1055-s-0042-124505-i14919cl4.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
Plastic stents were conventionally used for the drainage of pancreatic fluid collections, and although their pigtail feature decreases the risk of migration, premature occlusion usually occurs [1]. Metal stents provide larger diameter lumens for better drainage, but their tubular feature increases the risk of migration [2]. The LAMS attempts to overcome these technical challenges with a “dumbbell” configuration to avoid stent migration and a large diameter allowing necrosectomy in repeated sessions [3]. Fabbri et al. were the first to describe a rare adverse event for the use of the LAMS that resembled the “buried bumper” associated with complicated percutaneous endoscopic gastrostomy, which they called the “buried stent” [4]. The buried stent appears to be a potential problem associated with use of the LAMS. To the best of our knowledge, this is the second reported case of a buried stent and the first reported case of endoscopic ultrasound-guided pancreatic necrosectomy in Egypt.
Endoscopy_UCTN_Code_TTT_1AS_2AD
#
Competing interests
None
-
References
- 1 Singhal S, Rotman SR, Gaidhane M. et al. Pancreatic fluid collection drainage by endoscopic ultrasound: an update. Clin Endosc 2013; 46: 506-514
- 2 Walter D, Vleggaar F, Siersema P. Self-expandable metal stents for endoscopic ultrasound-guided drainage of peripancreatic fluid collections. Gastrointest Interv 2013; 2: 24-29
- 3 Yamamoto N, Isayama H, Kawakami H. et al. Preliminary report on a new, fully covered, metal stent designed for the treatment of pancreatic fluid collections. Gastrointest Endosc 2013; 77: 809-814
- 4 Fabbri C, Luigiano C, Marsico M. et al. A rare adverse event resulting from the use of a lumen apposing metal stent for drainage of a pancreatic fluid collection: “the buried stent”. Gastrointest Endosc 2015; 83: 585-587
Corresponding author
-
References
- 1 Singhal S, Rotman SR, Gaidhane M. et al. Pancreatic fluid collection drainage by endoscopic ultrasound: an update. Clin Endosc 2013; 46: 506-514
- 2 Walter D, Vleggaar F, Siersema P. Self-expandable metal stents for endoscopic ultrasound-guided drainage of peripancreatic fluid collections. Gastrointest Interv 2013; 2: 24-29
- 3 Yamamoto N, Isayama H, Kawakami H. et al. Preliminary report on a new, fully covered, metal stent designed for the treatment of pancreatic fluid collections. Gastrointest Endosc 2013; 77: 809-814
- 4 Fabbri C, Luigiano C, Marsico M. et al. A rare adverse event resulting from the use of a lumen apposing metal stent for drainage of a pancreatic fluid collection: “the buried stent”. Gastrointest Endosc 2015; 83: 585-587
![](https://www.thieme-connect.de/media/endoscopy/2017S01/thumbnails/10-1055-s-0042-124505-i14919cl1.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
![](https://www.thieme-connect.de/media/endoscopy/2017S01/thumbnails/10-1055-s-0042-124505-i14919cl2.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
![](https://www.thieme-connect.de/media/endoscopy/2017S01/thumbnails/10-1055-s-0042-124505-i14919cl3.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
![](https://www.thieme-connect.de/media/endoscopy/2017S01/thumbnails/10-1055-s-0042-124505-i14919cl4.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)