Background. The lumen-apposing metal stent (LAMS) has been increasingly used for EUS-guided drainage of symptomatic walled-off pancreatic fluid collection (WOPFC) in recent years. Nevertheless, some WOPFCs may require additional drainage methods including another LAMS as a result of complexity of the lesions. This current study aimed to compare clinical parameters of patients with complex WOPFC requiring LAMS with additional methods (complex WOPFC: group A) versus single LAMS alone (noncomplex WOPFC; group B). Method. Medical records of patients with complex (group A) versus noncomplex WOPFCs (group B) were reviewed and compared in three centers in Thailand and Malaysia, between January 2016 to December 2020. Result. 31 patients with WOPFCs were recruited. 6 of 31 (19%) patients were in group A. Multivariate analysis showed that the maximal diameter of WOPFCs in group A was significantly larger than that of group B (18 ± 6 versus 13 ± 3 cm in diameter, respectively,  = 0.021). Solid component proportion was higher in group A versus B (35.8% versus 17.8%, respectively,  = 0.025). The prevalence of pancreatic duct leakage was significantly higher in group A (67% versus 20%,  = 0.23). The need of direct endoscopic necrosectomy (DEN) and the number of DEN sessions were higher in group A versus B (100% vs. 48%,  = 0.020 and 3.5 vs 0  = 0.031, respectively). Conclusions. Complex WOPFC had larger diameter of lesions, higher proportion of solid component, higher prevalence of pancreatic duct leakage, and higher number of DEN is required than group noncomplex lesions. Trial Registration. This trial is registered with TCTR20180223004.

中文翻译：

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LAMS 时代复杂围墙胰液集合的引流：一项多中心研究

背景。近年来，管腔并置金属支架 (LAMS) 越来越多地用于 EUS 引导的症状性胰壁积液 (WOPFC) 引流。然而，由于病变的复杂性，一些 WOPFC 可能需要额外的引流方法，包括另一种 LAMS。本研究旨在比较复杂 WOPFC 患者（复杂 WOPFC：A 组）与单独 LAMS（非复杂 WOPFC；B 组）患者的临床参数的临床参数。方法。2016 年 1 月至 2020 年 12 月期间，在泰国和马来西亚的三个中心对复杂（A 组）与非复杂 WOPFC（B 组）患者的病历进行了审查和比较。结果. 招募了 31 名 WOPFC 患者。31 名患者中有 6 名 (19%) 在 A 组。多变量分析显示，A 组 WOPFC 的最大直径明显大于 B 组（直径分别为 18 ± 6 和 13 ± 3 cm， = 0.021） . A 组的固体成分比例高于 B 组（分别为 35.8% 和 17.8%  = 0.025）。A 组胰管渗漏的发生率明显更高（67% 对 20%， = 0.23）。A 组与 B 组相比，直接内窥镜坏死切除术 (DEN) 的需要和 DEN 疗程的数量更高（分别为 100% 对 48%， = 0.020 和 3.5 对 0  = 0.031）。结论. 复杂 WOPFC 的病灶直径更大，实性成分比例更高，胰管渗漏发生率更高，并且与非复杂病灶组相比需要更多的 DEN。试用注册。该试验已注册 TCTR20180223004。