Severe bleeding is a rare event in patients receiving lumen-apposing metal stents for the drainage of pancreatic fluid collections.

Pancreatic fluid collections (PFCs) including pancreatic pseudocysts (PPCs) and walled-off necrosis (WON) frequently develop in the context of pancreatitis. Lumen-apposing self-expanding metal stents (LAMS) are increasingly used for the endoscopic management of infected and symptomatic PFCs since they facilitate direct endoscopic inspection and necrosectomy of WONs.1–3 However, two reports recently published in Gut 4 5 demonstrated high rates of haemorrhage associated with LAMS that were observed in up to 25% of patients and often occurred in a delayed manner with serious and fatal bleeding episodes reported. These data raised important concerns about the safety of LAMS and the optimal management of patients with infected or symptomatic PFCs.As a limitation, the reports by Bang et al 4 and Stecher et al 5 were based on relatively small group sizes of 12 and 46 LAMS-treated patients, respectively. To investigate whether the reported safety signals are similarly observed in …