LAUSR

The advent of lumen-apposing metal stents (LAMSs) as a tool in endoscopic ultrasound (EUS) has had what can only be called a transformative effect on EUS‐guided drainage of pancreatic fluid collections (PFCs) including pseudocysts and, more importantly, walled‐off pancreatic necrosis.[1-6] These procedures are being performed at more centers and in much greater numbers than ever before. Older techniques using either double pigtail plastic stents or fully covered metal biliary stents (FCSEMSs)[7-9] are largely being phased out given the speed and ease with which LAMS can be placed in patients with PFCs despite the fact that these other devices are also safe and effective. Endoscopic necrosectomy is rapidly replacing surgical necrosectomy in the vast majority of patients as it is minimally invasive, does not require an abdominal incision, and allows debridement and clearance of very large amounts of necrotic tissue. Necrosectomy can be performed in poor operative candidates, patients with ascites, and patients with infected pancreatic necrosis.