Lotus sign: The lumen-apposing metal stent that failed to bloom

Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) with the use of a lumen-apposing metal stent (LAMS) has emerged as a promising modality for the treatment of a malignant gastric outlet obstruction (MGOO) [1]. The design of single-step delivery systems of LAMSs can significantly reduce the risk of adverse events. However, the process of stent deployment is the crucial step in determining the success of EUS-GE. This report describes the case of a patient who underwent EUS-GE with the deployment of the proximal flange of the LAMS failing to open.