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631 metal stents occurs more often than proximal dislocation.5 Despite this, proximal migration is believed to be a more serious clinical problem due to the high risk of perforation of the collection. Krupa et al1 reported that proximal migration of the metal stent into the lumen of the collection was discovered 24 hours after stent insertion, which was confirmed during control gastroscopy. How did the authors suspect distal stent migration before its confirmation? Were there any specific symptoms of the dislocation? Did the authors decide to perform a control imaging examination that identified the stent migration because of a lack of clinical improvement after endoscopic drainage? Another interesting, yet unclear, aspect is the treatment strategy for patients with metal transmural stent dislocation into PFC lumens. How was the dislocated stent removed? Were the forceps used to grasp it under fluoroscopic guidance alone or under endoscopic guidance through the insertion of a fiberscope into the pseudocyst lumen? Why was endoprosthesis removed with the forceps instead of other less traumatic endoscopic instruments, such as the polypectomy snare or Dormia basket? Perhaps other instruments were inefficient on initial removal attempts? The answers to those questions would be important for other endoscopists to guide the treatment of patients with such complications. Considering the wealth of experience at the authors’ medical center, these answers would be valuable and necessary.

Dislocation of a metal stent to the lumen of a large infected pseudocyst: questions addressing the next steps in management