A novel rescue maneuver for a distal dislodged lumen-apposing metal stent (LAMS): �LAMS-in-LAMS� technique

Luengo, María Curieses; Consiglieri, Claudia F.; Puga, Manuel; Gornals, Joan B.

doi:10.17235/reed.2019.5924/2018

Cited by 3 publications

(3 citation statements)

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“…We collected 48 studies from the literature that were fully assessed for eligibility in this review; 20 studies were excluded since they did not meet our inclusion criteria. A total of 28 studies were included in our review[ 10 , 12 , 57 , 64 - 88 ] including 15 studies in which LAMS misdeployment occurred[ 10 , 12 , 70 , 77 - 88 ] (Figure 3 ). The overall technical success of EUS-PFC drainage was 98.1%.…”

Section: Resultsmentioning

confidence: 99%

“…Both the colonic and gastric perforations were closed using over-the-scope clips. Although data regarding predictive factors related to LAMS misdeployment were lacking in the studies included in our review, Curieses Luengo et al [ 88 ] identified excessive flexion of the echoendoscope tip due to severe inflammatory duodenal stenosis as an unfavorable condition for correct LAMS deployment.…”

Section: Discussionmentioning

confidence: 99%

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Lumen-apposing-metal stent misdeployment in endoscopic ultrasound-guided drainages: A systematic review focusing on issues and rescue management

Armellini¹,

Metelli²,

Anderloni³

et al. 2023

World J Gastroenterol

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BACKGROUND The introduction of lumen-apposing metal stents (LAMS) for endoscopic ultrasound (EUS)-guided drainages has marked a turning point in the field of interventional ultrasound and it is gathering worldwide diffusion in different clinical settings. Nevertheless, the procedure may conceal unexpected pitfalls. LAMS misdeployment is the most frequent cause of technical failure and it can be considered a procedure-related adverse event when it hampers the conclusion of the planned procedure or results in significant clinical consequences. Stent misdeployment can be managed successfully by endoscopic rescue maneuvers to allow the completion of the procedure. To date, no standardized indication is available to guide an appropriate rescue strategy depending on the type of procedure or of misdeployment. AIM To evaluate the incidence of LAMS misdeployment during EUS-guided choledochoduodenostomy (EUS-CDS), gallbladder drainage (EUS-GBD) and pancreatic fluid collections drainage (EUS-PFC) and to describe the endoscopic rescue strategies adopted under the circumstance. METHODS We conducted a systematic review of the literature on PubMed by searching for studies published up to October 2022. The search was carried out using the exploded medical subject heading terms “lumen apposing metal stent”, “LAMS”, “endoscopic ultrasound” and “choledochoduodenostomy” or “gallbladder” or “pancreatic fluid collections”. We included in the review on-label EUS-guided procedures namely EUS-CDS, EUS-GBD and EUS-PFC. Only those publications reporting EUS-guided LAMS positioning were considered. The studies reporting a technical success rate of 100% and other procedure-related adverse events were considered to calculate the overall rate of LAMS misdeployment, while studies not reporting the causes of technical failure were excluded. Case reports were considered only for the extraction of data regarding the issues of misdeployment and rescue techniques. The following data were collected from each study: Author, year of publication, study design, study population, clinical indication, technical success, reported number of misdeployment, stent type and size, flange misdeployed and type of rescue strategy. RESULTS The overall technical success rate of EUS-CDS, EUS-GBD and EUS-PFC was 93.7%, 96.1%, and 98.1% respectively. Significant rates of LAMS misdeployment have been reported for EUS-CDS, EUS-GBD and EUS-PFC drainage, respectively 5.8%, 3.4%, and 2.0%. Endoscopic rescue treatment was feasible in 86.8%, 80%, and 96.8% of cases. Non endoscopic rescue strategies were required only in 10.3%, 16% and 3.2% for EUS-CDS, EUS-GBD, and EUS-PFC. The endoscopic rescue techniques described were over-the-wire deployment of a new stent through the created fistula tract in 44.1%, 8% and 64.5% and stent-in-stent in 23.5%, 60%, and 12.9%, respectively for EUS-CDS, EUS-GBD, and EUS-PFC. Further therapeutic option were endoscopic rendezvous in 11.8% of EU...

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Lumen-apposing-metal stent misdeployment in endoscopic ultrasound-guided drainages: A systematic review focusing on issues and rescue management

Armellini¹,

Metelli²,

Anderloni³

et al. 2023

World J Gastroenterol

View full text Add to dashboard Cite

show abstract

“…gastroentorostomy, pancreatic fluid collection, gallbladder), but mainly with the use of the 10 × 10‐mm size and located in the gastric cavity. At the same time, a LAMS‐in‐LAMS technique, a new variant of the well‐known stent‐in‐stent technique, has recently been described in a few cases to remove the embedded covered metal stent 1‐5 …”

Section: Brief Explanationmentioning

confidence: 99%