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Delayed severe bleeding complications after treatment of pancreatic fluid collections with lumen-apposing metal stents
  1. SS Stecher1,
  2. P Simon2,
  3. S Friesecke1,
  4. A Glitsch3,
  5. JP Kühn4,
  6. MM Lerch2,
  7. J Mayerle5
  1. 1 Department of Medicine B, University Medicine, Ernst-Moritz-Arndt-University, Greifswald, Germany
  2. 2 Department of Medicine A, University Medicine, Ernst-Moritz-Arndt-University, Greifswald, Germany
  3. 3 Department of General Surgery, University Medicine, Ernst-Moritz-Arndt-University, Greifswald, Germany
  4. 4 Institute of Radiology, University Medicine, Ernst-Moritz-Arndt-University, Greifswald, Germany
  5. 5 Medizinische Klinik und Poliklinik II, Klinikum der LMU, München-Grosshadern, Munich, Germany
  1. Correspondence to Dr Julia Mayerle, Medizinische Klinik und Poliklinik II, Klinikum der LMU München-Grosshadern, Anstalt des öffentlichen Rechts, Marchioninistr. 15, München D-81377, Germany; julia.mayerle{at}med.uni-muenchen.de

http://dx.doi.org/10.1136/gutjnl-2016-313562

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    With interest we read the paper by Bang et al,1 who observed delayed severe adverse events after endoscopic treatment of pancreatic fluid collections (PFCs) with the Hot AXIOS lumen-apposing metal stent (LAMS), which was unrelated to the initial procedure, in a randomised controlled trial. LAMS are increasingly used for transmural endoscopic ultrasound-guided drainage of PFC and infected walled-off pancreatic necrosis (WOPN).2 Procedure associate bleeding is a frequent adverse event after transmural drainage.3 While our experience confirms our colleagues' findings we would like to emphasize that complications are not restricted to Hot AXIOS stents and that certain insertion techniques may be more prone to early bleeding while non-pigtail, LAMS can cause late bleeding complications.

    From June 2013 to October 2016, we treated 46 patients with LAMS (8×Hot AXIOS 15×10 mm (Boston Scientific); 38×TAEWOONG MEDICAL Niti-S biliary covered stent (NAGI) …

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    Footnotes

    • Contributors SSS and JM have compiled the clinical data. JPK has provided angiography pictures and was involved in patients’ care. SF was the responsible consultant intensivist, JM, PS and MML have designed the manuscript. The manuscript was drafted by SSS and JM and reviewed by all authors.

    • Funding This work was supported by the Deutsche Krebshilfe/Dr Mildred-Scheel-Stiftung (109102), the Deutsche Forschungsgemeinschaft (DFG MA 4115/1-2/3), the Federal Ministry of Education and Research (BMBF GANI-MED 03IS2061A and BMBF 0314107, 01ZZ9603, 01ZZ0103, 01ZZ0403, 03ZIK012) and the European Union (EU-FP-7: EPC-TM).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.