S5303 Stenting the Sweep: A Rare Complication of LAMS-Induced Pancreatitis

Introduction: Lumen-apposing metal stents (LAMS), such as AXIOS, were designed for drainage of pancreatic fluid collection. Recently, it has been used for management of benign gastrointestinal strictures. We present a case of a benign duodenal sweep stricture treated with AXIOS stent placement, complicated by acute pancreatitis within 24 hours, which required inpatient stent removal and led to complete symptom resolution, highlighting a rare but important complication. Case Description: A 76-year-old gentleman with past medical history of diabetes and coronary artery disease admitted with chronic postprandial vomiting, weight loss and early satiety over several weeks. Physical examination was unremarkable except for mild epigastric tenderness. Initial laboratory workup including lipase was unremarkable. Upper endoscopy demonstrated a peptic, benign-appearing stricture in the duodenal sweep which could not be passed with adult gastroscope. Endoscopic biopsies were obtained. Given the degree of obstruction and failure to tolerate oral intake, an AXIOS LAMS (20 mm × 10 mm) was deployed to relieve the stricture. Post procedure, patient tolerated oral intake. Within 24 hours, the patient developed acute pancreatitis and computed tomography abdomen showed mild dilation of pancreatic duct with hazzinees. Due to persistent symptoms despite conservative management and imaging findings, a repeat inpatient esophagogastroduodenoscopy was performed, and the AXIOS stent was removed with immediate relief of abdominal pain. The patient resumed a soft diet and was discharged home tolerating oral intake without recurrence of symptoms. Discussion: Traditionally, covered duodenal stents have been associated with a risk of pancreatitis, primarily due to their length and the potential to cover the major papilla. The use of lumen-apposing metal stents (LAMS), such as the AXIOS stent, for managing benign strictures in the duodenal sweep has been reported in the literature. While the risk of pancreatitis is generally lower with LAMS due to their shorter length, it is not negligible. This report highlights the need for careful patient selection, detailed anatomical assessment prior to stent deployment, and close monitoring for complications.