Successful re-intervention using endoscopic ultrasound-guided drainage via an endoscopic tapered sheath for recurrent walled-off necrosis with fibrosis.

Patients with disconnected pancreatic duct syndrome recur with pancreatic fluid collection in 17–38 % of cases after transmural stent removal [1] [2]. Symptomatic patients require endoscopic re-intervention; however, an approach via the same puncture route is often complicated by fibrosis caused by previous treatment. Long-term placement of a plastic stent is recommended for endoscopic ultrasound-guided drainage of a recurrent walled-off necrosis (WON). However, commonly used pigtail stents are difficult to pass through a fistula even post-dilation, especially in fibrotic cases. Lumen-apposing metal stents can be easily employed in such cases, albeit with an increased risk of serious adverse events in long-term placements [3] [4]. We report a successful re-intervention using endoscopic ultrasound-guided drainage via an endoscopic tapered sheath (EndoSheather; Piolax, Inc., Kanagawa, Japan) ([Fig. 1]) for a recurrent WON with fibrosis.