Balloon catheter-assisted rescue for misplacement of lumen-apposing stent across the pylorus in endoscopic ultrasound-guided transduodenal drainage of walled-off necrosis

A 57-year-old man presented with a walled-off necrosis after endoscopic papillectomy. Endoscopic ultrasound-guided transduodenal drainage was attempted using a lumen-apposing metal stent (SPAXUS; TaeWoong Medical, Gimpo-si, South Korea) [1]. The proximal flange was deployed in the necrotic cavity and an enteral flange was deployed within the working channel of the echoendoscope. The stent was ejected from the working channel by pushing the stent delivery system. However, the enteral flange was positioned in the gastric antrum across the pyloric ring because the endoscope tip in the duodenum moved backward into the gastric antrum due to the reaction force generated by pushing the stent delivery system to eject the intrascope channel stent portion ([Fig. 1], [Fig. 2] a).