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

A novel mini-invasive step-up approach for the treatment of severe acute pancreatitis with extensive infected necrosis: A single center case series study

“…In contrast, another prospective cohort study enrolled 53 patients with IPN and found that the number of endoscopic transluminal necrosectomy procedures, incidence of complications, and total healthcare costs were comparable between the 2 stents. [33] The results of 2 ongoing randomized controlled studies will further evaluate the clinical efficacy and possible complications [34,35] ; however, shorter endoscope operation times with LAMS are unambiguously evident, which is a potentially crucial advantage for more critical cases. [12,32] Finally, approximately 27% to 32% of patients with IPN who underwent the endoscopic step-up approach required additional PCD procedures.…”

“…[12,32] Finally, approximately 27% to 32% of patients with IPN who underwent the endoscopic step-up approach required additional PCD procedures. [10,33] This may be due to the destruction of the well-defined necrosis wall associated with the endoscopic transluminal procedure, which results in the spread of necrosis, digestive enzymes, and pro-inflammatory mediators to other parts of the abdominal cavity. Furthermore, the endoscopic transluminal procedure also causes loss of retroperitoneal compartmentalization, leading to spread of necrosis into communicating recesses and cavities.…”

Treatment of walled-off necrosis using lumen-apposing metal stents versus plastic stents: a systematic review and meta-analysis of data from randomized trials

“…All studies included patients over age of 18 years with suspected/confirmed or symptomatic WON amenable to EUSguided drainage; however, in one study [10], only WON >15 cm in size were included. The follow-up period was 6 months from the index procedure or study enrollment in two studies [8,9] and 3 months in one study [10] (Table1A-C, Supplemental File).…”

“…Three randomized trials have compared the effectiveness of LAMS and plastic stents for the treatment of walled-off necrosis (WON) [8][9][10]. While the primary objective in the first study was number of interventions to achieve treatment success [8], the later studies compared need for necrosectomy and number of necrosectomy sessions required to achieve treatment success [9,10].…”

“…Three randomized trials have compared the effectiveness of LAMS and plastic stents for the treatment of walled-off necrosis (WON) [8][9][10]. While the primary objective in the first study was number of interventions to achieve treatment success [8], the later studies compared need for necrosectomy and number of necrosectomy sessions required to achieve treatment success [9,10]. While all three studies did not find any difference in the primary outcome measures, a possible limitation may be an inadequate sample size, which increases the likelihood of missing a treatment effect, even if it exists.…”