Single LAMS versus multigate plastic stent drainage of WON; fair comparison or apples versus oranges?

In the recent edition of Gut, Bang et al present an important randomised trial comparing lumen-apposing metal stents (LAMS) versus plastic endoprostheses for the drainage of walled-off pancreatic necrosis (WON).1 The authors demonstrate that caution needs to be exercised when using LAMS for this indication given that they may induce pseudoaneurysm formation and severe haemorrhage.

Interestingly, they also showed that there was no difference in the number of procedures required for the management of WON for LAMS versus plastic stents which contradicted prior cohort studies suggesting that the larger drainage pathway of LAMS presented an advantage.2 3

Nevertheless, in their methods section Bang et al indicate that multiple transluminal gateway technique, in which multiple drainage tracts are created, was reserved for patients with WON diameter >12 cm.1 The median diameter of WOPN among patients managed with LAMS was 8 cm compared with 6 cm for those who underwent...

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