Early Versus Standard Plastic Stent Replacement After Metal Stent Removal to Prevent Recurrence of Pancreatic Fluid Collections This Trial Compares Early (2-week) Versus Standard (4-week) Plastic Stent Replacement After Metal Stent Removal in Walled-off Necrosis to

NCT ID: NCT07307248

Last Updated: 2025-12-29

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

408 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-12-25

Study Completion Date

2028-12-31

Brief Summary

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In adults with walled-off pancreatic necrosis (WON) undergoing endoscopic ultrasound (EUS)-guided transluminal necrosectomy, does early removal of the lumen-apposing metal stent (LAMS) (at 2 weeks or immediately after the last necrosectomy) with placement of a double-pigtail plastic stent (DPT), compared to delayed LAMS removal at 4 weeks without a DPT, result in a lower rate of pancreatic fluid collection (PFC) recurrence or need for reintervention over 12 months.

Detailed Description

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Management of walled-off pancreatic necrosis (WON) following acute pancreatitis has been transformed by the use of endoscopic ultrasound (EUS)-guided transluminal drainage with a lumen-apposing metal stent (LAMS). The LAMS provides a large-caliber conduit for drainage and allows for direct endoscopic necrosectomy, leading to faster resolution of collections and reduced need for surgical intervention. However, the optimal timing for LAMS removal remains uncertain.

Prolonged retention of LAMS has been associated with several adverse events, including delayed bleeding due to vascular erosion, buried-stent syndrome, stent migration, and tissue hyperplasia at the tract site. Conversely, premature removal of the stent may lead to incomplete drainage, persistent or recurrent pancreatic fluid collections (PFCs), and the need for repeat interventions. Therefore, determining the ideal balance between minimizing stent-related complications and preventing recurrence is a key clinical challenge.

Early removal of the LAMS-either 2 weeks after insertion or immediately after the last necrosectomy session-may reduce the risk of delayed bleeding and other metal stent-related complications. However, to maintain tract patency and allow residual drainage, placement of a prophylactic double-pigtail plastic stent (DPT) at the time of LAMS removal has been proposed. The DPT provides a smaller but stable drainage channel that may prevent premature tract closure and recurrence of fluid collections.

This randomized controlled trial aims to rigorously test whether early LAMS removal combined with DPT placement offers better long-term outcomes compared to standard 4-week LAMS removal without DPT. The results are expected to provide evidence-based guidance on optimizing stent management in patients with WON undergoing endoscopic necrosectomy, balancing efficacy with safety.

Conditions

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Acute Pancreatitis Necrotizing Walled-off Pancreatic Necrosis Acute Necrotizing Pancreatitis

Keywords

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Lumen-apposing metal stent Early stent removal Endoscopic drainage Randomized controlled trial WON

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Two-arm parallel randomized controlled trial comparing early (2-week) versus standard (4-week) LAMS removal strategies in patients with walled-off pancreatic necrosis (WON).
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Early Stent Replacement Arm (2-Week LAMS Removal + DPT Placement)

Participants in this arm will undergo early removal of the lumen-apposing metal stent (LAMS) at 2 weeks after initial endoscopic drainage for walled-off pancreatic necrosis (WON). Following LAMS removal, a double-pigtail plastic stent (DPT) will be placed across the transmural tract to maintain drainage and reduce the risk of recurrent pancreatic fluid collection (PFC). Patients will undergo follow-up imaging at 3, 6, and 12 months to assess recurrence, complications, and need for reintervention.

Group Type EXPERIMENTAL

Standard LAMS Removal with Double-Pigtail Plastic Stent

Intervention Type PROCEDURE

In the early stent removal arm, LAMS will be removed at 2 weeks followed by placement of a double-pigtail plastic stent (DPT).

Standard Stent Replacement Arm (4-Week LAMS Removal without DPT)

Participants in this arm will undergo standard removal of the LAMS at 4 weeks after initial endoscopic drainage for walled-off pancreatic necrosis (WON). Patients will be followed at 3, 6, and 12 months to assess recurrence of pancreatic fluid collection (PFC), complications, and reintervention rates.

Group Type ACTIVE_COMPARATOR

Standard LAMS Removal without DPT

Intervention Type PROCEDURE

In the standard arm, LAMS will be removed at 4 weeks.

Interventions

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Standard LAMS Removal with Double-Pigtail Plastic Stent

In the early stent removal arm, LAMS will be removed at 2 weeks followed by placement of a double-pigtail plastic stent (DPT).

Intervention Type PROCEDURE

Standard LAMS Removal without DPT

In the standard arm, LAMS will be removed at 4 weeks.

Intervention Type PROCEDURE

Other Intervention Names

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EARLY

Eligibility Criteria

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Inclusion Criteria

Age ≥ 18 years Patients with walled-off necrosis (WON) undergoing endoscopic drainage with LAMS Resolution of pancreatic fluid collection (PFC) \>70% by 2 weeks on imaging

Exclusion Criteria

Chronic pancreatitis Pancreatic malignancy Incomplete necrosectomy or persistent large necrotic debris at 2 weeks Severe bleeding, infection, or stent migration within the first 2 weeks Failure to consent
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Asian Institute of Gastroenterology, India

OTHER

Sponsor Role lead

Responsible Party

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Mohan Ramchandani

Senior Registrar

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Deepak L Jha, (Medical Gastroenterology)

Role: PRINCIPAL_INVESTIGATOR

Asian Institute of Gastroenterology, Hyderabad

Locations

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Asian Institute of Gastroenterology

Hyderabad, Telangana, India

Site Status

Countries

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India

Central Contacts

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Deepak L JHA, DrNB( medical gastroenterology

Role: CONTACT

Phone: 91-9967807858

Email: [email protected]

Nitin G Jagtap, DNB (Medical Gastroenterology)

Role: CONTACT

Phone: +91-82859523

Email: [email protected]

Facility Contacts

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Deepak L JHA, Medical Gastroenterology

Role: primary

Nitin G Jagtap, Medical Gastroenterology)

Role: backup

References

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Zeng Y, Yang J, Zhang JW. Endoscopic transluminal drainage and necrosectomy for infected necrotizing pancreatitis: Progress and challenges. World J Clin Cases. 2023 Mar 26;11(9):1888-1902. doi: 10.12998/wjcc.v11.i9.1888.

Reference Type RESULT
PMID: 36998953 (View on PubMed)

Other Identifiers

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STEP 1

Identifier Type: -

Identifier Source: org_study_id