Amy Tyberg, MD from Weill Cornell Medical College in New York, New York, USA presents this video case, “Pancreatic Necrosectomy when using a Lumen-Apposing Metal Stent.”

This video describes a case of a patient with pancreatic walled-off necrosis who failed endoscopic drainage using plastic pigtail stents and subsequently underwent successful endoscopic drainage with a fully-covered, lumen-apposing metal stent.

The incorporation of fully-covered, self-expanding metal stents (FCSEMSs) into the endoscopic arsenal has dramatically changed the face of endoscopic necrosectomy. Several recent trials have validated endoscopic necrosectomy as the therapy of choice for drainage of pancreatic necrotic collections. Not only do the larger stent lumens facilitate improved drainage, they also allow for passage of an endoscope through the stent into the cyst cavity to mechanically remove necrotic debris. Yet despite these improvements, one limitation associated with FCSEMSs is stent migration. The emergence of the lumen-apposing metal stent, which has a design that involves a central lumen between 2 outer flanges to secure placement and prevent migration, helps overcome this limitation. This video illustrates the ease and efficacy of using this new stent when performing endoscopic necrosectomy.

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