Lumen-apposing metal stents for pancreatic fluid collection drainage: may not be business as usual?

We read with interest the paper by Bang et al1 concerning their interim analysis of an ongoing randomised study comparing a novel fully covered self-expanding metal stent (fcSEMS) to plastic stents in patients undergoing endoscopic drainage of walled-off pancreatic necrosis (WOPN). This was following concerns over higher than expected adverse events in the fcSEMS (50%) compared with the plastic stent group (0%). Specifically, these adverse events were three cases of bleeding, two cases of buried stent and one case of biliary stricture. The three cases of bleeding were found to have pseudoaneurysms, which were treated by radiologically guided coiling. One of the buried stent cases developed severe bleeding on removal and requiring radiological intervention. The biliary stricture was managed endoscopically with fcSEMS removal and biliary stent insertion. This report comes from an expert group with extensive experience in the endoscopic management of pancreatic fluid collections (PFCs).

The...

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