Project description:Video 1Narration of case and demonstration of the endoscopic management of an embedded stent with stent-in-stent technique to induce pressure necrosis, followed by a combination of needle-knife electroincision, argon plasma coagulation, stent intubation and transection with the gastroscope shaft, and cold and hot snare resection.
Project description:Lumen-opposing metal stents (LAMS) are evolving as novel treatment options in postsurgical strictues. Data on lower GI tract applications, however, are still limited, and technical procedural details need to be refined. This singular clinical report adds to the emerging experience in colorectal stricture treatment by LAMS.
Project description:Background and aimsPlacing a lumen-apposing metal stent (LAMS) through ascites carries serious risks, including death from leakage around the LAMS and failure to create a mature fistula between the 2 lumens. However, sometimes no options exist or are equally dangerous. We present 5 patients who underwent LAMS placement despite ascites in 2 different locations.MethodsThis is a retrospective review of 5 patients who underwent LAMS placement despite ascites in 2 different locations from 2016 to 2018.ResultsThree patients with cholecystitis and 2 patients with afferent limb syndrome and severe ascites were treated with a combination of preprocedural and intraprocedural paracentesis. Serum ascites albumin gradient was measured. Weight was recorded daily. Patients were encouraged to sleep at an incline, and periodic paracentesis (every 3-7 days) was performed when ascites reaccumulated over 4 weeks. Median volume of ascites aspirated was 2 L preprocedurally and 300 mL intraprocedurally. Only 1 patient had ascites with a high serum ascites albumin gradient and was treated with diuretics. Technical and clinical success was achieved in all 5 patients without any adverse events over a median follow-up of 28 weeks.ConclusionsIn situations in which no better options remain, LAMS placement appears to be safe after adequate and aggressive treatment of the underlying ascites pre-, intra-, and postprocedurally. Larger studies are needed to establish the safety of this approach.
Project description:Background and aimsLumen-apposing metal stents (LAMSs) play an increasing role in transgastric and transduodenal drainage of pancreatic fluid collections and allow novel EUS-guided interventions. Alongside the main adverse events of bleeding and occlusion, LAMSs can be overgrown by mucosa, which leads to the inability to visualize the stent in endoscopy.MethodsWe describe a series of 4 cases of buried LAMSs that were removed under EUS guidance for identification of the stent followed by removal with rat-tooth forceps.ResultsThe median in situ time of the LAMSs in the reported 4 cases was 53 days. All stents could no longer be visualized endoscopically when drainage of necrosis was complete. All 4 buried LAMSs could be identified by EUS and were removed successfully with forceps. In 1 case, balloon dilation of the stent tract was performed before stent removal. No adverse events were observed after the procedure.ConclusionsBuried stent syndrome is a rare adverse event of LAMSs. Here we describe a safe and effective approach for stent identification and removal without prior mucosal dissection.