Endoscopic necrosectomy through a lumen-apposing metal stent resulting in perforation: is it time to develop dedicated accessories?

A novel lumen-apposing self-expandable metal stent (LAMS; Axios EC; Boston Scientific Corp., Marlborough, Massachusetts, USA) that is able to create a stable communicating fistulous tract has simplified the performance of endoscopic necrosectomy for walled-off pancreatic necrosis (WOPN). A 44-year-old man with a 10-cm WOPN (>50% solid component) underwent successful endoscopic ultrasound (EUS)guided drainage with placement of a LAMS (15-mm wide×10-mm long). Balloon dilation of the central part of the stent up to 18mm was performed (▶Fig. 1 a), followed by removal of necrotic debris using various Dormia baskets (▶Fig. 1b; ▶Video1) and instillation of hydrogen peroxide into the cavity. The following day, the patient developed peritoneal signs and an abdominal computed tomography (CT) scan showed perforation of the wall of the WOPN on the opposite side to the position of the stent (▶Fig. 2). He underwent successful surgery. After the videos of the proceE-Videos