| Endoscopic ultrasonography (EUS)-guided drainage has emerged as the treatment of choice for peripancreatic fluid collections (PFC) which recent innovations such as lumen apposing metal stent (LAMS) have improved results in patients with walled-off necrosis (WON). In the early days of EUS-guided PFC, drainage was performed using plastic stents with double pigtail shape for minimizing migration risk. However, endoscopists have recognized the limitations of plastic stents (PS), which have a small-caliber diameter and require placement of multiple stents to ensure appropriate drainage. Placement of multiple PSs into the PFC is technically difficult and time-consuming, especially when using large-caliber stents. Small-caliber PS may be frequently exposed to stent occlusion, inefficient drainage, secondary infection, and the need for subsequent reinterventions. To overcome the limitations of PS, a fully covered self-expanding metal stent (FCSEMS) was developed, with the theoretical objective of facilitating wider-caliber drainage, which would improve stent patency, prevent secondary infections and the need for reintervention by reducing stent occlusion, and maintain fistula tract for further sessions of direct endoscopic necrosectomy (DEN). Despite the theoretical advantages of FCSEMS over PS, several studies have demonstrated that there was no significant difference in clinical efficacy or adverse events between FCSEMS and PS. More recently, a LAMS with bidirectional anchoring flanges has been demonstrated to be both safe and effective. In addition, it allows DEN of WON after stent deployment by passage of the endoscope through the stent lumen, which may improve efficacy and decrease adverse events associated with EUS-guided PFC drainage. However, superiority of LAMS in terms of clinical efficacy to PS was not identified in recent studies. Therefore, the debate regarding appropriate stent for EUS-guided PFC drainage has again come into the spotlight although the field of dedicated stent for interventional EUS is rapidly advancing and many more innovations are being continuously added. Furthermore, some important questions remain unaddressed such as which stent improves clinical outcomes and safety in EUS-guided PFC drainage. In this lecture, the current status and problems of available stent in the market are reviewed, including technical review and clinical data of previous studies, applicable indication, and long-term clinical outcomes, and their future prospects are discussed. |
