A novel puzzle ring replacement technique of a lumen-apposing metal stent with a double-pigtail plastic stent to prevent walled-off necrosis recurrence (with video).

ABSTRACT: Replacing a lumen-apposing metal stent (LAMS) with a double-pigtail plastic stent (DPS) after treatment for walled-off necrosis contributes to the prevention of recurrence. However, the success rate is not very high. To overcome this issue, we devised a novel stent-replacement technique. In the final treatment procedure, a 7-F DPS was placed in the lumen of the LAMS. Subsequently, the walled-off necrosis shrank, and granulation formed over the pigtail portion, which fixed the DPS. The LAMS alone was removed with grasping forceps, leaving the DPS in the lumen of the LAMS (i.e., a puzzle-ring technique; direct or rotary removal technique). Between August 2021 and August 2023, 18 patients were evaluated for recurrence prevention using this novel technique (median duration of LAMS placement, 3

SUBMITTER: Mukai S 

PROVIDER: S-EPMC11472131 | biostudies-literature | 2025 Apr

REPOSITORIES: biostudies-literature