Clinical evaluation of a novel lumen-apposing metal stent for endosonography-guided pancreatic pseudocyst and gallbladder drainage (with videos)

Itoi, Takao; Binmoeller, Kenneth F.; Shah, Janak N.; Itokawa, Fumihide; Kurihara, Toshio; Tsuchiya, Takayoshi; Ishii, Kentaro; Tsuji, Shujiro; Ikeuchi, Nobuhito; Moriyasu, Fuminori

doi:10.1016/j.gie.2011.10.020

Cited by 407 publications

(312 citation statements)

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“…In the meantime, other newly developed LAMSs has been applied in clinic as well. [6,7,[27][28][29] Technically, this design may be effective in anastomosis, even between two lumens that are physically separated. [30] There has not been strong evidence thus far in the published literature that favors the lumen-apposing stent when compared with the plastic stent in resolving simple PPs.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, covered self-expandable metal stents (CSEMS), which have a lumenapposing design and are used to drain fluid collections, have been studied. [4][5][6][7] However, the efficiency of plastic stents and lumen-apposing metal stents (LAMSs) is inconsistent between studies. [8] The aim of this study is to identify whether stent type can affect the clinical outcome and study other risk factors that may also affect the outcome.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic ultrasound-guided pancreatic pseudocyst drainage with lumen-apposing metal stents or plastic double-pigtail stents: A multifactorial analysis

Guo

Sun

et al. 2017

Journal of Translational Internal Medicine

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Objective: To compare the efficiency of plastic and metal stents for symptomatic pancreatic pseudocyst (PP) drainage and analyze other main associated factors that affect the outcome of drainage therapy. Method: Rates of technical and clinical success, procedure-related side effects (hemorrhage, stent migration, and cyst rupture), reinterventions, and duration of hospital stay. Results: There were 52 patients, 40 patients underwent plastic stent placement and 12 patients underwent lumen-apposing metal stent (LAMS) placement. The total rate of technical success was 100%. The total rate of clinical success was 100%. The total rate of adverse events was 7.7% (4/52). On multiple logistic regression analysis, the use of plastic stents (P < 0.05, Exp B = 12.168) and the presence of a large cyst (P < 0.05, Exp B = 1.036) were shown to significantly increase the risk of reintervention. On multivariate linear regression analysis, etiology of pseudocyst (P < 0.05, B = −8.427, −9.785, −5.514) was associated with prolonged hospital stent, while stent type was not shown be a factor (P > 0.05). Conclusion: Both plastic and LAMSs are proven to be highly efficient in PP drainage. The LAMS is superior in preventing complications such as migration and cyst leakage and reducing the rate of reintervention.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Endoscopic ultrasound-guided pancreatic pseudocyst drainage with lumen-apposing metal stents or plastic double-pigtail stents: A multifactorial analysis

Guo

Sun

et al. 2017

Journal of Translational Internal Medicine

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“…The active length between the flanges ranges of 10 to 20 mm and the diameter of these stents are 10 to 16 mm, which enables direct endoscopic passage and repeated necrosectomy through the lumen of the stent. 57,58 Several other series confirmed the high success rate in complete cyst resolution and a very low rate of serious complications with the use of these lumen-apposing metallic stents (LAMS). [59][60][61][62] These and other studies collectively demonstrate that EUSguided transmural drainage of PFCs (especially those containing solid necrotic material and often needing several necrosectomy sessions) is feasible and safe.…”

mentioning

confidence: 87%

Endoscopic ultrasound-guided extraluminal drainage: Novel concepts, challenges and future directions

Madácsy

Kaltsidis²

2017

Int J Gastrointest Interv

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A B S T R A C TEndoscopic ultrasound (EUS)-guided management of abdominal fluid collections adjacent to the gastroduodenal lumen is a relatively new concept attracting a lot of interest in recent years. The ability of EUS to identify and drain these collections in the same session accounts for the surge of interest in these novel techniques. On the other hand, the complexity of these interventions and associated serious complications has moderated the enthusiasm of novice endoscopists to some extent and reiterated that focused research and technical innovations are needed to make EUS-guided drainage simpler and safer. Self-expandable metallic stents (SEMS) have emerged in the last decade in the endoscopic management of malignant luminal gastrointestinal strictures. The use of SEMS in the management of benign conditions (biliary, pancreatic, and colonic strictures) is also rapidly expanding. Recently, fully-covered (FC)-SEMS have been successfully used for drainage of peripancreatic and pericholecystic fluid collections. Here we will review the existing data and future directions in the use of FC-SEMS for such drainage procedures. We will also review the literature on novel "purpose-made" prostheses, such as the lumen-apposing metallic stents, which aim to address technical problems arising in EUS-guided drainage procedures when conventional SEMS are used. Further development of these and other similar devices may transform EUS-guided drainage procedures from an esoteric concept to "mainstream", first-line intervention.

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“…The patient showed resolution of clinical symptoms and received outpatient chemotherapy. A previous report has demonstrated the usefulness of LAMS for transenteric drainage of pancreatic pseudocysts and the gallbladder [2]. Recently, EUS-guided transgastric access into the afferent limb with LAMS has been reported [3,4].…”

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confidence: 99%

Afferent loop syndrome treated by endoscopic ultrasound-guided gastrojejunostomy, using a lumen-apposing metal stent with an electrocautery-enhanced delivery system

et al. 2017

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Afferent loop syndrome treated by endoscopic ultrasound-guided gastrojejunostomy, using a lumen-apposing metal stent with an electrocautery-enhanced delivery system Afferent loop syndrome is a complication that infrequently occurs after pancreaticoduodenectomy [1]. Complete obstruction occurs which leads to cholangitis, pancreatitis, perforation, and necrosis. In particular, patients with cancer recurrence cannot continue chemotherapy treatment, become debilitated, and may eventually die. Therefore, early and appropriate decompression treatment is needed. This report describes endoscopic ultrasound (EUS)-guided gastrojejunostomy for treatment of afferent loop syndrome, using a lumen-apposing metal stent (LAMS) incorporated into an electrocautery-enhanced delivery system. A 44-year-old man was admitted to our hospital with vomiting and abdominal pain; he had undergone pancreatoduodenostomy for pancreatic head cancer 11 months earlier. Computed tomography (CT) revealed dilation of the afferent loop associated with a recurrence of cancer (▶ Fig. 1). First, multiple plastic stents were inserted by balloon-assisted enteroscopy (▶ Fig. 2) and his clinical condition improved. However, 1 month later he was admitted again with abdominal pain because of stent occlusion. CT revealed dilation of the afferent loop and intrahepatic bile duct (▶ Fig. 3). We performed EUS-guided gastrojejunostomy with a LAMS incorporated into an electrocautery-enhanced delivery system (Hot AXIOS; Boston Scientific, Natick, Massachusetts, USA) (▶ Fig. 4, ▶ Video 1). CT on the following day showed improvement in the dilation of the afferent loop (▶ Fig. 5). The patient showed resolution of clinical symptoms and received outpatient chemotherapy. A previous report has demonstrated the usefulness of LAMS for transenteric drainage of pancreatic pseudocysts and the gallbladder [2]. Recently, EUS-guided transgastric access into the afferent limb with LAMS has been reported [3,4].The use of the Hot AXIOS system has some advantages compared with conventional LAMS, namely, avoidance of the need to exchange devices for stent placement, shortening of procedure time, prevention of leakage in the abdominal cavity, and prevention of separation of the digestive wall and afferent loop tract wall during the procedure.Therefore, EUS-guided drainage with LAMS is a safe, easy-to-perform, and highly effective minimally invasive treatment modality for afferent loop syndrome. Endoscopy_UCTN_Code_TTT_1AR_2ADVideo 1 Endoscopic ultrasound-guided gastrojejunostomy, using a lumen-apposing metal stent with an electrocautery-enhanced delivery system, for treatment of afferent loop syndrome.▶ Fig. 1 Computed tomography (CT) revealed dilation of the afferent loop associated with a recurrence of cancer, in a 44-year-old man who had undergone pancreatoduodenostomy for pancreatic head cancer 11 months previously. E-Videos E270

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Clinical evaluation of a novel lumen-apposing metal stent for endosonography-guided pancreatic pseudocyst and gallbladder drainage (with videos)

Cited by 407 publications

References 10 publications

Endoscopic ultrasound-guided pancreatic pseudocyst drainage with lumen-apposing metal stents or plastic double-pigtail stents: A multifactorial analysis

Endoscopic ultrasound-guided pancreatic pseudocyst drainage with lumen-apposing metal stents or plastic double-pigtail stents: A multifactorial analysis

Endoscopic ultrasound-guided extraluminal drainage: Novel concepts, challenges and future directions

Afferent loop syndrome treated by endoscopic ultrasound-guided gastrojejunostomy, using a lumen-apposing metal stent with an electrocautery-enhanced delivery system

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