Lumen-apposing metal stents for pancreatic fluid collections: has advancing technology encouraged over-reach?

We read with great interest the article by Hamada et al 1 , which provides important insights into the real-world adoption of lumen-apposing metal stents (LAMS) for pancreatic fluid collections (PFCs). This nationwide, dual-database study enhances understanding of how evolving endoscopic practice influences patient care and resource use.

LAMS exemplifies the benefits of technical innovation and the need for careful evaluation of its role. The reported increase in bleeding risk with LAMS, particularly in pseudocyst cases, is an actionable finding.

In walled-off necrosis (WON), by contrast, LAMS was not linked to higher bleeding risk and was associated with shorter stays and lower costs. While caution against indiscriminate use is appropriate, favourable outcomes in WON deserve greater emphasis.

Selective use in complex WON, especially when endoscopic necrosectomy is anticipated, remains appropriate and minimally invasive in experienced centres. 2 3 Protocolised approaches further support improved efficiency when LAMS...