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Background Removing lumen-apposing metal stents (LAMSs) may be difficult and even harmful, but these features have seldom been analyzed. We aimed to generate a comprehensive assessment of the feasibility and safety of LAMS retrieval procedures. Methods A prospective multicenter case series including all technically successfully deployed LAMSs between January 2019 and January 2020 that underwent endoscopic stent removal. All retrieval-related data were prospectively recorded using standardized telephone questionnaires as part of centralized follow-up that ended after stent removal had been performed. Multivariable logistic regression models assessed the potential risk factors for complex removal. Results For the 407 LAMSs included, removal was attempted in 158 (38.8 %) after an indwell time of 46.5 days (interquartile range [IQR] 31–70). The median (IQR) removal time was 2 (1–4) minutes. Removal was labelled as complex in 13 procedures (8.2 %), although advanced endoscopic maneuvers were required in only two (1.3 %). Complex removal risk factors were stent embedment (relative risk [RR] 5.84, 95 %CI 2.14–15.89; P = 0.001), over-the-wire deployment (RR 4.66, 95 %CI 1.60–13.56; P = 0.01), and longer indwell times (RR 1.14, 95 %CI 1.03–1.27; P = 0.01). Partial and complete embedment were observed in 14 (8.9 %) and five cases (3.2 %), respectively. The embedment rate during the first 6 weeks was 3.1 % (2/65), reaching 15.9 % (10/63) during the following 6 weeks (P = 0.02). The adverse event rate was 5.1 %, including seven gastrointestinal bleeds (5 mild, 2 moderate). Conclusions LAMS removal is a safe procedure, mostly requiring basic endoscopic techniques attainable in conventional endoscopy rooms. Referral to advanced endoscopy units should be considered for stents with known embedment or long indwell times, which may require more technically demanding procedures. [ABSTRACT FROM AUTHOR]

Background: A validated classification of endoscopic ultrasound (EUS) morphological characteristics and consequent therapeutic intervention(s) in pancreatic and peripancreatic fluid collections (PFCs) is lacking. We performed an interobserver agreement study among expert endosonographers assessing EUS-related PFC features and the therapeutic approaches used.Methods: 50 EUS videos of PFCs were independently reviewed by 12 experts and evaluated for PFC type, percentage solid component, presence of infection, recognition of and communication with the main pancreatic duct (MPD), stent choice for drainage, and direct endoscopic necrosectomy (DEN) performance and timing. The Gwet's AC1 coefficient was used to assess interobserver agreement.Results: A moderate agreement was found for lesion type (AC1, 0.59), presence of infection (AC1, 0.41), and need for DEN (AC1, 0.50), while fair or poor agreements were stated for percentage solid component (AC1, 0.15) and MPD recognition (AC1, 0.31). Substantial agreement was rated for ability to assess PFC-MPD communication (AC1, 0.69), decision between placing a plastic versus lumen-apposing metal stent (AC1, 0.62), and timing of DEN (AC1, 0.75).Conclusions: Interobserver agreement between expert endosonographers regarding morphological features of PFCs appeared suboptimal, while decisions on therapeutic approaches seemed more homogeneous. Studies to achieve standardization of the diagnostic endosonographic criteria and therapeutic approaches to PFCs are warranted. [ABSTRACT FROM AUTHOR]

1 a Balloon dilation of a lumen-apposing metal stent (LAMS) to allow scope passage; b, c jejunal loop seen through the misplaced LAMS; d suctioning of small bowel into the transgastric LAMS before cutting with a needle-knife. Under endoscopic/fluoroscopic guidance, deploy a second coaxial rescue stent within the misplaced stent to create a bridge between the small bowel and the stomach. [Extracted from the article]

14867984-efc44546.mp4 The Giobor stent is a dedicated biliary stent for HGS and has been reported for use in malignant diseases but not as a temporary stent [1][2][3][4][5]. The recent change in covered design (70 %:30 %) enables its use in a biliary benign scenario as a temporary stent to create a transhepatic mature fistula, allowing subsequent anterograde stenting. 3 Endoscopic transhepatic anterograde intervention. a Balloon catheter and plastic stent within the mature hepaticogastrostomy fistula. b Anterograde dilation of extrahepatic distal biliary stenosis up to 8 mm, guided by fluoroscopy. [Extracted from the article]

A 78-year-old man developed a late fistula between the gastroplasty pouch and right bronchus following Ivor Lewis esophagectomy for esophageal neoplasia (Fig. To extract the fistula from the wall, traction was applied to the mucosal flap using the clip-with-line traction technique, enabling deeper dissection of the fistula tract. [Extracted from the article]

This case is recruited in a randomized trial (Multicenter study of lumen-apposing metal stents with or without pigtail in endoscopic ultrasound-guided biliary drainage for malignant obstruction-BAMPI TRIAL: an open-label, randomized controlled trial protocol). The DPS was removed and a specifically designed hepaticogastrostomy stent (8 × 80-mm, Niti-S Giobor biliary stent; TaeWoong Medical, Seoul, Korea) was inserted through the LAMS (Fig. 2 a Placement of a specialized hepaticogastrostomy stent through the biliary lumen-apposing metal stent. b Cholangiogram showing patent lumen with newly inserted stent. c Endoscopic image of the hepaticogastrostomy stent in place. [Extracted from the article]

Background: The aim of this study was to evaluate whether the placement of a coaxial double-pigtail plastic stent (DPS) within a lumen-apposing metal stent (LAMS) may improve the safety of endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collections (PFCs).Methods: This was a retrospective cohort study including patients with PFCs and an indication for transmural drainage. Two strategies (LAMS alone or LAMS plus DPS) were used at the endoscopist's discretion.Results: A total of 41 patients were treated (21 LAMS alone; 20 LAMS plus DPS). The characteristics of the PFCs, and the technical and clinical success rates did not differ between groups. The LAMS alone group had a significantly higher rate of adverse events than the LAMS plus DPS group (42.9 % vs. 10.0 %; P = 0.04). Bleeding was the most frequent adverse event observed.Conclusions: The addition of a coaxial DPS to LAMS was associated with a lower rate of adverse events in EUS-guided drainage of PFCs. [ABSTRACT FROM AUTHOR]

B Video 1 b A teaching video demonstrating the technique of direct endoscopic ultrasound-guided gastroenterostomy using a feeding-tube waterjet system. To facilitate the safe and simple introduction of an endoscopic ultrasound (EUS)-guided gastroenterostomy technique, we present a step-by-step teaching video of a variant technique for direct EUS-guided gastroenterostomy using a feeding tube (Video 1). [Extracted from the article]

After the bowel had been dilated up to 15 mm to allow the gastroscope to be passed across the duodenum, loops of the small bowel were distended with 1 L of saline mixed with methylene blue, using the water-jet channel. 2 Views of the enteral fully covered self-expandable metal stent deployed within the misplaced lumen-apposing stent to create a bridge between the small bowel and the stomach on: a fluoroscopy; b endoscopy. [Extracted from the article]

Endoscopic ultrasonography-guided deployment of embolization coils and cyanoacrylate injection in gastric varices versus coiling alone: a randomized trial. This section has its own submission website at https://mc.manuscriptcentral.com/e-videos References 1 Rowley M. W., Suarez J. Coil migration after EUS-guided coil embolization of gastric varices. Endoscopic ultrasound-guided treatment of gastric varices with coil embolization and absorbable hemostatic gelatin sponge: a novel alternative to cyanoacrylate. [Extracted from the article]

In a few cases, endoscopic ultrasound (EUS)-guided percutaneous endoscopic gastrostomy (PEG) has been reported as a safe alternative in cases that are not suitable for conventional PEG [1][2][3]. EUS-guided percutaneous endoscopic gastrostomy for enteral feeding tube placement. [Extracted from the article]

Background and study aims: A novel large-diameter, lumen-apposing, self-expanding metal stent with bilateral flanges was recently developed for endoscopic ultrasound (EUS)-guided transmural drainage of symptomatic pancreatic fluid collections (PFCs). The aim of this study was to evaluate the efficacy and safety of this stent in a large cohort. Patients and methods: Patients with a PFC undergoing EUS-guided drainage with this novel stent were prospectively enrolled in this multicenter cohort study. Results: There were 61 patients: 46 patients (75 %) with walled-off necrosis(WON) and 15 (25 %) with a pancreatic pseudocyst. Stent placement was technically successful in 60 patients (98 %, 95%CI 95%-100%). Clinical success, defined as resolution of clinical symptoms in combination with a decrease in the PFC size to ⩽2cm on imaging, was achieved in 93% of patients with a pancreatic pseudocyst (95 %CI 77%-100%) and in 81% of patients with WON (95 %CI 69%-94%). Treatment failure occurred in nine patients (16 %, 95%CI 6%- 26%), including four patients who required surgical intervention. Stent removal was performed in 82% of patients after a median of 32 days (range 2-178) and was rated as easy in all but one patient. In 10 patients, endoscopic stent removal was not performed because of stent migration (n=3), stent dislodgement during necrosectomy (n=3), stent removal during surgery (n=2), or refusal by the patient (n=2). In total, five major complications were reported (9 %, 95%CI 2%-16 %), including PFC infection (n=4) and perforation (n=1). Conclusion: EUS-guided drainage using this novel stent is feasible and the clinical results obtained are promising with a low major complication rate. [ABSTRACT FROM AUTHOR]

The stent-induced mural erosion technique using self-expandable plastic stents has been reported a few times [3][4][5]. 10-1055-a-1195-2191-1703evv01.mp4 Endoscopic removal of a nonadjustable bariatric band using an esophageal FCSEMS-induced gastric mural erosion technique seems to be feasible and effective, and could allow easier extraction of the band than using a plastic stent. [Extracted from the article]

However, LAMS are more expensive and their safety is controversial, with a significantly higher rate of adverse events such as bleeding and "buried stent syndrome" compared with plastic stents. Returning to the basic question of which stent is best, LAMS are really displacing plastic stents. To date, there are two comparative prospective studies of self-expandable LAMS-type metal stents versus plastic stents in the endoscopic treatment of WON, from China (NCT03027895) and Spain (NCT03100578) [7][8]. [Extracted from the article]

We therefore contacted an expert in the biological field, Dr. Conxita Avila from the Department of Evolutionary Biology, Ecology and Environmental Sciences, and Biodiversity Research Institute (IrBIO), University of Barcelona. The image was so extraordinary that we wondered whether any similar image might exist in nature. Our image of the papilla resembles this one of the Caribbean sponge, Mycale laxissima, https://spongeguide.uncw.edu/imageinfo.php?img=319 (photographer Sven Zea; The Sponge Guide, Universidad Nacional de Colombia). [Extracted from the article]

The article presents a case study of an 86-year-old woman with cholangitis and choledocholithiasis and underwent endoscopic ultrasound-guided methylene blue injection to achieve bile duct access after endoscopic retrograde cholangipancreatography (ERCP) failed.

The article presents a case study of a 44-year-old man with chronic pancreatitis, in which it discusses the endoscopic treatment of pancreatic duct strictures by using pancreaticogastrostomy drainage through lumen-apposing metal stent (LAMS).

The article presents a case study of a 56-year old woman with pancreatic cancer causing obstructive jaundice and anorexia, who was referred for tissue diagnosis and biliary drainage. It states that a solid tumor of pancreatic head and dilatation of common bile duct was detected in Endoscopic ultrasound (EUS). It discusses the performance of EUS-guided fine-needle aspiration (FNA) and EUS-guided biliary drainage, and choledochoduodenostomy with placement of a biliary lumen-apposing metal stent.

The article presents a case study of a 54-year-old patient with a pancreatic cyst lesion resulting to a massive pneumoperitoneum. The patient was directed to the hospital's emergency unit to underwent endoscopic ultrasound (EUS)-guided transmural drainage. Details on the step-by-step medical procedure to prevent the leakage of fluids to peritoneal cavity is explored. The article also examines the use for endoscopic management therapy for pancreatic fluid collections.

The article presents case study of a 62-year-old woman having squamous cell esophageal carcinoma. It also discusses a method for managing esophageal obstruction by using endoscopic ultrasound (EUS)-guided puncture. It also discusses the whole procedure conducted on the women patient to treat the condition. Several photographs depicting images of the esophageal total stricture are also presented.