Optimal timing for LAMS removal after EUS-guided drainage of PFC

The optimal timing for lumen-apposing metal stent (LAMS) removal after EUS-guided drainage of pancreatic fluid collections (PFCs) does not necessarily depend on a fixed timeline, such as early removal within 3–4 weeks. A systematic review and meta-analysis of 8 studies involving 1820 patients found no significant difference in adverse events (AEs) between early and late stent removal. The pooled risk ratio for AEs was 1.03, indicating comparable safety outcomes regardless of removal timing. Additionally, a sensitivity analysis using a strict 4-week cut-off confirmed these findings.

Prolonged stent placement has been associated with complications like bleeding, buried stents, and infection, but early removal does not appear to reduce these risks. The study suggests that removal timing should be guided by clinical judgment rather than a universal early-removal policy. Factors such as patient stability, imaging findings, and individual circumstances should dictate the decision, supporting a case-by-case approach rather than adhering to a rigid timeline.