Plastic Pigtail vs. Lumen-Apposing Metal Stents in Endoscopic Ultrasound-Guided Drainage of Walled-Off Pancreatic Necrosis: A Multicentre Randomised Trial (The Prometheus Study).

Impact of endoprosthesis type on inflammatory response in patients undergoing endoscopic drainage of pancreatic fluid collections

“…Three randomized trials (two published and one in abstract format) that compared the performance of LAMS and plastic stents in patients with necrotizing pancreatitis did not observe any significant difference in long-term clinical outcomes or length of hospitalization between cohorts. 2,7,8 However, a meta-analysis of these randomized trials demonstrated a shorter length of hospital stay for the LAMS cohort (standardized mean difference of À0.29, 95% CI À0.56 to À0.03; P = 0.029) (Table 5). This is likely because the individual trials were not sufficiently powered to evaluate the length of stay as an independent outcome measure.…”

“…A two-sided sample size calculation was performed based on the rate of postprocedural SIRS, which was estimated at 15% for the LAMS and 40% for the plastic stents. [1][2][3][4][5][6][7][8][9][10] A sample size calculation to detect a 25% difference in treatment success at 85% power and type I error (a) of 0.05 resulted in a sample size estimation of 53 patients per group (PASS 15 Power Analysis and Sample Size Software; NCSS, Kaysville, UT, USA).…”

“…Unfortunately, none of these advantages were borne out in randomized trials. [6][7][8] However, a major advantage of LAMS is the short procedural duration, which is attributed to the simpler, single-step stent deployment process. 6,9 In patients undergoing plastic stent placement, after the PFC is punctured, the transmural tract is balloon-dilated over a guidewire before the endoprosthesis is deployed.…”

Response to letter to the editor: lumen-apposing metal stents versus double-pigtail plastic stents for infected necrotising pancreatitis

“…In conclusion, we disagree with the opinion that our study created more doubts than answers. In our opinion, especially because a previous and another recent RCT also showed no benefit in clinical outcome for LAMS drainage over plastic stents, the question whether LAMS or plastic stents should be preferred is answered: both are justified 7 10…”

Plastic is as good as metal: is the ‘debris clearance’ debate for walled-off necrosis drainage finally over?

“…While plastic and LAMS seem to function equally for pancreatic fluid collections overall, two recently concluded randomised controlled trials have, in fact, reported in favour of LAMS for WON drainage 9 10. Larger studies, considering factors such as degree of necrotic debris, presence of organ failure, time to improvement, etc would be needed to probably better understand the choice of stent for the sicker cohort of infected WON.…”