Lumen-apposing metal stent as a salvage therapy for infectious complication after endoscopic ultrasoundguided transmural drainage of walled-off necrosis with double-pigtail plastic stents: a case report

Lumen-apposing metal stent as a salvage therapy for infectious complication after endoscopic ultrasoundguided transmural drainage of walled-off necrosis with double-pigtail plastic stents: a case report

Infectious complications after endoscopic transmural drainage of walled-off necrosis (WON) are not frequent. Herein, I report a case of alcoholic pancreatitis complicated by infected WON following endoscopic ultrasound-guided cystogastrostomy (EUS-CGS). A 53-year-old man underwent EUS-CGS with two double-pigtail plastic stents for symptomatic WON. On the sixth day after the procedure, he developed fever and chills. Abdominal computed tomography revealed that the WON had transformed into a gas-containing abscess. Subsequently, he underwent EUS-CGS again, and a lumen-apposing metal stent (LAMS) was utilized to maintain the new cystogastrostomy. His fever subsided the next day. The smaller diameters of the double-pigtail plastic stents may have contributed to the infection due to insufficient drainage, and a LAMS with larger diameter could be used as a salvage therapy.