A novel puzzle ring replacement technique of a lumen‐apposing metal stent with a double‐pigtail plastic stent to prevent walled‐off necrosis recurrence (with video)
Abstract Replacing a lumen‐apposing metal stent (LAMS) with a double‐pigtail plastic stent (DPS) after treatment for walled‐off necrosis contributes to the prevention of recurrence. However, the success rate is not very high. To overcome this issue, we devised a novel stent‐replacement technique. In...
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| Format: | Article |
| Language: | English |
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Wiley
2025-04-01
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| Series: | DEN Open |
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| Online Access: | https://doi.org/10.1002/deo2.70020 |
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| author | Shuntaro Mukai Atsushi Sofuni Takayoshi Tsuchiya Reina Tanaka Ryosuke Tonozuka Kenjiro Yamamoto Yukitoshi Matsunami Kazumasa Nagai Hiroyuki Kojima Hirohito Minami Kyoko Asano Takao Itoi |
| author_facet | Shuntaro Mukai Atsushi Sofuni Takayoshi Tsuchiya Reina Tanaka Ryosuke Tonozuka Kenjiro Yamamoto Yukitoshi Matsunami Kazumasa Nagai Hiroyuki Kojima Hirohito Minami Kyoko Asano Takao Itoi |
| author_sort | Shuntaro Mukai |
| collection | DOAJ |
| description | Abstract Replacing a lumen‐apposing metal stent (LAMS) with a double‐pigtail plastic stent (DPS) after treatment for walled‐off necrosis contributes to the prevention of recurrence. However, the success rate is not very high. To overcome this issue, we devised a novel stent‐replacement technique. In the final treatment procedure, a 7‐F DPS was placed in the lumen of the LAMS. Subsequently, the walled‐off necrosis shrank, and granulation formed over the pigtail portion, which fixed the DPS. The LAMS alone was removed with grasping forceps, leaving the DPS in the lumen of the LAMS (i.e., a puzzle‐ring technique; direct or rotary removal technique). Between August 2021 and August 2023, 18 patients were evaluated for recurrence prevention using this novel technique (median duration of LAMS placement, 37 days). In 17 patients (94.4%), the LAMS was successfully replaced with a 7‐F DPS (direct technique 14, rotary technique 3; median removal procedure time, 3 min). No recurrence was observed during the median observation period of 385 days. Before using this technique (April 2012 to August 2022), the technical success rate of replacement of LAMS with 7‐F DPS was significantly lower (61.8% [42/68, p = 0.02]). Recurrence of pancreatic fluid collection occurred in 15.3% (4/26) of the patients who could not undergo replacement with a 7‐F DPS. The novel puzzle ring technique, which improves the success rate of LAMS for DPS replacement, may be useful in reducing recurrence after walled‐off necrosis treatment. |
| format | Article |
| id | doaj-art-9b518d2634d14bbb845c5649c6e2d5c2 |
| institution | DOAJ |
| issn | 2692-4609 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | DEN Open |
| spelling | doaj-art-9b518d2634d14bbb845c5649c6e2d5c22025-08-20T03:13:50ZengWileyDEN Open2692-46092025-04-0151n/an/a10.1002/deo2.70020A novel puzzle ring replacement technique of a lumen‐apposing metal stent with a double‐pigtail plastic stent to prevent walled‐off necrosis recurrence (with video)Shuntaro Mukai0Atsushi Sofuni1Takayoshi Tsuchiya2Reina Tanaka3Ryosuke Tonozuka4Kenjiro Yamamoto5Yukitoshi Matsunami6Kazumasa Nagai7Hiroyuki Kojima8Hirohito Minami9Kyoko Asano10Takao Itoi11Department of Gastroenterology and Hepatology Tokyo Medical University Tokyo JapanDepartment of Gastroenterology and Hepatology Tokyo Medical University Tokyo JapanDepartment of Gastroenterology and Hepatology Tokyo Medical University Tokyo JapanDepartment of Gastroenterology and Hepatology Tokyo Medical University Tokyo JapanDepartment of Gastroenterology and Hepatology Tokyo Medical University Tokyo JapanDepartment of Gastroenterology and Hepatology Tokyo Medical University Tokyo JapanDepartment of Gastroenterology and Hepatology Tokyo Medical University Tokyo JapanDepartment of Gastroenterology and Hepatology Tokyo Medical University Tokyo JapanDepartment of Gastroenterology and Hepatology Tokyo Medical University Tokyo JapanDepartment of Gastroenterology and Hepatology Tokyo Medical University Tokyo JapanDepartment of Gastroenterology and Hepatology Tokyo Medical University Tokyo JapanDepartment of Gastroenterology and Hepatology Tokyo Medical University Tokyo JapanAbstract Replacing a lumen‐apposing metal stent (LAMS) with a double‐pigtail plastic stent (DPS) after treatment for walled‐off necrosis contributes to the prevention of recurrence. However, the success rate is not very high. To overcome this issue, we devised a novel stent‐replacement technique. In the final treatment procedure, a 7‐F DPS was placed in the lumen of the LAMS. Subsequently, the walled‐off necrosis shrank, and granulation formed over the pigtail portion, which fixed the DPS. The LAMS alone was removed with grasping forceps, leaving the DPS in the lumen of the LAMS (i.e., a puzzle‐ring technique; direct or rotary removal technique). Between August 2021 and August 2023, 18 patients were evaluated for recurrence prevention using this novel technique (median duration of LAMS placement, 37 days). In 17 patients (94.4%), the LAMS was successfully replaced with a 7‐F DPS (direct technique 14, rotary technique 3; median removal procedure time, 3 min). No recurrence was observed during the median observation period of 385 days. Before using this technique (April 2012 to August 2022), the technical success rate of replacement of LAMS with 7‐F DPS was significantly lower (61.8% [42/68, p = 0.02]). Recurrence of pancreatic fluid collection occurred in 15.3% (4/26) of the patients who could not undergo replacement with a 7‐F DPS. The novel puzzle ring technique, which improves the success rate of LAMS for DPS replacement, may be useful in reducing recurrence after walled‐off necrosis treatment.https://doi.org/10.1002/deo2.70020double‐pigtail plastic stentendoscopic ultrasound‐guided transluminal pancreatic fluid collection drainagelumen‐apposing metal stentnecrotizing pancreatitiswalled‐off necrosis |
| spellingShingle | Shuntaro Mukai Atsushi Sofuni Takayoshi Tsuchiya Reina Tanaka Ryosuke Tonozuka Kenjiro Yamamoto Yukitoshi Matsunami Kazumasa Nagai Hiroyuki Kojima Hirohito Minami Kyoko Asano Takao Itoi A novel puzzle ring replacement technique of a lumen‐apposing metal stent with a double‐pigtail plastic stent to prevent walled‐off necrosis recurrence (with video) DEN Open double‐pigtail plastic stent endoscopic ultrasound‐guided transluminal pancreatic fluid collection drainage lumen‐apposing metal stent necrotizing pancreatitis walled‐off necrosis |
| title | A novel puzzle ring replacement technique of a lumen‐apposing metal stent with a double‐pigtail plastic stent to prevent walled‐off necrosis recurrence (with video) |
| title_full | A novel puzzle ring replacement technique of a lumen‐apposing metal stent with a double‐pigtail plastic stent to prevent walled‐off necrosis recurrence (with video) |
| title_fullStr | A novel puzzle ring replacement technique of a lumen‐apposing metal stent with a double‐pigtail plastic stent to prevent walled‐off necrosis recurrence (with video) |
| title_full_unstemmed | A novel puzzle ring replacement technique of a lumen‐apposing metal stent with a double‐pigtail plastic stent to prevent walled‐off necrosis recurrence (with video) |
| title_short | A novel puzzle ring replacement technique of a lumen‐apposing metal stent with a double‐pigtail plastic stent to prevent walled‐off necrosis recurrence (with video) |
| title_sort | novel puzzle ring replacement technique of a lumen apposing metal stent with a double pigtail plastic stent to prevent walled off necrosis recurrence with video |
| topic | double‐pigtail plastic stent endoscopic ultrasound‐guided transluminal pancreatic fluid collection drainage lumen‐apposing metal stent necrotizing pancreatitis walled‐off necrosis |
| url | https://doi.org/10.1002/deo2.70020 |
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