877 Lumen-Apposing Metal Stents (LAMS) for Drainage of Pancreatic Fluid Collections (PFCs): When and for Whom?

Lumen apposing metal stents: A review of current uses and outcomes

“…1). [1][2][3][12][13][14] Due to their increased lumen size, AXIOS and NAGI LAMS are preferable when direct endoscopic necrosectomy (DEN) is required as it allows the endoscopist to pass the scope directly through the stent into the PFC to remove the necrotic material. 12,13 In a retrospective case-control study, Bang et al 14 compared 21 patients undergoing PP drainage (7 via LAMS, 14 via conventional plastic double pigtail stents) and 39 patients undergoing WON drainage (13 via LAMS, 26 via plastic stents).…”

“…The average duration of follow-up was 13 months with only 1 recurrence at 12 months after stent removal (Table 1). [14][15][16][17][18][19][20][21] With regard to the safety of LAMS versus plastic stents, a recent ongoing randomized trial for drainage of PFCs via LAMS versus plastic stents demonstrated stent-related adverse events in 50.0% (6/12) patients who received LAMS and no adverse events in patients who received plastic stents. 22 Similar results were seen in a previous study using both LAMS and plastic stents for drainage of PFCs where stent-related adverse events occurred in 10.0% (2/20) of patients who received LAMS and 2.5% (1/40) patients who received plastic stents.…”

Safety of lumen-apposing metal stents (LAMS) for pancreatic fluid collection drainage

“…They postulated that rapid decompression of the WON facilitated by the wide-bore LAMS may lead to the LAMS impinging on the internal wall of the collection cavity resulting in damage to adjacent vasculature, causing haemorrhage, or inward migration of the outer flange of the stent causing buried stent syndrome. Previously Bang et al 2 reported outcomes of 20 patients treated with the Hot AXIOS LAMS compared with 40 patients treated with double pigtail plastic stents. 13/20 of the patients treated with a LAMS had WON, and the stent-related adverse event rate in that subgroup was 15.4% (2/13),2 significantly lower than the rate reported in their more recent report 1.…”

“…Previously Bang et al 2 reported outcomes of 20 patients treated with the Hot AXIOS LAMS compared with 40 patients treated with double pigtail plastic stents. 13/20 of the patients treated with a LAMS had WON, and the stent-related adverse event rate in that subgroup was 15.4% (2/13),2 significantly lower than the rate reported in their more recent report 1. In both cases, the distal (internal) flange migrated inwards through the necrotic cavity into the lesser sac but there were no reported incidents of delayed bleeding or buried stent syndrome.…”

“…Given the large disparity in stent-related adverse events reported in the two recent publications from Bang et al ,2 we would be interested to know if, in retrospect, there are any identifiable differences in patient or collection characteristics in the two studies. For example, was there a difference in the nature of the WON collections in terms of size, percentage of necrotic content or timing of the drainage procedure relative to the index episode of pancreatitis?…”