Post written by Theodore W. James, MD, from the Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA.

We describe our experience rescuing a maldeployed lumen-apposing metal stent (LAMS) by passing an endoscopic ultrasound scope through the proximal end of the stent and re-puncturing the target bowel from within the peritoneum.

The ability to think on one’s feet is a necessity when performing therapeutic endoscopy. Many providers in a similar situation would default to a surgical consultation. We aimed to demonstrate that endoscopy offers solutions to problems (in this case, a maldeployed LAMS) that can help patients avoid surgery. Several elements of this case are noteworthy including: transgastric echoendoscopy and coaxial placement of a second LAMS..

Intraperitoneal echoendoscopy may have numerous future applications. This technique should be considered as an active area of research in minimally invasive endoscopic therapy.

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