Lumen-apposing metal stents for the treatment of benign gastrointestinal tract strictures: a single-center experience and proposed treatment algorithm

Mahmoud, Tala; Beran, Azizullah; Bazerbachi, Fateh; Matar, Reem; Jaruvongvanich, Veeravich; Razzak, Farah Abdul; Abboud, Donna Maria; Vargas, Eric J.; Martin, John A.; Kellogg, Todd A.; Ghanem, Omar M.; Petersen, Bret T.; Levy, Michael J.; Law, Ryan; Chandrasekhara, Vinay; Storm, Andrew C.; Song, Louis M. Wong Kee; Buttar, Navtej; Dayyeh, Barham K. Abu

doi:10.1007/s00464-022-09715-8

Cited by 9 publications

(5 citation statements)

References 29 publications

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“…A 15×10-mm LAMS was the most commonly used stent, with median stent dwell time varying from 60-119 days. Our study quality assessment found that 11 were of medium quality [ 14 - 18 , 21 , 22 , 24 , 26 - 28 ] and 7 were of low quality [ 11 - 13 , 19 , 20 , 23 , 25 ] ( ).…”

Section: Resultsmentioning

confidence: 99%

“…Our study showed high technical (99.9%) and short-term (94.6%) success rates, with few AEs (14.4%), when LAMS were used for anastomotic strictures. Although revisional surgery has a high clinical success rate for anastomotic strictures, it is associated with high postoperative morbidity and mortality [ 28 ]. Therefore, LAMS placement can be viewed as an alternative option after failed endoscopic dilatation in anastomotic strictures before surgery.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy of lumen-apposing metal stents for the management of benign gastrointestinal stricture: a systematic review and meta-analysis

Giri¹

2023

aog

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Background Lumen-apposing metal stents (LAMS) are an evolving option for the management of benign gastrointestinal (GI) strictures. Multiple studies have reported on the efficacy and safety of LAMS for benign GI strictures, but were limited by their small sample size. Hence, we conducted this meta-analysis to assess the critical role of LAMS for the management of benign GI strictures. Methods A literature search of various databases from inception until October 2022 was conducted for studies evaluating the outcome of LAMS in patients with benign GI strictures. The outcomes assessed included technical and clinical success, adverse events including stent migration, and reintervention. Pooled event rates across studies were expressed with summative statistics. Results A total of 18 studies (527 patients) were included in the present analysis. The pooled event rates for technical, short-term and long-term clinical success were 99.9% (95% confidence interval [CI] 99.1-100.0), 93.9% (95%CI 90.7-100.0), and 72.8% (95%CI 55.7-90.0), respectively. The pooled incidence of adverse events and stent migration with LAMS for benign GI strictures was 13.5% (95%CI 8.6-18.5) and 10.6% (95%CI 6.0-15.2), respectively. The pooled event rate for reintervention with LAMS for GI strictures was 23.0% (95%CI 15.7-30.3). In a subgroup analysis focusing only on anastomotic strictures there was no significant difference in the pooled event rates for various outcomes. Conclusions LAMS have a high technical and short-term clinical success rate, with an acceptable safety profile for the management of benign GI strictures. Further studies are needed to determine the appropriate duration of stent therapy and long-term outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Efficacy of lumen-apposing metal stents for the management of benign gastrointestinal stricture: a systematic review and meta-analysis

Giri¹

2023

aog

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“…Similarly, a retrospective review of 109 LAMS placements noted 58.3% of patients required repeat intervention after removal after a median 119-day dwell time. 10 These authors suggest a 3- to 6-month trial of dwell time before removal and consideration of destination stent placement and interval monitoring for epithelialization on trial failure. However, our patient's avoidance of destination therapy suggests extended dwell times may be worth pursuing.…”

Section: Discussionmentioning

confidence: 99%

A Successful 12-Month Trial of a Lumen-Apposing Self-Expandable Metallic Stent on a Benign Recalcitrant After Surgical Stricture

Bhowmick,

Habr,

Perera

2024

ACG Case Rep J

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Gastrojejunal anastomotic strictures are common postsurgical complications that may be treated endoscopically. In some cases, conventional endoscopic dilations may prove ineffective, prompting consideration of covered self-expandable metal stents as the next step. However, the efficacy of these stents may be limited by their risk of migration. Lumen-apposing self-expandable metallic stents pose a lower migration risk because of their unique design and offer a possible off-label solution for recalcitrant strictures. We describe a patient with a postsurgical, gastrojejunal anastomotic stricture refractory to several interventions, who achieved long-lasting remission of symptoms after a 12-month trial of lumen-apposing self-expandable metallic stent placement.

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“…Early investigation with upper endoscopy is essential for patients who present with upper gastrointestinal symptoms post-RYGB to assess the presence of a GJ stricture [52]. If identified, immediate intervention is recommended, utilizing flexible endoscopy combined with pneumatic balloon dilation to achieve a safe maximal diameter as well as lumen stents following failed endoscopic treatments [60]. Studies have demonstrated the effectiveness of this approach in managing early GJ strictures after RYGB, with successful responses reported in 17% to 67% of cases following the initial dilation, and 3% to 8% requiring three or more dilations [53,55].…”

Section: Anastomotic Stricturementioning

confidence: 99%

The Trajectory of Revisional Bariatric Surgery: Open to Laparoscopic to Robotic

Jawhar,

Sample,

Salame

et al. 2024

JCM

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Metabolic and bariatric surgery (MBS) is the most effective therapeutic intervention for patients with obesity, with sleeve gastrectomy (SG) being the most commonly performed primary MBS procedure. Long-term studies have demonstrated that 15–20% of patients require revisional bariatric surgery (RBS) due to weight-related issues or surgical complications. Despite the gold standard being laparoscopic revision, there are other available approaches such as open or robotic-assisted. An extensive literature review was performed for articles from their inception to February 2024. A descriptive review of MBS procedures (SG, Roux-en-Y gastric bypass (RYGB), single anastomosis duodeno-ileostomy (SADI) and biliopancreatic diversion-duodenal switch (BPD-DS)) was carried out to report and compare outcomes between primary and revisional bariatric surgery. A similar review was conducted to compare outcomes of revisional approaches (open, laparoscopic, robotic). RYGB remains the dominant RBS with a similar safety profile compared to revisional SADI and BPD-DS. In terms of the RBS surgical approach, all three options showed comparable short and long-term outcomes, with robotic RBS being associated with longer operative time and variable length of stay. Additional long-term studies are required to further validate our conclusions.

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Lumen-apposing metal stents for the treatment of benign gastrointestinal tract strictures: a single-center experience and proposed treatment algorithm

Cited by 9 publications

References 29 publications

Efficacy of lumen-apposing metal stents for the management of benign gastrointestinal stricture: a systematic review and meta-analysis

Efficacy of lumen-apposing metal stents for the management of benign gastrointestinal stricture: a systematic review and meta-analysis

A Successful 12-Month Trial of a Lumen-Apposing Self-Expandable Metallic Stent on a Benign Recalcitrant After Surgical Stricture

The Trajectory of Revisional Bariatric Surgery: Open to Laparoscopic to Robotic

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