# Comparing EUS-guided lumen-apposing metal stents with and without integrated electrocautery for endoscopic drainage of walled-off pancreatic necrosis

## TL;DR

This study compares two types of metal stents for draining pancreatic necrosis, finding that one type is faster and requires less sedation.

## Contribution

The study introduces evidence that EC-LAMSs offer faster and less demanding endoscopic drainage procedures for WOPN.

## Key findings

- EC-LAMS procedures were significantly faster than conventional LAMS procedures.
- EC-LAMS allowed for use of intravenous sedation and day-case procedures in selected patients.
- There was no difference in adverse events or clinical outcomes between the two stent types.

## Abstract

EUS-guided drainage using lumen-apposing metal stents (LAMSs) has become standard treatment of symptomatic walled-off pancreatic necrosis (WOPN). Delivery systems with integrated electrocautery (EC) enable direct access and stent deployment, whereas the conventional stent insertion requires several steps including access using a needle or cystotome, wire insertion, and enlargement of the created tract before the stent placement. This study aimed to compare the practicality of EUS-guided procedures and their outcomes between conventional LAMSs (cLAMSs) and integrated EC (EC-LAMSs).

In consecutive patients undergoing EUS-guided LAMS insertion with or without integrated EC, data on procedure time, sedation, and technical and clinical success, as well as adverse events, were analyzed.

From our prospectively maintained database, we analyzed 107 consecutive procedures of transmural EUS-stenting for drainage of WOPN. Thirty-nine cLAMSs and 68 EC-LAMSs were placed. Mean WOPN size was 12.9 ± 4.2 cm with mean 30% ± 15% solid necrosis.

Procedure times were shorter with EC-LAMSs (18.0 ± 6.6 vs. 39.7 ± 8.3 minutes; P < 0.05). All EUS-guided procedures with cLAMS drainage were performed under propofol sedation administered by anesthetist. In the EC-LAMS group, 36 patients tolerated the procedure under intravenous sedation (fentanyl/midazolam), and 17 interventions were performed as day case procedures. Adverse events and clinical outcome did not differ between both groups.

Compared with cLAMS, EC-LAMS deployment is faster and technically less demanding. This allows performing the procedure under conventional intravenous sedation and as day case procedure in selected patients.