Divide and drain: Simultaneous LAMS placement for multiple noncommunicating pancreatic fluid collections

Lumen-apposing metal stents (LAMS) are widely used for minimally invasive endoscopic drainage of pancreatic fluid collections (PFCs), including walled-off pancreatic necrosis (WOPN) and pseudocysts.We describe the use of multiple LAMS and endoscopic necrosectomy to manage three distinct PFCs after acute gallstone pancreatitis.A patient with acute gallstone pancreatitis and cholecystitis who had undergone laparoscopic cholecystectomy 19 days earlier presented with abdominal pain.Endoscopic ultrasound confirmed three noncommunicating PFCs: two pancreatic pseudocysts and one WOPN, with maximum diameters of 80 mm, 90 mm, and 100 mm.All 3 collections were drained during the same procedure.A 10 × 10 mm LAMS was placed in each of the 80-and 90-mm pseudocysts, and a 15 × 10 mm LAMS was placed in the 100-mm WOPN.One WOPN stent subsequently occluded with necrotic debris and required repeat intervention.After three endoscopic necrosectomy sessions, the patient's symptoms resolved without recurrence.The use of multiple LAMS to drain separate PFCs is uncommon and has not been fully characterized, although high technical and clinical success rates have been reported.This case illustrates the feasibility of an individualized, multiple-LAMS strategy for treating anatomically distinct PFCs.