Double-pigtail Plastic Stents Research Articles

EUS-guided drainage of peripancreatic fluid collections with lumen-apposing metal stents and plastic double-pigtail stents: comparison of efficacy and adverse event rates

Transmural drainage with double-pigtail plastic stents (DPPSs) was the mainstay of endoscopic therapy for symptomatic peripancreatic fluid collections (PPFCs) until the introduction of lumen-apposing covered self-expanding metal stents (LAMSs). Currently, there are limited data regarding the efficacy and adverse event rate of LAMSs compared with DPPSs. A retrospective analysis of EUS-guided PPFC drainage at a single tertiary care center between 2008 and 2015 was performed. Patients were classified based on drainage method: DPPSs and LAMSs. Adverse event rates, unplanned endoscopic procedures/necrosectomies, and PPFC resolution within 6 months were recorded. Significant bleeding was defined as necessitating transfusion or requiring endoscopic treatment/radiographic embolization. Subsequent endoscopic procedures were defined as unplanned procedures; stent removals were excluded. A total of 103 patients met inclusion criteria (84 DPPSs, 19 LAMSs). PPFCs were classified as walled-off necrosis (WON) in 23 (14 DPPSs, 9 LAMSs). There were significantly more bleeding episodes in the LAMS group (4 [19%]: 2 splenic artery pseudo-aneurysms, 1 collateral vessel bleed, 1 intracavitary variceal bleed; P= .0003) than in the DPPS group (1 (1%]: stent erosion into the gastric wall). One perforation occurred in the DPPS group.Unplanned repeat endoscopy was more frequent in the LAMS group (10% vs 26%, P= .07). Among retreated LAMS patients in with WON, 5 (56%) had obstruction by necrotic debris. In patients for whom follow-up was available, 67 of 70 (96%) with DPPSs and 16 of 17 (94%) with LAMSs had resolution of PPFCs within 6 months (P= .78). DPPSs and LAMSs are effective methods for treatment of PPFCs. In our cohort, use of LAMSs was associated with significantly higher rates of procedure-related bleeding and greater need for repeat endoscopic intervention.

Large-caliber metal stents versus plastic stents for the management of pancreatic walled-off necrosis

Symptomatic pancreatic walled-off necrosis (WON) may be managed by endoscopic transmural drainage and endoscopic transmural necrosectomy, with stent placement at endoscopic drainage sites. The optimal stent choice is yet to be determined. We compared outcomes after endoscopic management of WON using either large-caliber fully covered self-expandable metal stents (LC-SEMSs) or double-pigtail plastic stents (DPPSs). We performed a retrospective comparison of outcomes among patients who received LC-SEMSs or DPPSs before endoscopic transmural necrosectomy for WON. Among 94 patients included, WON resolution rates did not differ between the DPPS (36 patients) and LC-SEMS (58 patients) groups, whether concomitant percutaneous drainage was considered a failure (75% vs 82.8%; P= .36) or not (91.7% vs 94.8%; P= .55). Of 75 patients (80%) successfully treated without percutaneous drainage, 37 (49%) underwent endoscopic transmural drainage without subsequent endoscopic transmural necrosectomy. WON was more likely to resolve without subsequent endoscopic transmural necrosectomy in the LC-SEMS group than the DPPS group (60.4% vs 30.8%; P= .01). WON resolution without subsequent endoscopic transmural necrosectomy remained more likely with LC-SEMSs (odds ratio, 4.5 [95% confidence interval, 1.5-15.5]) after adjusting for patient age and size and location of WON. Rates of adverse events were similar except for clinically significant bleeding requiring endoscopic intervention, which was higher with DPPSs than LC-SEMSs (14% vs 2%; P= .02). Management of pancreatic WON with LC-SEMSs appears to decrease both the need for repeated necrosectomy procedures and the risk of intervention-related hemorrhage.

628 Lumen Apposing Metal Stents Compared With Double Pigtail Plastic Stents in the Management of Pancreatic Pseudocysts and Walled-Off Necrosis: A 5 Year Single Center Study

628 Lumen Apposing Metal Stents Compared With Double Pigtail Plastic Stents in the Management of Pancreatic Pseudocysts and Walled-Off Necrosis: A 5 Year Single Center Study

Su1302 A Multicenter Comparative Trial of Double Pigtail Plastic Stents and Lumen-Apposing Metal Stents for Endoscopic Drainage of Postoperative Peripancreatic Fluid Collections After Partial Pancreatic Resection: Evaluation of Clinical Outcomes and Predictors of Success

Su1302 A Multicenter Comparative Trial of Double Pigtail Plastic Stents and Lumen-Apposing Metal Stents for Endoscopic Drainage of Postoperative Peripancreatic Fluid Collections After Partial Pancreatic Resection: Evaluation of Clinical Outcomes and Predictors of Success

Mo1231 Double Pigtail Plastic Stents Versus Lumen-Apposing Fully Covered Self-Expanding Metal Stent for Endoscopic Drainage and Debridement of Pancreatic Walled-Off Necrosis: Does the Type of Stent Make a Difference in Outcomes If Endoscopic Necrosectomy Is Performed?

Mo1231 Double Pigtail Plastic Stents Versus Lumen-Apposing Fully Covered Self-Expanding Metal Stent for Endoscopic Drainage and Debridement of Pancreatic Walled-Off Necrosis: Does the Type of Stent Make a Difference in Outcomes If Endoscopic Necrosectomy Is Performed?

53 A Multicenter Comparative Analysis of Double Pigtail Plastic Stents and Lumen-Apposing Metal Stents for Endoscopic Drainage of Pancreatic Walled-Off Necrosis in the Pediatric Population: Evaluation of Clinical Outcomes and Success

53 A Multicenter Comparative Analysis of Double Pigtail Plastic Stents and Lumen-Apposing Metal Stents for Endoscopic Drainage of Pancreatic Walled-Off Necrosis in the Pediatric Population: Evaluation of Clinical Outcomes and Success

Endoscopic Ultrasound-Guided Perirectal Abscess Drainage without Drainage Catheter: A Case Series.

A perirectal abscess is a relatively common disease entity that occurs as a postsurgical complication or as a result of various medical conditions. Endoscopic ultrasound (EUS)-guided drainage was recently described as a promising alternative treatment. Previous reports have recommended placement of a drainage catheter through the anus for irrigation, which is inconvenient to the patient and carries a risk of accidental dislodgement. We report four cases of perirectal abscess that were successfully treated with only one or two 7 F double pigtail plastic stent placements and without a drainage catheter for irrigation.

The Stent Patency and Migration Rate of Different Shaped Plastic Stents in Bile Flow Phantom Model and In Vivo Animal Bile Duct Dilation Model.

In research and development of biliary plastic stents (PS), continuous efforts have been made to overcome short patency time and high rate of migration. The aim of this study was to evaluate the patency and migration rate of different PS shapes for a given period of time. Using an in vitro bile phantom model, we compared the patency among different shapes of PS (three straight PS, four double-pigtail PS, and a new screw-shaped PS). We performed an analysis of the degree of luminal narrowing by light microscopic examination. Using an in vivo swine model, we compared the patency and migration rate among the three different types of PS. Eight weeks after the bile exposure in the bile flow phantom model, 80 PS were retrieved and analyzed. The straight PS showed less biofilm formation and luminal narrowing than other types of PS (p<0.05). Forty-nine PS were inserted into the dilated bile ducts of 10 swine models, and 39 PS were successfully retrieved 8weeks later. The stent migration occurred less frequently in the double-pigtail PS and the screw-shaped PS than it did in the straight PS (11.1, 10, and 27.3%, respectively). However, there was no statistical difference in stent patency among the different shapes. Stent patency may not be significantly different depending on the shape of PS for 8weeks. The screw-shaped PS showed similar patency and migration rate to the double-pigtail PS. These results may help guiding future PS development and clinical decisions.

Endoscopic ultrasonography‐guided drainage of pancreatic fluid collections

Endoscopic ultrasound (EUS)-guided drainage is now firmly established as the best option for drainage of walled-off pancreatic fluid collections (PFC). It has high clinical efficacy, similar to surgical and percutaneous approaches, but with lower morbidity and costs. It is superior to non-EUS-guided approaches because even collections without endoluminal bulging can be successfully drained. Transmural drainage alone is sufficient for pseudocysts, but in the context of walled-off pancreatic necrosis (WON), adjunctive direct endoscopic necrosectomy (DEN) may be required. Traditionally, double pigtail plastic stents (PS) were used for transmural drainage, but, recently, fully covered self-expandable metallic stents (FCSEMS) customized for PFC drainage have become available and are increasingly used, especially in the management of WON, because the larger-diameter stent facilitates drainage and insertion of an endoscope into the WON cavity for DEN. The present review will discuss the evidence for EUS-guided drainage and DEN, the technical problems involved, and the roles of PS and FCSEMS in PFC drainage.

Endoscopic ultrasound-guided hepaticogastrostomy: Problems and solutions; some unsuccessful and then the right one!

A 36-year-old male presented with obstructive jaundice and acute pancreatitis. Both imaging and an upper gastrointestinal endoscopy revealed malignant duodenal obstruction involving first and second parts. The patient was managed conservatively for acute pancreatitis. Endoscopic retrograde cholangiopancreatography was not possible in view of duodenal pathology. Endoscopic ultrasound (EUS)-guided hepaticogastrostomy was planned. Walled-off pancreatic necrosis as well as ascites was noted on EUS. Hepatic duct access was gained; a guidewire placement with track dilation using 6 Fr cystotome (Endoflex) was performed. A Giobor stent (Taewoong Medical, 8 mm × 10 cm long) was placed between the liver and stomach; immediate migration of the stent was noted resulting in to the impaction of the proximal end in to the gastric wall. Retrieval attempts made over the in-stent placement of a 7 Fr. Double pigtail plastic stent was unsuccessful. Plastic stent was removed after stent intubation carried out over a guidewire placed through the side hole. Retrieval using a Hurricane balloon (8 mm, Boston Scientific) was also unsuccessful. Eventually, successful biliary drainage was performed using both bare (10 mm × 60 mm, Taewoong Medical) biliary metal stent placement through the Giobor stent. An enteral stent (WallFlex Duodenal, Boston Scientific) was placed for the duodenal obstruction.

Feasibility of conversion of percutaneous cholecystostomy to internal transmural endoscopic ultrasound-guided gallbladder drainage.

Background/Aim:Percutaneous cholecystostomy [percutaneous transhepatic gallbladder drainage (PTGBD)] is the treatment of choice in surgically unfit patients with acute cholecystitis. However, PTGBD tube removal after symptoms resolution results in 41–46% recurrence. This study aims to demonstrate the feasibility of the conversion of PTGBD to transmural endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using plastic stents in patients unfit for cholecystectomy.Patients and Methods:Patients who underwent internal transmural EUS-GBD as a conversion from PTGBD were reviewed. EUS-GBD was performed after the improvement of cholecystitis due to recurrent cholecystitis and PTGBD intolerance. One or two 7-Fr double pigtail plastic stent insertion with or without temporary endoscopic naso-gallbladder drainage (ENGBD) insertion was performed.Results:Six patients (age 61–88), with three cases of acute cholecystitis after metallic biliary stenting and three cases of calculus cholecystitis, who underwent PTGBD were included. EUS-GBD was performed 10–63 days after PTGBD, using one plastic stent in five cases, two stents in one case, with temporary ENGBD in two cases. The technical success and clinical success were achieved and the PTGBD tubes were subsequently removed in all patients. All ENGBD tubes were removed within 5 days after insertion. Bile leak with peritonitis was demonstrated in one case, which was treated conservatively. No recurrent cholecystitis was seen during 3–26 months of follow-up.Conclusion:The conversion of percutaneous cholecystostomy to internal transmural EUS-GBD with plastic stents is feasible for patients unfit for cholecystectomy. However, more studies are still needed to confirm the results.

Case Report: Endoscopic Management of Sleeve Gastrectomy Fistula

Abstract Background. Morbid obesity is an important cause of morbidity and mortality. Bariatric surgery is the best option to manage obesity. Vertical gastrectomy is safe and effective but sometimes complicate with hemorrhage, fistulas and stenosis. Fistulas can be solved by conventional surgery or interventional endoscopy. Case presentation. We describe a morbidly obese patient with vertical gastrectomy who developed complications after surgery. Immediately after surgery the patient developed sepsis. Upper gastrointestinal endoscopy excluded fistula. One month later a peri-gastric abscess developed due to a fistula orifice in the distal esophagus, treated with argon plasma and two double pigtail plastic stents placed endoscopically to drain the abscess. The stents were removed two weeks later and was placed a covered metallic stent in the distal esophagus. Six weeks later the metallic stent was removed and the orifice closed. Four months later the patient developed sepsis. Computer tomography revealed a subdiaphragmatic abscess and endoscopy revealed a 2 mm fistula orifice at the previous site, treated with argon plasma and two trough-the-scope clips that closed it. There were no further incidents after two years of follow-up. Conclusions. Early diagnosis and endoscopic approach can resolve these complications without the morbidity and increased mortality risk of surgical re-interventions.

Conversion of Percutaneous Cholecystostomy to Endoscopic Gallbladder Stenting by Using the Rendezvous Technique.

We report the successful conversion of percutaneous cholecystostomy (PC) to endoscopic transpapillary gallbladder stenting (ETGS) with insertion of an antegrade guidewire into the duodenum. An 84-year-old man presented with severe acute cholecystitis and septic shock. He had significant comorbidities, and emergent PC was successfully performed. Subsequent ETGS was attempted but unsuccessful owing to difficulties with cystic duct cannulation. However, via the PC tract, the guidewire was passed antegradely into the duodenum, and ETGS with a double-pigtail plastic stent was successfully performed with the rendezvous technique. The PC tube was removed, and no recurrence was reported during the 17-month follow-up period. Conversion of PC to ETGS is a viable option in patients with acute cholecystitis who are not candidates for surgery. Antegrade guidewire insertion via the PC tract may increase the success rate of conversion and decrease the risk of procedure-related complications.

EUS-Guided Cyst-Enterostomy Using a Self-Expanding Metal Stent Is a More Cost-Effective Strategy for the Treatment of Pancreatic Fluid Collections

Introduction: EUS-guided cyst-enterostomy (EUS-CE) has become the mainstay for endoscopic treatment of symptomatic pancreatic fluid collections (PFCs). The traditional approach (Approach I) of inserting multiple double-pigtail plastic stents with sequential dilation of the tract with or without nasocystic irrigation is successful but requires repeated endoscopic intervention. The comparative effectiveness of newer approaches utilizing a fully covered expandable metal stent (FCEMS, Approach II) is not understood very well.Our aim is to compare the clinical efficacy and cost impact of these approaches in the management of PFCs. Methods: We include all patients that underwent EUS-CE for PFCs. Clinical efficacy was defined as symptomatic improvement and cyst resolution on cross-sectional imaging. Follow-up was until stent removal. The total cost was calculated for each EUS-CE (including anesthesia and radiology costs), all subsequent procedures and hospital length of stay (HLOS). Results: Between 11/2010 and 03/2016, 12 patients underwent Approach I and 16 patients underwent Approach II. Patients in Approach I had a mean of 3.9 endoscopic interventions (range 1-8), mean procedure time of 72 min (range 43-130 min) and 11.4 days of HLOS (range 0-33 days) compared with 1 endoscopic intervention, mean procedure time of 39 min (range 16-65 min) and 2.2 days HLOS (range 0-7 days) in Approach II (p=0.001, p=0.01 and p=0.02, respectively). Cyst resolution was documented in 12/12 patients with a mean follow-up of 284 days in Approach I (range 86-628 days) and 15/16 patients with a mean follow-up of 98 days in Approach II (range 1-239 days). There were 6 adverse events in Approach I compared with 2 in Approach II (p=0.03). The average cost of Approach I was $17,590 compared with $6,165 for Approach II (p=0.01). Conclusion: Despite the increased upfront cost of a metal stent, the use of a FCEMS for EUS-CE in the treatment of PFCs is effective, safe and results in significant overall cost savings by reducing the number of endoscopic re-interventions and HLOS.

Endoscopic Treatment of Walled-off Necrosis in Children: Clinical Experience and Treatment Outcomes.

Data on the endoscopic treatment outcomes for walled-off necrosis (WON) in children are limited. The aim of the present study was to evaluate the efficacy and safety of endoscopic approach for the treatment of WON in children. A retrospective study was conducted of all children with symptomatic WON treated endoscopically over 6 years. Treatment consisted of endoscopic ultrasound-guided transmural drainage using either a lumen-apposing metal stent or multiple 7Fr double pigtail plastic stents with or without percutaneous drainage. Main outcome measures were technical success, treatment success, recurrence, reinterventions, and adverse events. Six children (5 girls, median age 12 years) underwent endoscopic ultrasound-guided WON drainage by creation of a single transmural tract in 5 patients and multiple transmural tracts in 1. Stents placed were plastic in 5 patients and lumen-apposing metal stent in 1. One patient underwent concomitant percutaneous drainage. Treatment success was achieved in all of the 6 patients (100%) following a single intervention in 4 patients and 2 interventions in 2. No procedure-related adverse events were encountered. At 8-week follow-up, the transmural stents were retrieved in all but 1 patient who had a disconnected pancreatic duct. At a median follow-up of 781 days (interquartile range 336-869 days), no WON or symptom recurrence was encountered in any patient. Endoscopic treatment is effective, safe, and when available should be the first-line modality for the management of WON in children.

Fully covered self-expanding metal stents versus lumen-apposing fully covered self-expanding metal stent versus plastic stents for endoscopic drainage of pancreatic walled-off necrosis: clinical outcomes and success

Endoscopic transmural drainage/debridement of pancreatic walled-off necrosis (WON) has been performed using double-pigtail plastic (DP), fully covered self-expanding metal stents (FCSEMSs), or the novel lumen-apposing fully covered self-expanding metal stent (LAMS). Our aim was to perform a retrospective cohort study to compare the clinical outcomes and adverse events of EUS-guided drainage/debridement of WON with DP stents, FCSEMSs, and LAMSs. Consecutive patients in 2 centers with WON managed by EUS-guided debridement were divided into 3 groups: (1) those who underwent debridement using DP stents, (2) debridement using FCSEMSs, (3) debridement using LAMSs. Technical success (ability to access and drain a WON by placement of transmural stents), early adverse events, number of procedures performed per patient to achieve WON resolution, and long-term success (complete resolution of the WON without need for further reintervention at 6 months after treatment) were evaluated. From 2010 to 2015, 313 patients (23.3% female; mean age, 53 years) underwent WON debridement, including 106 who were drained using DP stents, 121 using FCSEMSs, and 86 using LAMSs. The 3 groups were matched for age, cause of the pancreatitis, WON size, and location. The cause of the patients' pancreatitis was gallstones (40.6%), alcohol (30.7%), idiopathic (13.1%), and other causes (15.6%). The mean cyst size was 102mm (range, 20-510mm). The mean number of endoscopy sessions was 2.5 (range, 1-13). The technical success rate of stent placement was 99%. Early adverse events were noted in 27 of 313 (8.6%) patients (perforation in 6, bleeding in 8, suprainfection in 9, other in 7). Successful endoscopic therapy was noted in 277 of 313 (89.6%) patients. When comparing the 3 groups, there was no difference in the technical success (P= .37). Early adverse events were significantly lower in the FCSEMS group compared with the DP and LAMS groups (1.6%, 7.5%, and 9.3%; P< .01). At 6-month follow-up, the rate of complete resolution of WON was lower with DP stents compared with FCSEMSs and LAMSs (81% vs 95% vs 90%; P= .001). The mean number of procedures required for WON resolution was significantly lower in the LAMS group compared with the FCSEMS and DP groups (2.2 vs 3 vs 3.6, respectively; P= .04). On multivariable analysis, DP stents remain the sole negative predictor for successful resolution of WON (odds ratio [OR], 0.18; 95% confidence interval, 0.06-0.53; P= .002) after adjusting for age, sex, and WON size. Although there was no significant difference between FCSEMSs and LAMSs for WON resolution, the LAMS was more likely to have early adverse events (OR, 6.6; P= .02). EUS-guided drainage/debridement of WON using FCSEMSs and LAMSs is superior to DP stents in terms of overall treatment efficacy. The number of procedures required for WON resolution was significantly lower with LAMSs compared with FCSEMSs and DP stents.

A fully covered self-expandable metal stent anchored by a 10-Fr double pigtail plastic stent: an effective anti-migration technique.

BackgroundFully covered self-expandable metal stents (FCSEMS) have been used successfully in the treatment of malignant and benign biliary strictures. However, stent migration is a major complication. We investigated the efficacy of anchoring FCSEMS with a 10-Fr double-pigtail plastic stent to prevent migration in patients with biliary strictures.MethodsBetween January 2012 and May 2013, 10 patients with malignant biliary strictures and one patient with a suprapapillary benign biliary stenosis were enrolled in the study. The primary endpoint of the study was to record the migration rate of FCSEMS.ResultsThe placement of FCSEMSs and the anchoring with a 10-Fr double-pigtail plastic stent were successful in all patients. During a median follow-up period of eight months, proximal or distal migration of FCSEMS was not observed. No procedural complications related to the placement of FCSEMS and/or the anchoring plastic stent were recorded.ConclusionsThe placement of an anchoring 10-Fr double-pigtail stent is a simple and effective anti-migration technique for FCSEMS in patients with malignant biliary strictures.

A two-center comparative study of plastic and lumen-apposing large diameter self-expandable metallic stents in endoscopic ultrasound-guided drainage of pancreatic fluid collections.

Background and Objectives:Endoscopic ultrasound-guided drainage of walled-off pancreatic fluid collections (PFCs) (pseudocyst [PC]; walled-off necrosis [WON]) utilizes double pigtail plastic stents (PS) and the newer large diameter fully covered self-expandable stents (FCSEMS) customized for PFC drainage. This study examined the impact of type of stent on clinical outcomes and costs.Patients and Methods:Retrospective two-center study. Outcome variables were technical and clinical success, need for repeat procedures, need for direct endoscopic necrosectomy (DEN), and procedure-related costs.Results:A total of 49 (PC: 31, WON: 18) patients were analyzed. Initially, PS was used in 37 and FCSEMS in 12. Repeat transmural drainage was required in 14 (PS: 13 [9 treated with PS, 4 treated with FCSEMS]; FCSEMS: 1 [treated with PS]) due to stent migration (PS: 3; FCSEMS: 1) or inadequate drainage (PS: 10). Technical success was 100%. Initial clinical success was 64.9% (25/38) for PS versus 91.7% (11/12) for FCSEMS (P = 0.074). With repeat transmural stenting, final clinical success was achieved in 94.6% and 100%, respectively (P = 0.411). Compared to FCSEMS, PS was associated with greater need for repeat drainage (34.2% vs. 6.3%, P = 0.032). The need for and frequency of DEN was similar between both groups, but PS required more frequent balloon dilatation. PS was significantly cheaper for noninfected PC. Costs were similar for infected PC and WON.Conclusion:PS was associated with a higher need for a second drainage procedure to achieve clinical success. The use of FCSEMS did not increase procedural costs for infected PC and WON.

Metal versus plastic for pancreatic pseudocyst drainage: clinical outcomes and success

Endoscopic transmural drainage of pancreatic pseudocysts (PPs) by using double-pigtail (DP) plastic stents requires placement of multiple stents and can be restricted by inadequate drainage and leakage risk. Recently, the use of fully covered self-expanding metal stents (FCSEMSs) has been reported as an alternative to DP plastic stents. To evaluate the clinical outcomes, success rate, and adverse events of EUS-guided drainage of PPs with DP plastic stents and FCSEMSs. Retrospective cohort study. Two tertiary-care academic medical centers. This study involved 230 patients (mean age, 52.6 years) with PPs who underwent EUS-guided transmural drainage including 118 that were drained by using DP plastic stents and 112 by using FCSEMSs. A transgastric approach was used in 210 patients (91%), and transduodenal drainage was performed in 20 patients (9%). Stent deployment under EUS guidance. Technical success, early adverse events, stent occlusion requiring reintervention, and long-term success. At 12-month follow-up after the initial procedure, complete resolution of PPs by using DP plastic stents was lower compared with those that underwent drainage with FCSEMSs (89% vs 98%; P= .01). Procedural adverse events were noted in 31% in the DP plastic stent group and 16% in the FCSEMS group (P= .006). On multivariable analysis, patients with plastic stents were 2.9 times more likely to experience adverse events (odds ratio 2.9; 95% confidence interval, 1.4-6.3). Retrospective study. In patients with PPs, EUS-guided drainage by using FCSEMSs improves clinical outcomes and lowers adverse event rates compared with those drained with DP plastic stents.

707 Endoscopic Necrosectomy Using Large Diameter Self-Expandable Metal Stents Is Superior to Necrosectomy With Plastic Stents

Endoscopic management of symptomatic walled-off pancreatic necrosis (WON) is challenging with associated morbidity. Through-the-scope large caliber fully covered self-expandable metal stents (LC-SEMS) are now available. LC-SEMS may permit spontaneous passage of necrotic material into the stomach, decreasing the need for repeated endoscopic interventions. We aimed to compare outcomes of endoscopic management of WON using LC-SEMS compared to double pigtail plastic stents (dp-plastic) in a large series.