Endoscopic necrosectomy of infected pancreatic Walled-Off Necrosis using two types of Lumen-Apposing Metal Stents

Background Lumen-apposing metal stent (LAMS) placement enables transmural drainage of walled-off necrosis (WON) with secure anchoring and provides endoscopic access for subsequent necrosectomy. This study compared the efficacy and safety of two commercially available LAMS designs (Hot-Axios vs. Micro-Tech) in patients with infected WON. Methods We retrospectively reviewed patients with infected WON who underwent endoscopic ultrasound (EUS)-guided LAMS placement followed by endoscopic debridement at our center between August 2020 and June 2025. Results Thirty-one patients were included (Hot-Axios, n = 21; Micro-Tech, n = 10). The overall necrosectomy success rate was 80.65% (25/31). Necrosectomy success was numerically higher with Hot-Axios than with Micro-Tech (85.71% vs. 70.00%), but the difference was not statistically significant (p = 0.358). There was a statistically significant difference in the incidence of complications between the two groups (P = 0.007); bleeding occurred more frequently in the Hot-Axios group (33.33% vs. 0%), whereas stent migration was more common in the Micro-Tech group (0% vs. 20.00%). Conclusions In conclusion, endoscopic necrosectomy for infected WON using LAMS is feasible and effective. Hot-Axios may provide more secure fixation and better resistance to migration; however, it may carry a higher risk of bleeding.