EUS-guided treatment of WON using lumen-apposing metal stents: protocol standardisation based on the occurrence of natural healing processes

We read with great interest the paper by Bang et al,1 which reported the results of a randomised controlled trial comparing endoscopic ultrasound (EUS)-guided placement of lumen-apposing metal stents (LAMS) (Hot Axios) versus plastic stents (PS) for the treatment of patients with walled-off pancreatic necrosis (WON). During the first phase of the study, a very high number of adverse events (AEs) (32.2%) occurred in the LAMS arm, including two patients with a buried stent, three with bleeding pseudoaneurysms that required coil embolisation and other three with stent-induced biliary stricture. All these AEs occurred within 6 weeks from stent placement, which was the time established to assess treatment response by an abdominal CT. Due to this high rate of AEs, the protocol was changed and follow-up CT anticipated at 3 weeks, resulting in a decrease of AEs to 6.5% in the subsequent patients treated with LAMS.

A high risk of bleeding due to...

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