LAMS in the Limelight: Transforming Pancreatic Necrosis Management with High Success and No Complications

Background: Pancreatic necrosis, a severe complication of acute pancreatitis, significantly impacts morbidity and mortality. Introducing lumen-apposing metal stents (LAMS) as the primary treatment modality offers a less invasive option, potentially improving patient outcomes.

Aims: This study evaluates the effectiveness and safety of using LAMS as the primary intervention for pancreatic necrosis, with a focus on technical and clinical success rates and the management of nonresponsive cases.

Methods: We conducted a retrospective review of 71 patients treated with LAMS for pancreatic necrosis from January 2019 to December 2023. The study assessed the technical success of stent placement, clinical improvement, and the approach to cases not responding to initial treatment.

Results: The technical success rate of LAMS placement was 100%, with a clinical success rate of 91.55%. Six patients (8.45%) did not respond to LAMS treatment: four underwent necrosectomy, one received percutaneous drainage (PCD), and one had a persistent collection managed conservatively ([Table 1]). Notably, there were no complications related to the LAMS procedure, underscoring its safety. The primary use of LAMS resulted in significantly reduced hospital stays and eliminated the need for additional surgical interventions in the majority of cases.

Conclusion: Employing LAMS as the primary treatment for pancreatic necrosis achieves high technical and clinical success rates, with a distinct absence of procedure-related complications. The findings support the use of LAMS as a safe and effective management strategy for pancreatic necrosis, highlighting the need for further studies to refine patient selection and treatment protocols.

Table 1 Results and adverse events

	Repeat PEG (n = 42)	LSP (n = 30)	p-Value
BBPS (mean ± SD)	5.43 ± 3.08	8.37 ± 1.09	<0.001
Left colon (mean ± SD)	1.74 ± 1.12	2.73 ± 0.52	<0.001
Transverse colon (mean ± SD)	2.1 ± 1.00	2.87 ± 0.43	<0.001
Right colon (mean ± SD)	1.60 ± 1.23	2.70 ± 0.65	<0.001
Adequate bowel preparation (BBPS ≥ 6), n (%)	26 (61.90%)	29 (96.66%)	<0.001
Ileal intubation rate	21 (50%)	26 (86.66%)	0.01
Cecal intubation rate, n (%)	27 (64.28%)	30 (100%)	<0.001
Total expenditure (₹)	11,676.19 ± 3,438.36	6,003.23 ± 1,973.06	<0.001
Nausea (n)	15	3	0.01
Vomiting (n)	4	1	0.29
Abdominal pain (n)	5	1	0.23
Bloating (n)	11	4	0.24
Dizziness (n)	3	0	0.25
Sleep disturbance (n)	27	0	<0.001

Publication History

Article published online:
22 April 2024