The buried stent: a rare complication of endoscopic ultrasound-guided pancreatic necrosectomy using a lumen-apposing metal stent.

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, ▶Video1). 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 CTscan after 3 months revealed an almost totally collapsed cyst cavity, consistent with drainage of the collection. 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].