@article {Boxhoorn66, author = {Lotte Boxhoorn and Robert C Verdonk and Marc G Besselink and Marja Boermeester and Thomas L Bollen and Stefan AW Bouwense and Vincent C Cappendijk and Wouter L Curvers and Cornelis H Dejong and Sven M van Dijk and Hendrik M van Dullemen and Casper HJ van Eijck and Erwin JM van Geenen and Muhammed Hadithi and Wouter L Hazen and Pieter Honkoop and Jeanin E van Hooft and Maarten AJM Jacobs and June EC Kievits and Marnix PM Kop and Eva Kouw and Sjoerd D Kuiken and Michiel Ledeboer and Vincent B Nieuwenhuijs and Lars E Perk and Jan-Werner Poley and Rutger Quispel and Rogier JJ de Ridder and Hjalmar C van Santvoort and Christina J Sperna Weiland and Martijn WJ Stommel and Hester C Timmerhuis and Ben J Witteman and Devica S Umans and Niels G Venneman and Frank P Vleggaar and Roy LJ van Wanrooij and Marco J Bruno and Paul Fockens and Rogier P Voermans}, editor = {,}, title = {Comparison of lumen-apposing metal stents versus double-pigtail plastic stents for infected necrotising pancreatitis}, volume = {72}, number = {1}, pages = {66--72}, year = {2023}, doi = {10.1136/gutjnl-2021-325632}, publisher = {BMJ Publishing Group}, abstract = {Objective Lumen-apposing metal stents (LAMS) are believed to clinically improve endoscopic transluminal drainage of infected necrosis when compared with double-pigtail plastic stents. However, comparative data from prospective studies are very limited.Design Patients with infected necrotising pancreatitis, who underwent an endoscopic step-up approach with LAMS within a multicentre prospective cohort study were compared with the data of 51 patients in the randomised TENSION trial who had been assigned to the endoscopic step-up approach with double-pigtail plastic stents. The clinical study protocol was otherwise identical for both groups. Primary end point was the need for endoscopic transluminal necrosectomy. Secondary end points included mortality, major complications, hospital stay and healthcare costs.Results A total of 53 patients were treated with LAMS in 16 hospitals during 27 months. The need for endoscopic transluminal necrosectomy was 64\% (n=34) and was not different from the previous trial using plastic stents (53\%, n=27)), also after correction for baseline characteristics (OR 1.21 (95\% CI 0.45 to 3.23)). Secondary end points did not differ between groups either, which also included bleeding requiring intervention{\textemdash}5 patients (9\%) after LAMS placement vs 11 patients (22\%) after placement of plastic stents (relative risk 0.44; 95\% CI 0.16 to 1.17). Total healthcare costs were also comparable (mean difference -{\texteuro}6348, bias-corrected and accelerated 95\% CI -{\texteuro}26 386 to {\texteuro}10 121).Conclusion Our comparison of two patient groups from two multicentre prospective studies with a similar design suggests that LAMS do not reduce the need for endoscopic transluminal necrosectomy when compared with double-pigtail plastic stents in patients with infected necrotising pancreatitis. Also, the rate of bleeding complications was comparable.Data are available on reasonable request. Request for data can be made to the corresponding author (r.p.voermans@amsterdamumc.nl) and will first be discussed during a meeting of the Dutch Pancreatitis Study Group.}, issn = {0017-5749}, URL = {https://gut.bmj.com/content/72/1/66}, eprint = {https://gut.bmj.com/content/72/1/66.full.pdf}, journal = {Gut} }