Placement of Plastic Stents after Direct Endoscopic Necrosectomy through a Novel Lumen-Apposing Metal Stent for Effective Treatment of Laterally Extended Walled-Off Necrosis: A Pilot Study

Abstract

Direct endoscopic necrosectomy (DEN) using a lumen-apposing metal stent (LAMS) is a standard therapy for the management of symptomatic walled-off necrosis (WON). Here, we demonstrated the efficacy of the routine placement of long plastic stents after a DEN session to treat laterally extended WON. Patients (n = 6) with symptomatic laterally extended WON who underwent DEN after long plastic stent placement were included. The primary endpoint was clinical efficacy of the procedure. The technical and clinical success rates were 100% without major adverse events. The WON extended to the pelvic cavity or pericolic area, and the WON size was between 18.6 and 35.8 cm in length. The median number of DEN sessions was 10 (range 6–16), and two or three long plastic stents were placed after every DEN session. Only one patient suffered from pneumoperitoneum during DEN, which spontaneously resolved within 20 min. Placement of a long plastic stent after DEN using LAMS is a minimally invasive and effective treatment for symptomatic laterally extended WON. Further studies are needed to define the indications and most suitable patients.

A comparison of novel electrocautery-enhanced lumen-apposing metal stents and plastic stents in endoscopic ultrasound-guided drainage of infected walled-off necrosis: a multicenter randomized study

“…The conventional LAMS has a tubular-shaped cylindrical mesh at both ends of the stent, whereas the novel LAMS has folded back anchoring flanges, reducing the risk of mechanical irritation caused by 14 the stent edges, potentially leading to a lower risk of bleeding. [28] The hypothesis regarding the lower risk of bleeding with LAMS was based on the specific design features of the stent. Although the stent was in place for >4 weeks, the risk of bleeding was not significantly increased in the LAMS group, indicating that prolonged indwelling times may not be a concern for bleeding associated with the stent.…”

“…This difference may be attributed to design differences in the bilateral stent edges between the stents used in each study. The conventional LAMS has a tubular-shaped cylindrical mesh at both ends of the stent, whereas the novel LAMS has folded back anchoring flanges, reducing the risk of mechanical irritation caused by the stent edges, potentially leading to a lower risk of bleeding [29]. The hypothesis regarding the lower risk of bleeding with LAMS was based on the specific design features of the stent.…”