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Severe bleeding is a rare event in patients receiving lumen-apposing metal stents for the drainage of pancreatic fluid collections
  1. Sebastian Zeissig1,2,
  2. Stefan Sulk1,
  3. Stefan Brueckner1,
  4. Katja Matthes1,
  5. Margarete Hohmann1,
  6. Stephanie Reichel3,
  7. Mark Ellrichmann4,
  8. Alexander Arlt4,
  9. Uwe Will3,
  10. Jochen Hampe1
  1. 1Department of Medicine I, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden (TU Dresden), Dresden, Germany
  2. 2Center for Regenerative Therapies Dresden (CRTD), Technische Universität Dresden (TU Dresden), Dresden, Germany
  3. 3Department of Gastroenterology, Hepatology and Internal Medicine, SRH Waldklinikum Gera, Gera, Germany
  4. 4Department of Internal Medicine I, Universitätsklinikum Schleswig-Holstein Kiel, Kiel, Germany
  1. Correspondence to Dr Sebastian Zeissig, Department of Medicine I, University Hospital Carl Gustav Carus, Technische Universität Dresden (TU Dresden), Dresden 01307, Germany; sebastian.zeissig{at}tu-dresden.de

https://doi.org/10.1136/gutjnl-2018-316581

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    Pancreatic fluid collections (PFCs) including pancreatic pseudocysts (PPCs) and walled-off necrosis (WON) frequently develop in the context of pancreatitis. Lumen-apposing self-expanding metal stents (LAMS) are increasingly used for the endoscopic management of infected and symptomatic PFCs since they facilitate direct endoscopic inspection and necrosectomy of WONs.1–3 However, two reports recently published in Gut4 5 demonstrated high rates of haemorrhage associated with LAMS that were observed in up to 25% of patients and often occurred in a delayed manner with serious and fatal bleeding episodes reported. These data raised important concerns about the safety of LAMS and the optimal management of patients with infected or symptomatic PFCs.

    As a limitation, the reports by Bang et al4 and Stecher et al5 were based on relatively small group sizes of 12 and 46 LAMS-treated patients, respectively. To investigate whether the reported safety signals are similarly observed in …

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    Footnotes

    • SZ and SS contributed equally.

    • Contributors All authors were involved in the endoscopic management of patients included in this study and contributed to data collection. SZ and SS wrote the manuscript with input from all co-authors. ME, AA, UW and JH supervised the work.

    • Competing interests SZ received consulting fees from Biogen, Ferring, Janssen-Cilag, Takeda and lecture fees from Abbvie, Falk, Ferring, MSD, Roche, Takeda. AA and ME received consulting and lecture fees from Boston Scientific. JH received grant support from Bayer Technology Services, Metanomics GmbH and travel support and consulting fees from Braun, Takeda, Abbvie, MSD, Falk Foundation, Boston Scientific, Pfizer and Johnson & Johnson.

    • Patient consent Not required.

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