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Background: Lumen-apposing metal stents (LAMS) have displaced double-pigtail plastic stents (DPS) as the standard treatment for walled-off necrosis (WON),β but evidence for exclusively using LAMS is limited. We aimed to assess whether the theoretical benefit of LAMS was superior to DPS. Methods: This multicenter, open-label, randomized trial was carried out in 9 tertiary hospitals. Between June 2017, and Oct 2020, we screened 99 patients with symptomatic WON, of whom 64 were enrolled and randomly assigned to the DPS group (n= 31) or the LAMS group (n= 33). The primary outcome was short-term (4-weeks) clinical success determined by the reduction of collection. Secondary endpoints included long-term clinical success, hospitalization, procedure duration, recurrence, safety, and costs. Analyses were by intention-to-treat. ClinicalTrials.gov, NCT03100578. Results: A similar clinical success rate in the short term (RR, 1.41; 95% CI 0.88–2.25; p= 0.218) and in the long term (RR, 1.2; 95% CI 0.92–1.58; p= 0.291) was observed between both groups. Procedure duration was significantly shorter in the LAMS group (35 vs. 45-min, p= 0.003). The hospital admission after the index procedure (median difference, − 10 [95% CI − 17.5, − 1]; p= 0.077) and global hospitalization (median difference − 4 [95% CI − 33, 25.51]; p= 0.82) were similar between both groups. Reported stent-related adverse events were similar for the two groups (36 vs.45% in LAMS vs. DPS), except for de novo fever, which was significantly 26% lower in LAMS (RR, 0.26 [0.08–0.83], p= 0.015). Conclusions: The clinical superiority of LAMS over DPS for WON therapy was not proved, with similar clinical success, hospital stay and similar safety profile between both groups, yet a significant reduction in procedure time was observed. Trial registration number: ClinicalTrials.gov, NCT03100578. Graphical abstract:

Borderline Resectable Pancreatic Ductal Adenocarcinoma (BR-PDAC) benefits from neoadjuvant treatment (NAT) with the intent of surgical salvage in the absence of disease progression during chemotherapy (CT) or chemoradiotherapy (CRT). Scarce literature exists about prognostic factors of resectability at the time of diagnosis or during neoadjuvant treatment, especially regarding vascular relationships.

La disponibilidad de nuevas técnicas de imagen ha condicionado un incremento en el diagnóstico incidental de pequeños tumores neuroendocrinos pancreáticos no funcionantes (TNP-NF). El mejor tratamiento de estos tumores es controvertido: algunos autores aconsejan una actitud conservadora en casos seleccionados. Nuestro objetivo es analizar la evolución de TNP-NF incidentales de pequeño tamaño, tratados con seguimiento clínico sin cirugía.

El tratamiento de los tumores neuroendocrinos pancreáticos no funcionantes (TNEPNF) es la resección en caso de enfermedad localizada o metástasis hepáticas resecables. Existe controversia en metástasis hepáticas irresecables.