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Self-expandable metal stent in lumen-apposing metal stent (the SEMS-in-LAMS procedure): a simple salvage procedure after LAMS misplacement E-Videos Video 1 Deployment of a self-expandable metal stent (SEMS) through a lumen-apposing metal stent (LAMS) after LAMS misplacement during endoscopic ultrasound-guided drainage of a pancreatic fluid collection: the SEMS-in-LAMS procedure. ▶ Fig. 1 Computed tomography scan showing a large pancreatic pseudocyst (20.3 × 16.8 × 15.0 cm; total volume 2660 mL).▶ Fig. 2 Endoscopic view of the lumen-apposing metal stent (LAMS) after traction with forceps showing: a the proximal flange of the LAMS in the gastric lumen; b the retroperitoneum and the orifice in the pseudocyst wall. Lera Marcos E et al. SEMS-in-LAMS procedure … Endoscopy 2019; 51: E77-E78

-Background -Endoscopic ultrasound is considered the best imaging test for the diagnosis and evaluation of subepithelial lesions of the gastrointestinal tract. Objective -The present study aims to describe the endosonographic characteristics of upper gastric subepithelial lesions and our experience using endoscopic ultrasound for evaluation of such lesions. Methods -Retrospective data study of 342 patients who underwent endoscopic ultrasound evaluation of subepithelial lesions. Results -Lesions of the fourth layer were more common in the stomach (63.72%) than in the esophagus (44.68%) and duodenum (29.03%). In stomach, 81.1% of the lesions ≥2 cm, and 96.5% ≥3 cm, were from the fourth layer. Endosonographic signs that could be related to malignant behavior, such as irregular borders, echogenic foci, cystic spaces and/or size greater than 3 cm were identified in 34 (15.81%) lesions at the first endoscopic ultrasound evaluation. Endoscopic ultrasound-fine needle aspiration did the diagnosis in 21 (61.76%) patients who were submitted a puncture. Three (12.0%) lesions of 25 who were submitted to regular endoscopic ultrasound surveillance increased the size. Conclusion -Stomach is the organ most affected with subepithelial lesions of the gastrointestinal tract and the fourth layer was the most common layer of origin. More than 80% of gastric subepithelial lesions from the fourth layer are ≥2 cm. Endoscopic ultrasound evaluation of subepithelial lesions has been very important for stratification into risk groups and to determine the best management. HEADINGS -Endosonography. Gastrointestinal stromal tumors. Endoscopic ultrasound-guided fine needle aspiration. Biopsy fine-needle.

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