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We read with great interest the paper by Bang et al,1 which reported the results of a randomised controlled trial comparing endoscopic ultrasound (EUS)-guided placement of lumen-apposing metal stents (LAMS) (Hot Axios) versus plastic stents (PS) for the treatment of patients with walled-off pancreatic necrosis (WON). During the first phase of the study, a very high number of adverse events (AEs) (32.2%) occurred in the LAMS arm, including two patients with a buried stent, three with bleeding pseudoaneurysms that required coil embolisation and other three with stent-induced biliary stricture. All these AEs occurred within 6 weeks from stent placement, which was the time established to assess treatment response by an abdominal CT. Due to this high rate of AEs, the protocol was changed and follow-up CT anticipated at 3 weeks, resulting in a decrease of AEs to 6.5% in the …
Contributors MR, MP and AL did the literature search. MR and AL drafted the manuscript. All authors approved the final version of the manuscript.
Competing interests None declared.
Patient consent Not required.
Provenance and peer review Not commissioned; internally peer reviewed.