SELF-EXPANDING METALLIC PROSTHESES WITH LUMEN IN THE APPROACH TO PANCREATIC COLLECTIONS: A NEW ERA IN INTERVENTIONAL ENDOSCOPY

Abstract

Introduction: Walled-off pancreatic necrosis represents one of the most severe late complications of acute necrotizing pancreatitis, associated with significant morbidity and mortality. Advances in interventional endoscopy, particularly the development of lumen-apposing metal stents (LAMS), have profoundly changed therapeutic strategies, reducing the need for invasive surgery and redefining multidisciplinary care, with a pivotal role for specialized nursing. Objectives: To critically analyze the current management of walled-off pancreatic necrosis, emphasizing the role of LAMS as a first-line therapeutic option, and to highlight the clinical and safety impact of specialized nursing care throughout the endoscopic intervention. Methods: A narrative review of the scientific literature published between 2010 and 2024, including prospective multicenter studies, meta-analyses, and international guidelines, namely ASGE and ESGE. The search was conducted in the PubMed, Scopus, and Cochrane Library databases, using the terms: “walled-off pancreatic necrosis”, “lumen-apposing metal stent”, “endoscopic necrosectomy”, and “nursing care”. Studies in English and Portuguese focusing on clinical outcomes, safety, and multidisciplinary approach were included. Results: The use of LAMS shows high technical success and clinical resolution rates, with reduced morbidity and fewer interventions compared to traditional approaches. The ability to perform direct transluminal endoscopic necrosectomy constitutes a major therapeutic advantage. Clinical outcomes are closely linked to structured protocols and advanced nursing expertise in patient preparation, intra-procedural monitoring, and post-procedural surveillance. Conclusion: Lumen-apposing metal stents represent a paradigm shift in the minimally invasive treatment of walled-off pancreatic necrosis. Their effectiveness relies not only on technological innovation but also on the integration of evidence-based, highly specialized nursing care, which is essential to achieving optimal and safe clinical outcomes.