Case Report: Unexpected LAMS obstruction following successful EUS-BD in a patient with pancreatic carcinoma.

Background: Endoscopic ultrasound-guided biliary drainage (EUS-BD) has become an established alternative for managing malignant biliary obstruction. While recurrent biliary obstruction-commonly due to tumor ingrowth or stent migration following EUS-BD-remains a major clinical challenge, food impaction within lumen-apposing metal stents (LAMSs) has been rarely reported. Case presentation: A 75-year-old man with unresectable pancreatic carcinoma and duodenal invasion, who had undergone successful EUS-BD with LAMS placement 8 months previously, presented with recurrent obstructive jaundice. Initial imaging indicated no significant tumor progression compared with a follow-up CT performed three months earlier. No tumor ingrowth, overgrowth, or sludge accumulation was observed. Subsequent endoscopy revealed that the LAMS was occluded by food debris. Following endoscopic removal of the impacted food, purulent bile overflowed and a coaxial double-pigtail plastic stent was placed through the LAMS to maintain luminal patency. The patient recovered promptly. In retrospect, the patient reported no dietary restrictions since the previous EUS-BD. At 1-month follow-up, the patient remained asymptomatic, without recurrent jaundice or need for reintervention. Conclusion: This case highlights food impaction as an unusual but clinically significant cause of recurrent obstructive jaundice following EUS-BD with LAMS. Successful management with endoscopic debridement and coaxial plastic stent placement offers a potential endoscopic strategy for this subgroup of patients. Moreover, this case emphasizes the importance of long-term dietary counseling in patients with indwelling LAMS to prevent this rare but potentially severe complication.