International multicenter comprehensive analysis of adverse events associated with lumen-apposing metal stent placement for pancreatic fluid collection drainage

Published:November 20, 2019DOI:

      Background and Aims

      High rates of technical and clinical success were reported for lumen-apposing metal stent (LAMS) placement for peripancreatic fluid collection (PFC) drainage. However, data on the adverse event (AE) rates are heterogeneous. The aim of this study was to evaluate the incidence, severity, management, and risk factors of AEs related to the use of LAMSs for drainage of PFCs in a large cohort of patients.


      This is a multicenter, international, retrospective review from 15 centers of all patients who underwent placement of LAMSs for the management of PFCs. A nested case-control study was conducted in patients with (case) or without (control) AEs.


      Three hundred thirty-three procedures in 328 patients were performed (5 patients treated with 2 LAMSs). Technical success was achieved in 321 patients (97.9%). Three hundred four patients were finally included in the study (7 excluded for lost to follow-up information; 10 excluded for deaths unrelated to LAMSs). The rate of clinical success was 89.5%. Seventy-nine LAMS-related AEs occurred in 74 of 304 patients (24.3%), after a mean time of 25.3 days (median, 18 days; interquartile range, 6-30) classified as 20 (25.3%) mild, 54 (68.4%) moderate, or 5 (6.3%) severe. On multivariable analysis compared with control subjects, cases were more likely to have walled-off necrosis (WON) versus pancreatic pseudocysts (odds ratio, 2.18; 95% confidence interval, 1.09-4.46; P = .028), whereas cases were less likely to have undergone tract (balloon) dilation (yes vs no; odds ratio, .47; 95% confidence interval, .22-.93; P = .034).


      Data from this large international retrospective study confirm that the use of LAMSs for management of PFCs has excellent technical and good clinical success rates. The rate of AEs, however, is not negligible and should be carefully considered before using these stents for drainage of PFCs and in particular for WON. Further prospective studies are needed to confirm these findings. (Clinical trial registration number: NCT 03544008.)


      AE (adverse event), ASGE (American Society for Gastrointestinal Endoscopy), LAMS (lumen-apposing metal stent), PFC (peripancreatic fluid collection), MOF (multiorgan failure), OR (odds ratio), PP (pancreatic pseudocyst), SEMS (self-expanding metallic stent), WON (walled-off necrosis)
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      Linked Article

      • Adverse events of lumen-apposing stents for pancreatic fluid collections: opening Pandora’s box
        Gastrointestinal EndoscopyVol. 91Issue 5
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          We read with great interest the article by Fugazza et al,1 retrospectively evaluating the occurrence of adverse events (AEs) in 304 patients with pancreatic pseudocysts (PCs) (153) and walled-off necrosis (WON) (151) treated with lumen-apposing metal stents (LAMSs). Seventy-four (24.3%) patients experienced 79 AEs, of which bleeding (22), stent migration (20), stent occlusion (14), and infection (19) were the most frequently observed. At multivariate analysis, WON and lack of pneumatic tract dilation were the only statistically significant risk factors associated with AEs.
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