Lumen-apposing metal stents (LAMSs) may facilitate endoscopic ultrasound (EUS)-guided treatment of walled-off necrosis (WON) as a transluminal port for necrosectomy [1] [2]. However, this modality has a risk of potentially lethal bleeding [3] [4]. In this case, we experienced dreadful bleeding when conducting EUS-guided LAMS placement with balloon dilation for direct endoscopic necrosectomy (DEN) ([Video 1]).

Severe bleeding associated with lumen-apposing metal stent placement for walled-off necrosis: bloody memory in WONderland