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Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) has been an effective and safe alternative to surgery for the palliation of symptoms of gastric outlet obstruction (GOO) due to benign or malignant conditions [1–3]. The lumenapposing metal stent (LAMS) is a necessary device for EUS-GE because of its anti-migration role and long-term patency [4]. However, there is no clear in vivo evidence of the duration of LAMS efficacy. There is still no evidence on when the LAMS should be exchanged especially when used in benign GOO. We report a case of endoscopic exchange of LAMS after EUS-GE in severe acute pancreatitis. A 49-year-old man experienced severe acute pancreatitis after excessive alcohol intake. Although his condition greatly improved with active treatment, he presented 3 months later with progressive nausea, vomiting, and poor oral food intake. Upper gastrointestinal imaging (UGI) and gastroscopy revealed duodenal obstruction due to distortion of the descending part of the duodenum. A nasojujunal feeding tube was implanted deeply beyond the ligament of Treitz and exchanged every 3 months. However, the symptoms had not improved E-Videos

Endoscopic exchange of a lumen-apposing metal stent after endoscopic ultrasound-guided gastroenterostomy in severe acute pancreatitis