Same-session placement of multiple lumen-apposing metal stents to provide effective drainage of extensive walled-off pancreatic necrosis

Abstract

Same-session placement of multiple lumen-apposing metal stents to provide effective drainage of extensive walled-off pancreatic necrosis A 78-year-old man initially presented with gallstone pancreatitis. Three months later he presented with abdominal pain, early satiety, and weight loss. Blood test results showed severe leukocytosis. CT imaging of the abdomen showed an extensive, complex, multilocular, rim-enhancing fluid collection with significant necrosis that surrounded the entire pancreas and extended into the mesentery (Fig. 1A). On the basis of the radiologic findings, it was highly unlikely that the walled-off pancreatic necrosis (WOPN) could be successfully treated by the placement of 1 lumen-apposing metal stent (LAMS). Thus, we opted to place 2 LAMSs at different locations in the stomach to allow for better drainage and more effective necrosectomy (Video 1, available online at www. VideoGIE.org). At the initial procedure, EUS was performed with the placement of 2 LAMSs: 1 in the distal stomach at the antrum, and the other in the proximal body of the stomach (Figs. 1B and C). Large amounts of purulent drainage from