Delayed severe bleeding complications after treatment of pancreatic fluid collections with lumen-apposing metal stents

With interest we read the paper by Bang et al,1 who observed delayed severe adverse events after endoscopic treatment of pancreatic fluid collections (PFCs) with the Hot AXIOS lumen-apposing metal stent (LAMS), which was unrelated to the initial procedure, in a randomised controlled trial. LAMS are increasingly used for transmural endoscopic ultrasound-guided drainage of PFC and infected walled-off pancreatic necrosis (WOPN).2 Procedure associate bleeding is a frequent adverse event after transmural drainage.3 While our experience confirms our colleagues' findings we would like to emphasize that complications are not restricted to Hot AXIOS stents and that certain insertion techniques may be more prone to early bleeding while non-pigtail, LAMS can cause late bleeding complications.

From June 2013 to October 2016, we treated 46 patients with LAMS (8xHot AXIOS 15x10 mm (Boston Scientific); 38xTAEWOONG MEDICAL Niti-S biliary covered stent (NAGI) 10.5F 14x20 mm) for infected WOPNs. The...