Innovative coaxial plastic stent within a lumen-apposing metal stent to prevent recurrence of pancreatic fluid collection

Endoscopic ultrasound-guided transluminal drainage with a lumen-apposing metal stent (LAMS) is the favored initial approach to manage a symptomatic pancreatic fluid collection (PFC) [1]. The recurrence rate of PFCs was significantly lower when the LAMS was replaced with a double-pigtail plastic stent (DPPS), particularly for disconnected pancreatic duct syndrome [1] [2]. However, replacing the LAMS with a DPPS can be challenging when the PFC cavity has shrunk, leaving insufficient space for the DPPS. The optimal strategy involves placing a coaxial DPPS within the LAMS concurrently during initial treatment and removing the LAMS afterward, leaving the DPPS in place to prevent PFC recurrence [3] [4]. However, during LAMS removal, the DPPS may sometimes be unintentionally dislodged as well. To address this issue, we demonstrate an innovative coaxial plastic stent designed to facilitate the removal of only the LAMS while leaving the plastic stent in place.