Lumen-apposing covered self-expandable metal stents for short benign gastrointestinal strictures: a multicenter study

Abstract

Use of the fully covered self-expandable metal stent (SEMS) for benign luminal gastrointestinal (GI) stricture (BLGS) has been limited by the migration rate. The role of the lumen-apposing metal stent (LAMS) for BLGS is not well defined. We assessed the safety, feasibility, and efficacy of LAMS for the treatment of BLGS. This was an observational, open-label, retrospective, single-arm, multicenter consecutive case series of patients undergoing LAMS placement for BLGS. Technical success was defined as successful placement of the LAMS. Short- and long-term clinical success rates were defined as symptom improvement/resolution with indwelling stent and after stent removal, respectively. All adverse events and additional interventions were recorded. A total of 30 patients (mean age 51.6 years; 63.3 % women) underwent LAMS placement for GI strictures (83.9 % anastomotic). Median stricture diameter and length were 4.5 mm (range 2 - 10 mm) and 8 mm (range 5 - 10 mm), respectively. Technical success was achieved in 29 patients (96.7 %), with an adverse event rate of 13.3 %. The stent migration rate was 8.0 % (2/25) on follow-up endoscopy. Short-term clinical success was achieved in 90.0 % (27/30) at a median of 60 days (interquartile range [IQR] 40 - 90 days). Most patients (19/23; 82.6 %) experienced sustained symptom improvement/resolution without the need for additional interventions at a median follow-up of 100 days (IQR 60 - 139 days) after LAMS removal. This multicenter study demonstrated that LAMS placement represents a safe, feasible, and effective therapeutic option for patients with BLGS and is associated with a low stent migration rate. Our initial findings suggest that future prospective comparative studies are needed on the use of LAMS, endoscopic dilation, and conventional SEMS. .

What is the ideal indwelling time for metal stents after endoscopic ultrasound‐guided gastrojejunostomy? Case report of delayed iatrogenic perforation with a review of the literature

“…I N TOTAL, 19 studies and case reports were identified and included in the review [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] (Table 1 and Fig. S1).…”

Lumen-apposing metal stents for gastrointestinal luminal strictures: current use and future directions

“…1). To date, 22 patients in the reviewed literature had a LAMS placed for an esophageal stricture [13][14][15][16]. Anastomotic strictures were the most common indication, seen in 17 of the 22 patients.…”

“…Yang et al reported 5 patients who underwent LAMS for esophageal anastomotic or esophageal gastric junction strictures [16]. Only 1 patient had an associated adverse event: stent migration.…”

Advances in the Treatment of Postsurgical Benign Colorectal Strictures

“…This characteristic led to its use in the treatment of benign strictures of the digestive tract. Several studies have assessed its usefulness, although with only a few patients and mostly concerning benign strictures of the upper digestive tract; however, some include postsurgical colon strictures [35][36][37][38]. The clinical success rate improves significantly as compared with the traditional covered metal stents, reducing the rate of stent migration and with a lower complication rate.…”

“…Yang et al [36] presented results for 30 patients, with a clinical success rate of 82.6% after a follow-up period of 100 days. The migration rate was 8%, and complications arose in 13.3%…”