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

Figure 1  Abdominal computed tomography demonstrating the formation of peripancreatic walled-off necrosis in a 34-year-old man.

Figure 2 Endoscopic retrieval of necrotic debris via the lumen-apposing metal stents lumen. A: Abdominal computed tomography showing the lumen-apposing metal stents in good position and fully expanded; B: Endoscopic view using a retrieval net to extract necrotic debris; C: Visualization of the entire cavity after debris removal.

Figure 3 Significant reduction of the peripancreatic collection post-debridement. A-C: Abdominal computed tomography scans showing marked decrease in collection size; D: Endoscopic view confirming near-complete cavity closure.

Figure 4  Abdominal computed tomography revealing recurrent peripancreatic fluid collection.

Figure 5 Management of branch cavity ostium occlusion by lumen-apposing metal stents edge with plastic stents placement. A: Endoscopic view showing sealed lumen-apposing metal stents cavity-side opening; B: Lumen-apposing metal stents removal using a snare; C: Small fistula with purulent discharge at the 9 o’clock position of the cavity wall; D: Fluoroscopic confirmation of guidewires access into recurrent collection (arrow indicates guidewires); E: Fluoroscopic view showing nasobiliary drainage tube and double-pigtail stent placement (arrows indicate devices); F: Follow-up computed tomography demonstrating proper stents position and near-complete resolution of the collection.

Figure 6 Follow-up abdominal computed tomography at three months. Post-procedure showed slight pancreatic swelling with essentially normal morphology, and near-complete resolution of the cavity without recurrence.