Novel Uses of Lumen-apposing Metal Stents

Abstract

The field of therapeutic endoscopy has seen many recent advancements. One such emerging field is the use of lumen-apposing metal stents (LAMS). Although a few LAMS have been developed, the most commonly reviewed and the only Food and Drug Administration (FDA)-approved LAMS is the Axios stent by Boston Scientific. In 2013, LAMS were initially approved by the FDA for the management of pancreatic fluid collection drainage in the presence walled-off necrosis. Pancreatic fluid collections are traditionally drained with either a plastic stent or a covered biliary self-expanding metal stent. Plastic stents have a double pigtail feature which prevents stent migration. However, their narrow lumen poses limitations as it can lead to early stent occlusion. Fully covered metal stents have larger diameters, allowing improved drainage and decreased stent occlusion but their tubular shape is prone to migration. Consequently, this results in leakage, and frequent retrievals. Over the years, due to their versatility, LAMS now have many off label uses. This includes management of gastric outlet obstruction, superior mesenteric artery syndrome, strictures, gallbladder drainage, and postsurgical collection drainage. In this review, we will be discussing the FDA approved and the nonapproved uses of LAMS.

Endoscopic Ultrasound-Guided Gastrojejunostomy for Superior Mesenteric Artery Syndrome Secondary to Rapid Weight Loss

“…The lumen-apposing metal stent (LAMS) was first approved for drainage of walled-off pancreatic necrosis in 2013. 1 Since then, its off-label use has expanded to include endoscopic ultrasound-guided gastroenterostomy (EUS-GE), endoscopic ultrasound-guided biliary drainage, and endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography. 2 EUS-GE is a minimally invasive procedure for the treatment of gastric outlet obstruction.…”

Endoscopic step up: When and how

“…LAMSs have wider diameter, shorter length, and biflanged design that result in more effective drainage of solid necrotic debris and reduced chances of migration and facilitate easy DEN ( Fig 2 ) [ 29 ]. As mentioned earlier, cautery enhanced LAMSs like Hot Spaxus and Hot Axios stent systems enable quicker delivery of LAMS without the need for guide wire and further dilatation of fistula [ 29 , 30 ].

Fig 2 EUS-guided transmural drainage with cautery enhanced LAMS.

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

“…Lumen-apposing, fully covered, self-expanding metal stents (LAMS) were first developed to facilitate endoscopic transluminal drainage and are commonly used to treat pancreatic fluid collections [ 5 , 6 ]. They subsequently received approval for bile duct drainage in failed endoscopic retrograde cholangiopancreatography, malignant distal biliary obstruction cases, and gallbladder drainage in non-surgical patients [ 7 ]. In practice, the application of LAMS has expanded beyond the indications provided in the device’s labeling, including enteric anastomosis, drainage of post-surgical collections, and benign GI luminal strictures [ 7 , 8 ].…”

“…They subsequently received approval for bile duct drainage in failed endoscopic retrograde cholangiopancreatography, malignant distal biliary obstruction cases, and gallbladder drainage in non-surgical patients [ 7 ]. In practice, the application of LAMS has expanded beyond the indications provided in the device’s labeling, including enteric anastomosis, drainage of post-surgical collections, and benign GI luminal strictures [ 7 , 8 ]. The LAMS provides several benefits, such as 3 different diameters (10 mm, 15 mm, and 20 mm), a saddle-shaped design that provides an anchorage via its wide flanges, reducing migration risk, and a simple stepwise deployment technique that enables great technical success [ 7 ].…”