LUMEN-APPOSING METAL STENT DEPLOYMENT FAILURE.

Endoscopic ultrasound-guided transmural drainage has become a first-line therapy of pancreatic fluid collections (1). The appearance of lumen-apposing metal stents has resulted in an authentic revolution due to their efficacy (clinical success rate of 93%) and their easy deployment (technical success rate of 98%) (2), with a shorter procedure time, lower risk of migration and a wider lumen which could provide a more effective drainage (3). We report the case of a 78-year-old male who, as a late complication of an acalculous severe acute pancreatitis, developed an infected pancreatic pseudocyst. After failed computed tomography-guided percutaneous drainage with placement of a pig-tail catheter, an endoscopic ultrasound-guided transmural drainage was carried out. A gastrocystic fistula was created and an AxiosTM lumen-apposing metal stent (Boston Scientific; Massachusetts, United States) was inserted. Nevertheless, it remained lodged in the pancreatic pseudocyst at the time of its deployment. A computed tomography scan confirmed stent placement inside de collection (Figure 1). After endoscopic balloon dilatation of gastrocystic fistulous tract, removal was tried unsuccessfully with proximal traction of the lumen stent flange with a biopsy forceps. Surgical treatment was decided and a gastrotomy was performed, the fistula was identified in the posterior gastric wall and the stent was removed. Endoscopic ultrasound-guided transmural drainage of pancreatic fluid collections using lumen-apposing metal stents is a safe procedure. However, it is not exempt of complications such as stent migration, bleeding, gastrointestinal perforation and air embolism (4) . Technical failure of lumen-apposing metal stents deployment is a rare complication that may require surgical treatment if endoscopic removal is not possible.