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EUS-guided stent removal in buried lumen-apposing metal stent syndrome: a case series.

ABSTRACT: Background and Aims:Lumen-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. Methods:We 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. Results:The 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. Conclusions:Buried 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.

SUBMITTER: Biedermann J

PROVIDER: S-EPMC6945230 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Background and aimsPelvic fluid collections (PFCs) are frequent adverse events of abdominal surgery or inflammatory conditions. A percutaneous approach to deep PFCs could be challenging and result in a longer, painful recovery. The transvaginal approach has been considered easy but is limited by the difficulty of leaving a stent in place. The transrectal approach has been described, but issues related to fecal contamination were hypothesized. Data on EUS-guided transrectal drainage (EUS-TRD) with lumen-apposing metal stents (LAMSs) are few and suggest unsatisfactory outcomes. The aim of this study was to evaluate the safety and efficacy of EUS-TRD with LAMSs in patients with PFCs.MethodsA retrospective analysis of a prospectively maintained database on therapeutic EUS was conducted. All EUS-TRD procedures were included.ResultsFive patients (2 male, age 44-89 years) were included. Four patients had postoperative PFCs, and 1 presented with a pelvic abscess complicating acute diverticulitis. Two of 5 had fecal diversion; the remaining 3 had unaltered large-bowel anatomy. One case had a concomitant abdominal collection, treated with percutaneous drainage in the same session. An electrocautery-enhanced LAMS delivery system (15 × 10 mm) was used in all cases. EUS-TRD was performed with the direct-puncture technique and lasted less than 10 minutes in 4 cases; in the remaining case, needle puncture and LAMS placement over a guidewire was required, and the procedure length was 14 minutes. The clinical success rate was 100%. LAMSs were removed after a median of 14 (range, 12-24) days. One patient reported partial proximal LAMS migration after 24 days (mild adverse event). No PFC recurrence was observed.ConclusionEUS-TRD with LAMSs is a safe and effective technique for treatment of PFCs. The use of 15- × 10-mm LAMSs allows rapid PFC resolution. EUS-TRD could be performed not only in patients with fecal diversion but also in cases of unaltered anatomy.

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EUS-guided stent removal in buried lumen-apposing metal stent syndrome: a case series.

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