Nodes to the rescue. Retrieval of an extra-luminally migrated lumen opposing metal stand. I have no disclosures. Background. Since the first transgastric natural orifice transluminal endoscopic surgery for nodes well described, various applications and modified procedures have been investigated, including peritoneoscopy. The submucosal tunneling method enhances the safety peritoneal access and gastric closure and minimizes the risk of interperitoneal leakage of gastric air and juice. Aim. The aim of this video is to demonstrate the use of transgastric nodes as a rescue measure to retrieve an extra-luminally migrated lumens. This is a case of a 52-year-old male admitted due to a liver abscess secondary to a complicated diverticulitis. He was referred for EOS guided drainage. During the procedure, there was a complication. There was a misplacement of the lamps with the proximal flange migrated into the peritoneum due to the miscalculation of the length of the stand as the distance between the abscess and the lumen wall. Oops. The abscess was then successfully drained by the placement of a longer lamps with a bigger diameter transluminally. Here we can see the second lamp successfully draining the abscess with the placement of a double pigtail stand to prevent migration and secure patency of the stand. A second endoscopic procedure was scheduled for an attempt of removal of the migrated stand through the second lamps, but it was impossible due to stream angulation. After discussion of the case in a multidisciplinary meeting, a decision to remove the stand by transgastric nodes was taken. Guided by fluoroscopy, a mucosal incision was made in the gastric antrum and a submucosal tunnel was created. An intentional gastric bulb perforation was done inside the tunnel in order to access the peritoneal cavity. In order to reduce the risk of dense capnoperytonium, underwater dissection is carefully undertaken guided by fluoroscopy until the amigrated stent is reached. The migrated stent was successfully retrieved using a gastric hook through the tunnel without any complications. Finally, the mucosal incision was sealed using an over-the-scope clip. The patient evolution was satisfactory, and he was discharged two days after the procedure. A CT scan performed six weeks later showed resolution of the liver abscess, so the lump was removed uneventfully. Conclusion. This case demonstrates the feasibility of transgastric nodes for the retrieval of extraluminally migrated stents.

transgastric nodes

rescue measure

extra-luminally migrated

lumen opposing metal stand

liver abscess