What is the optimal stent type for drainage of pancreatic pseudocysts?

In a randomised study, plastic stents proved to be non-inferior to lumen-apposing metal stents for the endoscopic ultrasound-guided drainage of pancreatic pseudocysts. According to the authors, plastic stents may serve as a first-line option for this indication.

The WONDER-02 trial (NCT06133023) compared plastic stents with the standard lumen-apposing metal stents in 80 Japanese patients who underwent endoscopic ultrasound-guided drainage of pancreatic pseudocysts [1]. The primary endpoint was ‘clinical success’, defined as a reduction of the pseudocyst of at least 2 cm and improvement in inflammatory markers within 6 months from the procedure. This endpoint was tested for non-inferiority.

Clinical success was achieved in 97% of the participants in the plastic stent arm and 95% of those in the metal stent arm (P_{non-inferiority}<0.001). There was also no significant difference regarding procedure-related adverse events (AEs), with rates of 21% in the plastic stent arm and 15% in the metal stent arm (P=0.56). The most common AE in the plastic stent arm was stent migration (13%), whereas bleeding was the most frequently observed AE in the metal stent arm (7.3%). Finally, recurrence rates were 13% and 7.7% for participants treated with plastic stents and metal stents, respectively (P=0.48).

“The WONDER-02 trial demonstrated non-inferiority of plastic stents to lumen-apposing metal stents for endoscopic ultrasound-guided pseudocyst drainage,” concluded Dr Tomotaka Saito (Tokyo University, Japan).

1. Saito T, et al. Plastic stents vs lumen-apposing metal stent for endoscopic ultrasound-guided drainage of pancreatic pseudocysts: a multicenter, randomised controlled, non-inferiority trial (WONDER-02). Abstract 987c, Digestive Disease Week 2025, 3–6 May 2025, San Diego, USA.

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Posted on 21 May 202526 September 2025