Surgical, percutaneous, or endoscopic approaches may all be considered for pancreatic pseudocyst drainage. The surgical approach is associated with higher rates of morbidity (7%–37%) and mortality (6%), whereas the percutaneous cystic drainage is associated with infection or fistula formation (14%).7–9 Endoscopic cystogastrostomy is the preferred approach because it is associated with decreased re-intervention rate, reimaging rate, and a shorter hospital stay.10
EUS-guided drainage of pancreatic fluid collections has traditionally been performed using double-pigtail plastic stents after cystogastrostomy. The narrow lumen of double-pigtail plastic stents may cause premature occlusion in up to 18% of cases, resulting in frequent stent replacement.11,12 LAMS are designed to overcome the limitations of double-pigtail plastic stents. The AXIOS stent is the only approved LAMS in the United States; its wider diameter makes it more effective to drain solid necrotic components. In addition, its “dumbbell” configuration minimizes the risk for stent migration. Despite the unique design, stent migration can still occur occasionally.
EUS-guided pseudocyst drainage using LAMS has a technical success rate of 88% in 1 case series with no migration, and follow-up showed complete resolution of the cysts in all patients.13 Similarly, in another study, among 29 patients who received LAMS, 93% showed pseudocyst resolution and only 1 patient had stent migration.14
The overall complication rate for LAMS is low. Early complications include pneumothorax, pneumoperitoneum, perforation, infection, and minor and massive bleeding.6 Delayed LAMS migration rates were found in 3 studies to be 1%, 3%, and 6% (totaling 3 cases of stent migration in all reviewed studies).6 In our case, we observed how a LAMS became embedded in the gastric wall approximately 6 months after a pseudocyst was decompressed. We observed that such stent migration was of no clinical significance as the patient was asymptomatic before and after the eventual stent removal. Finally, we concluded that the transmural defect resulting from the stent removal would likely resolve spontaneously without the need for further endoscopic closure.
Author contributions: A. Alshati wrote the manuscript and is the article guarantor. I. Srinivasan wrote and revised the manuscript. K-Y Chuang performed the procedure and revised the manuscript.
Financial disclosure: None to report.
Informed patient consent was obtained for this case report.
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