Lumen-apposing metal stents versus double pigtail plastic stents for early (<4 weeks of illness) endoscopic transluminal drainage of pancreatic necrotic collections

Abstract

Background Pancreatic necrotic collections (PNC) gradually liquefy over time. In the early phase of pancreatitis (<4 weeks), collections contain more solid debris. This study retrospectively compared the safety and efficacy of endoscopic transluminal drainage (ETD) using multiple plastic stents (MPS) vs. lumen-apposing metal stents (LAMS) in early-phase PNC.

Methods A retrospective, single-center, and non-randomized review was conducted of patients who underwent endoscopic ultrasound-guided drainage/debridement of PNC between January 2018 and November 2024. Patients who had early ETD with either MPS or LAMS were included. Data compared included demographics, clinical features, indications, intervention details, need for endoscopic necrosectomy (ETN), complications, need for surgery, and outcomes.

Results Forty-five patients (39 male) received LAMS, and 21 (18 male) received MPS. PNC size and necrotic content were similar between groups. Technical success was 100% in both groups, but clinical success was significantly higher with LAMS (89% vs. 48%; P<0.001). ETN was more frequent in the MPS group (86% vs. 58%; P=0.02), as was the mean number of procedures (6.1 vs. 4.1; P=0.009). MPS was associated with higher mortality (19% vs. 6%), need for surgical necrosectomy (52% vs. 11%), and post-procedure bleeding (24% vs. 11%).

Conclusion LAMS seem to be superior to MPS for ETD of early-phase symptomatic PNC, showing higher clinical success, with fewer complications, procedures and rescue surgical interventions.

Keywords Pancreatitis, lumen-apposing metal stents, necrosectomy, computed tomography, endosonography

Ann Gastroenterol 2026; 39 (1): 71-78