Lumen-apposing metal stent deployment for walled-off necrosis using semi-free hand technique from the intestine

Lumen-apposing metal stent (LAMS) deployment under en- doscopic ultrasonography (EUS) guidance has been used for walled-off necrosis (WON) [1] . Recently, LAMS with electrocautery enhanced delivery system has been developed. One of the advan- tages of this stent is that the stent can be delivered without any dilation devices. However, to prevent stent migration into the in- testinal lumen, it is important that stent delivery system should be inserted within the WON. When the diameter of WON is not large enough to insert stent delivery system, contralateral wall of WON may be injured. To prevent this adverse event, guidewire insertion may be useful after puncturing. In addition, according to the re- cent reports [2–4] , EUS-guided LAMS placement for WON drainage has been performed. We herein described a case of LAMS deploy- ment from the second part of the duodenum using semi-free hand technique.