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. 2025 Jan 29;17(1):e78177.
doi: 10.7759/cureus.78177. eCollection 2025 Jan.

Efficacy and Safety of Endoscopic Ultrasound (EUS)-Guided Lumen-Apposing Metal Stents (LAMS) as a Primary Treatment for Walled-Off Pancreatic Necrosis

Varun Mehta  1 , Yogesh K Gupta  1 , Abhinav Gupta  1 , Yogesh Kumar  1 , Manisha Khubber  1 , Ajit Sood  1 , Tanisha Sehgal  2 , Prabhav Mehta  2 , Ashita R Vuthaluru  3 , Manjeet K Goyal  4
Affiliations

Efficacy and Safety of Endoscopic Ultrasound (EUS)-Guided Lumen-Apposing Metal Stents (LAMS) as a Primary Treatment for Walled-Off Pancreatic Necrosis

Varun Mehta et al. Cureus. .

Abstract

Pancreatic necrosis, a severe complication of acute pancreatitis, is associated with significant morbidity and mortality. The use of lumen-apposing metal stents (LAMS) as a primary treatment offers a less invasive approach that may improve patient outcomes. This study evaluates the efficacy and safety of endoscopic ultrasound (EUS)-guided LAMS for treating walled-off pancreatic necrosis. In this retrospective cohort study, 95 patients treated with EUS-guided LAMS between March 2020 and October 2023 were included. Data were collected on the technical success of stent placement, clinical improvement, and management of symptomatic patients. Patients with other primary interventions, preexisting chronic pancreatitis, or incomplete clinical data were excluded. The technical success rate for LAMS placement was 100%, with a clinical success rate of 92.63%. Seven patients (7.37%) did not respond to LAMS treatment: five underwent video-assisted retroperitoneal drainage, and two had percutaneous drainage. Stent occlusion occurred in seven patients within the first week, managed through saline irrigation or direct endoscopic necrosectomy. No procedure-related complications were reported. The use of LAMS significantly reduced hospital stays and eliminated the need for additional surgeries in most cases. These findings suggest that LAMS is a highly effective and safe primary treatment for pancreatic necrosis, with high success rates and no related complications. The study's strengths include a large sample size and comprehensive follow-up, although its retrospective, single-center design may limit generalizability. These results support the use of LAMS as a primary treatment option for pancreatic necrosis, with future research needed to refine patient selection and explore long-term outcomes.

Keywords: acute pancreatitis; endoscopy; eus; lams; minimally invasive treatment; pancreatic necrosis.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Dayanand Medical College & Hospital issued approval DMCH/IEC/2024/331, dated May 30, 2024. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Flowchart depicting the procedural details for LAMS insertion in the drainage of WON
EUS, endoscopic ultrasound; FNA, fine needle aspiration; LAMS, lumen-apposing metal stents; WON, walled-off necrosis
Figure 2
Figure 2. Overview of the study
LAMS, lumen-apposing metal stents; PCD, percutaneous catheter drainage; VARD, video-assisted retroperitoneal debridement
Figure 3
Figure 3. (A) EUS image in a patient with acute pancreatitis showing walled-off pancreatic necrosis, with (i) hypoechoic liquid content and (ii) hyperechoic solid content. (B) EUS image in the same patient showing FNA needle placement into the collection (green arrow). (C) Endoscopic image in the same patient showing a LAMS with solid necrotic debris efflux post-stent deployment (red arrow). (D) Endoscopic image in the same patient showing a gush of necrotic fluid (red arrow).
EUS, endoscopic ultrasound; FNA, fine needle aspiration; LAMS, lumen-apposing metal stents; WON, walled-off necrosis
Figure 4
Figure 4. (A) CECT abdomen in a patient with acute pancreatitis showing the pancreas replaced by WON (red arrow). (B) CECT abdomen in a patient with acute pancreatitis showing a large collection replacing the bulk of the pancreas and extending into the lesser sac (red arrow). (C) CECT abdomen in a patient with acute pancreatitis showing pancreatic parenchyma replaced by a relatively well-defined collection (red arrow). The collection extends into the lesser sac, compressing and displacing the stomach anteriorly. (D) CECT abdomen in a patient with acute pancreatitis showing a well-defined collection (red arrow).
CECT, contrast-enhanced CT; WON, walled-off necrosis
Figure 5
Figure 5. Photograph of EGIS LAMS stent used in the study
LAMS, lumen-apposing metal stents
See this image and copyright information in PMC

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