Lumen-apposing metal stents (with videos)

Law, Ryan; Chandrasekhara, Vinay; Bhatt, Amit; Bucobo, Juan Carlos; Copland, Andrew; Krishnan, Kumar; Kumta, Nikhil A.; Pannala, Rahul; Parsi, Mansour A.; Rahimi, Erik; Saumoy, Monica; Trikudanathan, Guru; Trindade, Arvind J.; Yang, Julie; Lichtenstein, David R.

doi:10.1016/j.gie.2021.05.020

Cited by 20 publications

(8 citation statements)

References 61 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…15 The LAMS is intended for implantation up to 60 days and is typically removed upon confirmation of WON resolution. Three sizes of LAMS were available in the trial (10,15, and 20 mm diameter), but only the 15 and 20 mm were used given the selection of complex WON with large solid necrotic debris burden.…”

Section: Methodsmentioning

confidence: 99%

Combined Drainage and Protocolized Necrosectomy Through a Coaxial Lumen-apposing Metal Stent for Pancreatic Walled-off Necrosis

et al. 2023

Self Cite

View full text Add to dashboard Cite

Objective: We evaluated a protocolized endoscopic necrosectomy approach with a lumen-apposing metal stent (LAMS) in patients with large symptomatic walled-off pancreatic necrosis (WON) comprising significant necrotic content, with or without infection. Summary Background Data: Randomized trials have shown similar efficacy of endoscopic treatment compared with surgery for infected WON. Design: We conducted a regulatory, prospective, multicenter single-arm clinical trial examining the efficacy and safety of endoscopic ultrasound -guided LAMS with protocolized necrosectomy to treat symptomatic WON ≥6 cm in diameter with >30% solid necrosis. After LAMS placement, protocolized WON assessment was conducted and endoscopic necrosectomy was performed for insufficient WON size reduction and persistent symptoms. Patients with radiographic WON resolution to ≤ 3 cm and/or 60-day LAMS indwell had LAMS removal, then 6-month follow-up. Primary endpoints were probability of radiographic resolution by 60 days and procedure-related serious adverse events. Results: Forty consecutive patients were enrolled September 2018 to March 2020, of whom 27 (67.5%) were inpatients and 19 (47.5%) had clinical evidence of infection at their index procedure. Mean WON size was 15.0 ± 5.6 cm with mean 53.2% ± 16.7% solid necrosis. Radiographic WON resolution was seen in 97.5% (95% CI, 86.8%, 99.9%) by 60 days, without recurrence in 34 patients with 6-month follow-up data. Mean time to radiographic WON resolution was 34.1 ± 16.8 days. Serious adverse events occurred in 3 patients (7.5%), including sepsis, vancomycin-resistant enterococcal bacteremia and shock, and upper gastrointestinal bleeding. There were no procedure-related deaths. Conclusions: Endoscopic ultrasound-guided drainage with protocolized endoscopic necrosectomy to treat large symptomatic or infected walled-off necrotic pancreatic collections was highly effective and safe. Clinicaltrials.-gov no: NCT03525808.

show abstract

Section: Methodsmentioning

confidence: 99%

Combined Drainage and Protocolized Necrosectomy Through a Coaxial Lumen-apposing Metal Stent for Pancreatic Walled-off Necrosis

et al. 2023

Self Cite

View full text Add to dashboard Cite

show abstract

“…Intra-procedural or postprocedural bleeding is a rare adverse event that is encountered in EUS-guided transluminal LAMS deployment and it can occur at any of the following stages: fistula creation [46], dilation of the LAMS during single-session EDGE [47], or as late onset LAMS-induced erosion or marginal ulcer of the mucosa of the GI tract [47][48][49]. Fortunately, endoscopic hemostatic techniques that include the use of balloon tamponade, stent-instent placement, and other traditional technique such as cautery and hemostatic forceps are effective management modalities [50], and very rarely emergent angiography with vessel embolization or surgical exploration has been required [2].…”

Section: Adverse Events and Time For Lumen Apposing Metal Stents Removalmentioning

confidence: 99%

“…The advent of lumen apposing metal stents (LAMS) has revolutionized the array of procedures that can be performed endoscopically [1]. While initially developed for the management of pancreatic fluid collections (PFC), the electrocautery-enhanced stent with its antimigratory property broadened its offlabel use for managing both luminal and transluminal conditions [2,3]. In particular, the endoscopic ultrasound (EUS)-guided transluminal deployment of LAMS facilitated management of broader gastrointestinal (GI) pathologies such as gastric outlet obstruction (GOO) [4][5][6], drainage of pancreatic and nonpancreatic (intra-abdominal and pelvic) fluid collections [7,8], gallbladder drainage [9], and the management of distal malignant biliary obstruction [10], among others.…”

Section: Introductionmentioning

confidence: 99%

“…In particular, the endoscopic ultrasound (EUS)-guided transluminal deployment of LAMS facilitated management of broader gastrointestinal (GI) pathologies such as gastric outlet obstruction (GOO) [4][5][6], drainage of pancreatic and nonpancreatic (intra-abdominal and pelvic) fluid collections [7,8], gallbladder drainage [9], and the management of distal malignant biliary obstruction [10], among others. More recently, LAMS have been increasingly used to manage patients with surgically altered anatomy (SAA), who would have otherwise required percutaneous or surgical interventions [11,12], because LAMS and its wide lumen design allow the passage of standard endoscopes into the distant parts of the tracts that would have been otherwise hard to access [2]. The minimally invasive nature of such interventions has gained significant popularity in recent years, with a growing body of literature attesting to their efficacy and safety [7,11].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Use of lumen apposing metal stents in patients with altered gastrointestinal anatomy

Ichkhanian,

Jovani

2023

Current Opinion in Gastroenterology

View full text Add to dashboard Cite

Purpose of review Lumen apposing metal stents (LAMS) have been increasingly used to manage patients with surgically altered anatomy (SAA), who would have otherwise required percutaneous or surgical interventions. Via the creation of de-novo anastomoses, LAMS provides a conduit to access distal parts of the gastrointestinal tract to perform various interventions. Recent findings Pancreatobiliary (PB) and non-PB interventions are challenging in patients with SAA. Endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography (ERCP) (EDGE) and endoscopic ultrasound (EUS)-directed transenteric ERCP (EDEE) are effective procedures that are being increasingly utilized to perform ERCP in patient with Roux-en-Y gastric bypass (RYGB) and non-RYGB SAA, respectively. Furthermore, EUS-directed trans-gastric intervention (EDGI) is a collective term for the non-PB procedures that could be performed in patients with SAA. EDGE/EDEE/EDGI are considered relatively safe procedures, however, intra-procedural stent misdeployement, and long-term ramifications of persistent fistula and stent migration could require endoscopic or, in rare instances, surgical management. Summary The advent of LAMS has revolutionized the therapeutic capabilities of EUS, by allowing the creation of new gastrointestinal anastomoses. With the growing body of literature, it is expected that such techniques will be more commonly performed in the community, providing less invasive and more effective treatment options for patients with SAA.

show abstract

“…EUS-GE consists of a minimally-invasive endoscopic creation of a surgical-like anastomosis. The design of LAMS has made this procedure possible through the following characteristics: 1) electrocautery-enhanced penetration of the 2 walls allows single-step access and stabilization of the fistula, without accessory exchange; 2) the dumb-bell shape of the LAMS reduces the risk of migration; 3) the high radial force and progressive dilation of the stent facilitates compression of the 2 walls, gradually fusing them into a stable anastomosis; and 4) the silicon covering of the stent avoids leakage [ 67 ].…”

Section: Introductionmentioning

confidence: 99%

Endoscopic ultrasound-guided biliary drainage and gastrointestinal anastomoses: the journey from promising innovations to standard of care

Vanella

Dell’Anna

Bronswijk

et al. 2022

aog

View full text Add to dashboard Cite

Biliary obstruction (BO) and gastric outlet obstruction (GOO) are frequent complications of pancreatobiliary and gastroduodenal neoplasia, which can severely impact oncological outcomes, patient survival and quality of life. Although endoscopic retrograde cholangiopancreatography (ERCP) remains the gold standard for biliary drainage, this may fail or be unfeasible because of duodenal/papillary infiltration or surgically-altered anatomy. Percutaneous transhepatic biliary drainage (PTBD) has been the standard rescue therapy in this setting, but is burdened by high morbidity and reduced quality of life. As for GOO, surgical gastroenterostomy and enteral stenting are limited by invasiveness and suboptimal long-term outcomes, respectively. Endoscopic ultrasound (EUS) has evolved from a diagnostic to a therapeutic modality, providing a safe and effective alternative for draining the pancreatobiliary tract into the stomach or duodenum. EUS-guided biliary drainage (EUS-BD) has already demonstrated similar efficacy, greater safety and fewer reinterventions compared to PTBD, and can be performed in the same session after ERCP failure. Further development of lumen apposing metal stents has paved the way towards the creation of EUS-guided anastomoses. EUS-guided gastroenterostomy (EUS-GE) is nowadays increasingly used to treat GOO, combining the minimal invasiveness of endoscopy with surgical-range efficacy. This review summarizes the technical details, current evidence and society recommendations contributing to EUS-BD and EUS-GE gaining ground in everyday practice or tertiary referral centers and becoming crucial in improving the multidisciplinary management of cancer-related symptoms.

show abstract

Lumen-apposing metal stents (with videos)

Cited by 20 publications

References 61 publications

Combined Drainage and Protocolized Necrosectomy Through a Coaxial Lumen-apposing Metal Stent for Pancreatic Walled-off Necrosis

Combined Drainage and Protocolized Necrosectomy Through a Coaxial Lumen-apposing Metal Stent for Pancreatic Walled-off Necrosis

Use of lumen apposing metal stents in patients with altered gastrointestinal anatomy

Endoscopic ultrasound-guided biliary drainage and gastrointestinal anastomoses: the journey from promising innovations to standard of care

Contact Info

Product

Resources

About