EUS-guided rescue of lumen-apposing stent

Saowanee Ngamruengphong, MD, from the Department of Medicine and Division of Gastroenterology and Hepatology at the Johns Hopkins Medical Institutions in Baltimore, Maryland, USA presents this VideoGIE case “EUS-guided rescue of early dislodgement of a lumen-apposing stent.”

A 74-year-old man presented with cholelithiasis and choledocholithiasis. The patient underwent an ERCP with biliary sphincterotomy and placement of a plastic stent in the bile duct. He was not a surgical candidate for cholecystectomy because of his multiple comorbidities. We offered endoscopic drainage through EUS-guided direct transmural stent placement into the gallbladder. A transmural lumen-apposing stent placement was performed through the duodenal bulb into the gallbladder. Immediately after stent deployment, the stent externally migrated, with one flange of the stent in the peritoneal cavity and one flange still in the gallbladder. This video describes placement of a bridging stent using a fully covered metal stent for salvaging early migration/dislodgement of a lumen-apposing metal stent.

Figure 1. Fluoroscopic view of a fully covered metal stent (bridging stent) inside the migrated lumen-apposing metal stent and bridges between the gallbladder and duodenal bulb.

The lumen-apposing stent has been used for endoscopic management of pseudocyst and gallbladder drainage with very high technical and clinical success. Even though it has bilateral large flanges to prevent migration, stent migration and dislodgement have been reported in 5% of patients. This video describes a novel endoscopic technique for management of early migration of the lumen-apposing metal stent during EUS-guided gallbladder drainage.

Find more VideoGIE cases online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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