Early reports on the application of Lumen-Apposing Metal Stents (LAMS) guided by EUS for the drainage of peripancreatic fluid collections (PFCs) reported a high number of adverse events (AEs) mainly related to the indwelling time of the stent. The recommendation is to remove LAMS within 3-4 weeks of placement.¹ The aim was to evaluate the AEs rate in patients undergoing PFC drainage with LAMS, focusing on the timing of these events with the date of stent placement.

A total of 1,242 studies were identified in the initial search. After the selection process, 15 studies were included, comprising 674 patients. The databases consulted were: Scopus (n=250), Web of Science (n=286), PubMed (n=243), Embase (n=226), and Cochrane Library (n=83).

1,242 references were identified, of which 15 studies encompassing 674 patients were included. 129 (19.1%; CI 95% 0.17-0.23) AEs were reported, with the timing ascertainable for 123 (95.3%) cases. The most frequently reported AEs were stent obstruction (n=39, 31.7%; CI95%: 0.22-0.37) and bleeding (n=31, 24%; CI95%: 0.15-0.29). 12 (8.8%; CI 95%: 0.06-0.18) AEs occurred during the stent removal. 41 (6%; CI95%:0.04-0.08) AEs were classified as severe. Mortality associated with LAMS was reported in 5 (0.73%; CI95%=0-0.02) cases. Of the total AEs for which the timing of occurrence was documented (n=123), 65 AEs (52.8%; CI 95%= 0.41-0.58) occurred within the first 4 weeks following stent placement. The remaining AEs (n=58, 47.2%; CI95%=0.42-0.59) occurred in patients who retained the stent >4 weeks. No significant differences were observed concerning the type of collection (pseudocyst vs. necrosis).

The observed AEs rate is noteworthy; however, most reported AEs (94%) were mild. This study did not find a correlation between the duration of stent indwelling and the development or severity of complications.