Hot-Axios and Micro-Tech LAMS produced similar necrosectomy success in infected WON
Endoscopic treatment of infected walled-off necrosis depends on two linked goals: safe drainage and reliable access for repeated debridement. In this retrospective single-center series, both lumen-apposing metal stent designs supported that strategy, but they did not behave identically at the bedside. The overall necrosectomy success rate reached 80.65% across 31 patients, and the comparison between devices showed a clear tradeoff: Hot-Axios was associated with more bleeding, while Micro-Tech was associated with more migration.
The cohort was small, yet the signal was clinically relevant. Investigators followed patients with infected WON who underwent EUS-guided LAMS placement and endoscopic debridement between August 2020 and June 2025, then tracked outcomes through follow-up completed in April 2026. Hot-Axios was used in 21 patients and Micro-Tech in 10. Baseline characteristics were similar between the two groups, which makes the device-level comparison more interpretable, even if it cannot settle the question definitively.
Necrosectomy was effective, but not uniformly simple
The global success rate of 80.65% means most patients avoided persistent necrotic collections after the endoscopic step-up approach. Success was numerically higher with Hot-Axios than with Micro-Tech, 85.71% versus 70.00%, but the difference did not reach statistical significance. In practical terms, both stents were capable of supporting a workable drainage-to-debridement pathway for infected WON.
The anatomy and biology of the disease help explain why no stent can make this a simple procedure. WON contains liquefied debris mixed with substantial solid necrotic material, and drainage alone often fails when the cavity is densely packed. In this series, the mean lesion size was 12.77 cm, and the collection was large enough in every included patient to require endoscopic intervention. The use of LAMS gave endoscopists a stable conduit between the gastrointestinal lumen and the necrotic cavity, which is exactly what repeated access demands when debridement is needed.
A separate detail matters: the lesions had to lie within 1.5 cm of the gastric or duodenal wall and contain more than 30% solid component on imaging. Those selection criteria identify a group in which endoscopic access is technically plausible but still vulnerable to adverse events if the stent shifts or the cavity is poorly controlled.
Bleeding clustered with Hot-Axios, migration with Micro-Tech
The most important divergence in this series involved complications. The overall difference between groups was statistically significant, with P = 0.007. Bleeding occurred in 33.33% of patients treated with Hot-Axios and in 0% of those treated with Micro-Tech. Stent migration, by contrast, was seen in 20.00% of Micro-Tech cases and in none of the Hot-Axios cases.
Those are not interchangeable complications. Bleeding raises immediate procedural risk and can interrupt the debridement sequence, while migration threatens drainage continuity and can force repeat intervention. In this cohort, the two devices appeared to distribute risk differently rather than separating cleanly into a superior and inferior option. Hot-Axios may offer firmer anchoring across the wall-apposed tract, but the same fixation profile may carry more mucosal trauma or vascular irritation during the procedure. Micro-Tech may be less prone to bleeding at placement, yet the higher migration rate suggests less stable apposition once the cavity begins to decompress.
This is the clearest bedside lesson from the series. Device choice changed the type of problem, not the fact that problems still occurred.
The procedural pathway depended on repeated endoscopic access
All debridement was performed by the same experienced endoscopist, which reduced operator variability. After LAMS placement, the cavity was entered endoscopically and necrotic tissue was removed using foreign body forceps, retrieval baskets, and snares until the cavity was cleared on endoscopic and cross-sectional assessment. Once debridement was complete, the metal stent was removed and a double pigtail stent was placed to continue drainage.
That sequence reflects the core logic of the step-up model for infected pancreatic necrosis. Drain first, then debride only when the cavity remains burdened with solid tissue. The study also recorded operational variables such as time from pancreatitis onset, time from index drainage to first necrosectomy, total number of necrosectomies, overall debridement time, LAMS retention time, and drainage time after the final necrosectomy. Those details matter because endoscopic management is judged not only by whether the collection resolves, but also by how many procedures and how much device time are required to get there.
The article does not provide a clean shortcut for choosing one device in every case. Instead, it frames the decision around the specific hazards of the tract and the collection. When secure fixation is the priority, Hot-Axios may be attractive. When minimizing bleeding risk is the priority, Micro-Tech may have an edge, provided the team is prepared for possible migration.
Infected WON remains a high-acuity pancreatitis complication
The study population reflects the broader burden of severe acute pancreatitis. The most common causes in this cohort were gallstone pancreatitis and hyperlipidemic pancreatitis, with smaller proportions of alcohol-related and idiopathic disease. Patients presented mainly with abdominal pain, fever, or both, and C-reactive protein was elevated, consistent with active infection and systemic inflammation. Imaging showed encapsulated necrosis, and gas was present in some collections, a classic marker of infected necrotic material.
Those features help explain why intervention was necessary. Infected WON is not a passive radiologic finding; it is a persistent infectious and obstructive process that often demands source control. Endoscopic drainage followed by necrosectomy can avoid more invasive surgical routes, but the approach depends on tract stability, repeat access, and complication control.
For now, this series supports the feasibility of both LAMS designs in infected WON and suggests that each carries a different procedural burden. The sample size was modest, the comparison was retrospective, and the numbers were too small to make the complication split definitive. Even so, the pattern is difficult to ignore: similar overall efficacy, different adverse-event profiles, and no device that fully removes the need for careful post-placement surveillance.