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

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.