Natural orifice surgery for rescue of stent misplacement in endoscopic gallbladder drainage.

Background and Aims: Lumen-apposing metal stent (LAMS) misdeployment in endoscopic ultrasound-guided gallbladder drainage is one of the primary adverse events, but few studies, to our knowledge, have reported the misplacement of the LAMS into the abdominal cavity and the following endoscopic rescue treatment. Methods: We reported a case of the proximal flange misplaced into the abdominal cavity in a fully expanded condition, whereas the distal flange was attached to the gallbladder, resulting in a perforation between the gallbladder and abdominal cavity, and only the puncture site was identified on the duodenal wall. After multidisciplinary discussion, we performed natural orifice transluminal endoscopic surgery (NOTES) as a rescue therapy immediately. Results: Using NOTES, we identified the misplaced LAMS in the abdominal cavity and repositioned it with the basket. No other serious consequences occurred. Conclusions: NOTES was a feasible method to deal with LAMS misplacement in this case as a rescue therapy. However, the adverse event should be avoided carefully during the procedure in case further serious consequences occur.