Feasibility and patency of echoendoscopic anastomoses with lumen apposing metal stents depending on the gastrointestinal segment involved

Abstract

EUS-guided anastomoses with LAMS have emerged as a therapeutic option for patients with obstruction of the digestive tract. However, the long-term permeability of these anastomoses remains unknown. Most of the published cases involve the gastric wall and experience in distal obstruction is limited to few case reports. We review our series of patients treated with LAMS for gastrointestinal obstruction and describe the technical success according to the anastomotic site and the long-term follow-up in those cases in which the stent migrated spontaneously or was removed. Out of 30 cases treated with LAMS, EUS-guided anastomosis did not involve the gastric wall in 6 patients. These procedures were technically more challenging as two failures were recorded (2/6, 33%) while technical success was achieved in 100% of the cases in which the stent was placed through the gastric wall. In two of the patients, one with entero-enteric and another with recto-colic anastomosis, stent removal after spontaneous displacement was followed by long term permeability of the EUS-guided anastomosis (172 and 234 days respectively). In a EUS-guided gastroenterostomy the stent was removed at 118 days, but closure of the fistula was confirmed 26 days later. Our experience suggests that LAMS placement between bowel loops is feasible and might allow the creation of an anastomosis with long-term patency. As compared to LAMS placement between bowel loops, when LAMS are placed through the gastric wall, removal of the LAMS seems to lead to closure of the fistula.

Clinical and technical outcomes of patients undergoing endoscopic ultrasound-guided gastroenterostomy using 20-mm vs. 15-mm lumen-apposing metal stents

“…(8.7% [95%CI 4.8-14.6] in the 15 mm LAMS group vs 8.4% [95%CI 4.1-14.9] in the 20 mm LAMS group). Overall adverse events were reported in 33 procedures ) which was similar to the overall adverse events seen in a recent systematic review and meta-analysis of 12 studies (12%, [95% CI [8][9][10][11][12][13][14][15][16]) [6]. The 20 mm LAMS group had comparable rates of total adverse events with the 15 mm LAMS group ] vs 12.8% [95%CI 7.5-18.2]).…”

“…Primary and secondary outcomes were compared between the two groups. A total of 109 cases from 4 centers were included in previously published literature on EUS-GE [7,[9][10][11][12][13].…”

“…A total of 109 of the cases, from 4 centers, had been included in previously published literature on EUS-GE [7,[9][10][11][12][13]. These studies mainly involved patients who underwent EUS-GE using the 15-mm LAMS, with some using the 20-mm LAMS, but none of them were comparative trials that looked at the difference in outcomes for the two stent sizes.…”

Afferent-Loop Syndrome Treated with Endoscopic Ultrasound-Guided Drainage of the Afferent Loop with a Plastic Stent

“…Unlike pancreatic fluid collection and walled-off necrosis, LAMSs for ALS often need to remain for some months and may have the potential to cause hemorrhage. Betés et al [15] reported that hemorrhage after placement of LAMS for echoendoscopic anastomoses occurred in only one of thirty cases (3.3%). The efficacy and complications of LAMSs use for ALS remain to be investigated for a number of cases.…”

Endoscopic esophagogastric anastomosis using a lumen-apposing metal stent to manage an anastomotic leakage after esophagectomy

“…Ivor-Lewis esophagectomy (ILE) for esophageal cancer is associated with a significant risk of anastomotic leakage [1]. Recently, a lumen-apposing metal stent (LAMS) has been used to create an anastomosis between the lumen of two digestive structures [2]. An animal study showed technical feasibility of endoscopic esophagogastric anastomosis with LAMS following ILE [3].…”