Post written by Pradev Inavolu, MD, DM, Wladyslaw Januszewicz, MD, PhD, and Sundeep Lakhtakia, MD, DM, from AIG Hospitals and Asian Institute of Gastroenterology, Hyderabad, Telangana, India.

We encountered a case of maldeployment of a lumen-apposing mental stent (LAMS) into the pseudocyst cavity with loss of access.

Typically, such an adverse event necessitates a surgical intervention to retrieve the stent. In this video, we demonstrate a novel approach in an uncommon situation using a forward-view echoendoscope (FVE) for better alignment.

This was initially not possible using a conventional linear echoendoscope. The pseudocyst was accessed through the lumen of the internally migrated LAMS using a 19-gauge FNA needle. The guidewire was passed and coiled into the remnant pseudocyst cavity. After track dilation with a balloon, an endoscope was introduced, and the migrated LAMS was successfully retrieved.

LAMSs are widely used for drainage of pancreatic fluid collections, and occasional mishaps including maldeployment or internal migrations can occur. The learning from this case is to consider use of a FVE in situations of suboptimal access with a conventional linear echoendoscope. This video shares the sequential steps to retrieve a maldeployed LAMS.

FVEs, though not commonly available, represent a valuable tool for addressing challenging situations such as the one described. Their availability can greatly aid in managing complex cases and providing effective solutions when standard equipment may not suffice.

Endoscopic image using an ultrathin nasal gastroscope in the pancreatic collection with a visible lumen-apposing stent.

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