Lotus sign: The lumen-apposing metal stent that failed to bloom.
Journal
Endoscopy
Journal Volume
56
Pages
E327 - E328
ISSN
1438-8812
Date Issued
2024-12
Author(s)
Abstract
Lotus sign: The lumen-apposing metal stent that failed to bloom Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) with the use of a lumen-apposing metal stent (LAMS) has emerged as a promising modality for the treatment of a malignant gastric outlet obstruction (MGOO) [1].The design of single-step delivery systems of LAMSs can significantly reduce the risk of adverse events.However, the process of stent deployment is the crucial step in determining the success of EUS-GE.This report describes the case of a patient who underwent EUS-GE with the deployment of the proximal flange of the LAMS failing to open.A 54-year-old man with advanced pancreatic adenocarcinoma presented with vomiting due to MGOO.After admission, EUS-GE with the wireless simplified technique [2] was performed using a 20-mm LAMS (Hot AXIOS stent; Boston Scientific, Marlborough, Massachusetts, USA).The distal flange of the LAMS deployed successfully.However, on deployment of the proximal portion, the most proximal end of the LAMS failed to open, resulting in a lotus-shaped flange in the stomach ( Fig. 1, Video 1).Despite gentle manipulation of the internal sheath and allowing some time for the flange to expand, it still failed to bloom.A 20-mm E-Videos Video 1 Unexpected failure of the proximal flange of lumen-apposing metal stent to open and rescue management to prevent stent misdeployment. Fig. 1 Endoscopy showed lotus sign of the proximal flange of the lumen-apposing metal stent (LAMS) resulting from the failure of the proximal end of LAMS to bloom. Fig. 2 A 20-mm extraction balloon catheter was passed through the narrow opening of the proximal end of LAMS and inflated carefully to dilate the flange. Fig. 3 The proximal flange of LAMS satisfactorily opened after repeated balloon inflation.
SDGs
Publisher
Georg Thieme Verlag
Type
other