GI Endoscopy · 1 min read
LAMS vs Plastic Stents in Infected Pancreatic Necrosis
Experienced teaching points
Clinical Pearls
- Despite their larger diameter and theoretical drainage advantage, Lumen-Apposing Metal Stents (LAMS) do not negate the need for further necrosectomy when compared to traditional plastic pigtail stents for infected pancreatic necrosis.
- LAMS are not a panacea for complex walled-off necrosis (WON); successful resolution still mandates close clinical observation, aggressive irrigation, and proactive, stepwise endoscopic interventions.
- The placement of a drainage stent (whether LAMS or plastic) is only the first step in managing complex pancreatic necrosis—there is no 'set it and forget it' option for these high-risk collections.
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.
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