{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T05:07:23Z","timestamp":1767848843403,"version":"3.49.0"},"reference-count":13,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,10,14]],"date-time":"2024-10-14T00:00:00Z","timestamp":1728864000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["DEN Open"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Replacing a lumen\u2010apposing metal stent (LAMS) with a double\u2010pigtail plastic stent (DPS) after treatment for walled\u2010off necrosis contributes to the prevention of recurrence. However, the success rate is not very high. To overcome this issue, we devised a novel stent\u2010replacement technique. In the final treatment procedure, a 7\u2010F DPS was placed in the lumen of the LAMS. Subsequently, the walled\u2010off necrosis\u00a0shrank, and granulation formed over the pigtail portion, which fixed the DPS. The LAMS alone was removed with grasping forceps, leaving the DPS in the lumen of the LAMS (i.e., a puzzle\u2010ring technique; direct or rotary removal technique). Between August 2021 and August 2023, 18 patients were evaluated for recurrence prevention using this novel technique (median duration of LAMS placement, 37 days). In 17 patients (94.4%), the LAMS was successfully replaced with a 7\u2010F DPS (direct technique 14, rotary technique 3; median removal procedure time, 3 min). No recurrence was observed during the median observation period of 385 days. Before using this technique (April 2012 to August 2022), the technical success rate of replacement of LAMS with 7\u2010F DPS was significantly lower (61.8% [42\/68, <jats:italic>p<\/jats:italic> = 0.02]). Recurrence of pancreatic fluid collection occurred in 15.3% (4\/26) of the patients who could not undergo replacement with a 7\u2010F DPS. The novel puzzle ring technique, which improves the success rate of LAMS for DPS replacement, may be useful in reducing recurrence after walled\u2010off necrosis\u00a0treatment.<\/jats:p>","DOI":"10.1002\/deo2.70020","type":"journal-article","created":{"date-parts":[[2024,10,14]],"date-time":"2024-10-14T10:39:30Z","timestamp":1728902370000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["A novel puzzle ring replacement technique of a lumen\u2010apposing metal stent with a double\u2010pigtail plastic stent to prevent walled\u2010off necrosis recurrence (with video)"],"prefix":"10.1002","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5737-620X","authenticated-orcid":false,"given":"Shuntaro","family":"Mukai","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology Tokyo Medical University  Tokyo 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