Successful redrainage after failure of lumen-apposing metal stents by addressing flange-induced ostial occlusion: A case report

doi:10.4240/wjgs.117909

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Case Report

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Surg. Jun 27, 2026; 18(6): 117909
Published online Jun 27, 2026. doi: 10.4240/wjgs.117909

Successful redrainage after failure of lumen-apposing metal stents by addressing flange-induced ostial occlusion: A case report

Yi Wen, Hao Luo, Qin Xie, Xiao Li, Hao-Xian Gou, Lin Yang, Dong-Xu Liao

Dong-Xu Liao, Lin Yang, Yi Wen, College of Medicine, Southwest Jiaotong University, Chengdu 610031, Sichuan Province, China

Hao-Xian Gou, Xiao Li, Qin Xie, Hao Luo, Yi Wen, Department of General Surgery, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China

Co-first authors: Dong-Xu Liao and Lin Yang.

Co-corresponding authors: Hao Luo and Yi Wen.

Author contributions: Liao DX, Yang L, Luo H, and Wen Y contributed to design of the study; Liao DX , Yang L, Gou HX, Xie Q, and Li X contributed to data collection acquire; Liao DX and Yang L contributed to analyze data, and they contributed equally to this manuscript as co-first authors; Wen Y, Liao DX, and Yang L contributed to write the actual manuscript; Gou HX, Xie Q, Luo H, and Li X contributed to picture preparation; Wen Y and Luo H contributed to supervision and they contributed equally to this manuscript as co-corresponding authors. All authors have read and approved the final manuscript.

AI contribution statement: No AI tools were used. The main content of this manuscript (abstract, introduction, materials and methods, results, discussion, and conclusion) was not generated by AI. Nor were AI tools employed for manuscript polishing, translation, data analysis, or writing assistance.

Supported by the National Natural Science Foundation of China, No. 32471419; the National Clinical Key Subject of China, No. 41732113; and the General Hospital of Western Theater Command, No. 2024-YGLC-B03.

Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).

Corresponding author: Yi Wen, Department of General Surgery, The General Hospital of Western Theater Command, No. 270 Tianhui Road, Rongdu Avenue, Chengdu 610083, Sichuan Province, China. 13980881194@163.com

Received: December 18, 2025
Revised: January 21, 2026
Accepted: March 6, 2026
Published online: June 27, 2026
Processing time: 184 Days and 3.7 Hours

Abstract

BACKGROUND

Endoscopic ultrasound-guided drainage is the standard treatment for symptomatic walled-off necrosis (WON). Lumen-apposing metal stents (LAMSs) revolutionize this approach using large lumens and stable flanges, enabling efficient drainage and direct necrosectomy. While established complications (intraluminal occlusion, and migration) are well-documented, LAMS flange-complex WON anatomy interaction remains unclear. Up to date, no cases of the distal flange causing mechanical occlusion of branch cavity ostia have been reported. This case addresses this complication and its successful endoscopic management.

CASE SUMMARY

We report a 34-year-old man with recurrent WON caused by LAMS edge-induced branch cavity ostium obstruction, managed via endoscopic LAMS removal and salvage plastic stent drainage. Admitted for biliary pancreatitis complicated by cholangitis, he underwent endoscopic stone extraction and biliary stenting. Postoperative fever prompted abdominal computed tomography (CT), which revealed peripancreatic collections consistent with WON; endoscopic ultrasound-guided transgastric LAMS placement achieved immediate purulent drainage. Endoscopic necrosectomy resolved fever, and follow-up CT/endoscopy confirmed near-complete cavity collapse before discharge. Five days later, recurrent high fever led to repeat CT, showing pancreatic body reaccumulation. Endoscopy indicated branch ostium obstruction by the LAMS distal flange. LAMS removal identified a purulent fistula, and fluoroscopy-guided stenting with a double-pigtail stent and nasobiliary tube achieved prompt resolution. The nasobiliary tube was removed prior to discharge, with the pigtail stent retained for spontaneous passage.

CONCLUSION

LAMS edge obstruction of branch ostia can cause recurrent WON. Endoscopic removal plus cavity inspection and drainage is effective.

Keywords: Lumen-apposing metal stent; Walled-off necrosis; Endoscopic ultrasound; Complication; Salvage drainage; Case report

Core Tip: This case report describes a rare complication of recurrent walled-off necrosis caused by mechanical occlusion of a branch cavity ostium by the edge of a lumen-apposing metal stent. This was successfully managed by endoscopic removal of the lumen-apposing metal stent, followed by salvage drainage with plastic stents, resulting in complete resolution of symptoms and radiographic findings. The case highlights a novel failure mechanism that underscores the importance of precise stent positioning and the effectiveness of this endoscopic salvage approach.