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Lumen-apposing metal stents versus double-pigtail plastic stents for infected necrotising pancreatitis: more doubts than answers
  1. Alberto Larghi1,
  2. Antonio Facciorusso2
  1. 1Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
  2. 2Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
  1. Correspondence to Dr Alberto Larghi, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy; alberto.larghi{at}

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We read with great interest the study published by Boxhoorn et al, comparing lumen-apposing metal stents (LAMS) versus double-pigtail plastic stents (DPPS) for treatment of infected necrotising pancreatitis.1 The authors did not find a significant difference in the primary aim, that is, the need for endoscopic transluminal necrosectomy, based on an indirect comparison between a multicentre prospective cohort treated with LAMS (step-up approach) and a previous cohort from the TENSION randomised controlled trial (RCT), where patients were treated with DPPS according to a similar protocol.2

In spite of the undoubted interest to authors’ results, we have some methodological concerns raised by the indirect comparison between non-contemporary cohorts drawn from different studies. This approach cannot completely exclude the risk of selection bias and the indirect comparison provides weaker evidence, as …

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  • Contributors Study concept and design: AF, AL. Drafting of the manuscript: AF. Revision of the manuscript for important intellectual content: AL. Approval of the final manuscript: All the authors. Guarantor of the article: AL.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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