Lumen-apposing metal stents (LAMS) have larger lumen and are supposed to drain better. In this comparative study, the need for further necrosectomy was the same for LAMS or plastic stents. It was not a head-to-head comparative study.
The authors compared the results from the TENSION trial (plastic stents only) versus an ongoing LAMS trial. Nonetheless, the data seems clinically significant and the data appears compelling.
It is time to step back and realize that LAMS are not a panacea for complex pancreatic necrosis and that these collections mandate a continued and close observation and intervention approach.
When dealing with complex pancreatic necrosis, there is no time to place a stent and then "sit back and relax".
On: Boxhoorn L, et al. Comparison of lumen-apposing metal stents versus double-pigtail plastic stents for infected necrotising pancreatitis. Gut. 2022 Jun 14:gutjnl-2021-325632. doi: 10.1136/gutjnl-2021-325632. Epub ahead of print.