THE LUMEN-APPOSING METAL stent (LAMS) deployment has been reported to be easier and timesaving. However, with the increasing use of LAMS, adverse events have been more frequently reported. We describe the case of an 83-year-old male whom we provided with optimal supportive care for advanced pancreatic cancer in outpatient clinic. Subsequently, the patient suffered from severe epigastric pain caused by pancreatic fluid collection (PFC) owing to pancreatic duct obstruction (Fig. 1a) and was admitted to relieve the pain. We considered that transgastric drainage would be the best care for the patient. Hence, the patient underwent placement of the Hot Axios (Boston Scientific, Marlborough, MA, USA). After advancement of the stent by electrocautery under endoscopic ultrasound guidance, the proximal flange was deployed by grasping the stent deployment hub. However, the distal flange was also deployed within the PFC. To correct the problem, we additionally placed a double pigtail stent and a nasobiliary catheter (Video S1). Fortunately, the pain was resolved, and no adverse event was observed. Finally, the nasocatheter was removed seven days after the procedure (Fig. 1b). The stent deployment hub should be stopped by the locking system designed on the stent deployment hub before deployment of the distal flange (Fig. 2a and Video S2), but was not stopped. We attempted some holding methods and found that handling and touching the locking system can release the lock (Fig. 2c), although a click can be felt. To visualize the target lesion, the endoscopist took an unnatural posture in this case. Therefore, the hub was held in a backhand grip and the stent lock was touched unintentionally (Video S3). Furthermore, we did not feel the click caused by the pressure from the unnatural posture. To avoid such misplacement, correct handling and cautious tactile feeling are very important.

中文翻译：

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在处理支架部署中心期间，请勿接触 Hot Axios 的锁定系统

据报道，LUMEN-APPOSING METAL 支架 (LAMS) 部署更容易、更省时。然而，随着 LAMS 使用的增加，不良事件的报道越来越频繁。我们描述了一名 83 岁男性的病例，我们在门诊为他提供了晚期胰腺癌的最佳支持治疗。随后，患者因胰管阻塞（图1a）出现由胰液聚集（PFC）引起的严重上腹部疼痛，并入院以缓解疼痛。我们认为经胃引流将是对患者最好的护理。因此，患者接受了 Hot Axios (Boston Scientific, Marlborough, MA, USA) 的放置。内镜超声引导下电灼支架推进后，通过抓住支架部署毂来部署近端法兰。然而，远端法兰也在 PFC 内展开。为了纠正这个问题，我们另外放置了一个双猪尾支架和一个鼻胆管（视频 S1）。幸运的是，疼痛得到了解决，并且没有观察到不良事件。最后，手术后 7 天取出鼻导管（图 1b）。在部署远端法兰之前，支架部署轮毂应通过设计在支架部署轮毂上的锁定系统停止（图 2a 和视频 S2），但并未停止。我们尝试了一些握持方法，发现处理和触摸锁定系统可以释放锁定（图 2c），尽管可以感觉到咔嗒声。为了可视化目标病变，内窥镜医师在这种情况下采取了不自然的姿势。所以，反手握住轮毂，无意中接触到支架锁（视频 S3）。此外，我们没有感觉到不自然姿势的压力引起的咔嗒声。为了避免这种错位，正确的处理和谨慎的触觉是非常重要的。