Through the LAMS towards the future: current uses and outcomes of lumen-apposing metal stents

Abstract

The lumen-apposing metal stent (LAMS) is one of the revolutionary devices recently developed for gastrointestinal endoscopy. This device has a saddle-shaped design and large lumen. It was originally designed for drainage of transmural pancreatic fluid collection and in the last few years it has been used extensively for that indication. More recently, other in- and off-label indications have been proposed. Several types of LAMS are available, with or without an electrocautery-enhanced delivery system. In the current review we discuss the state of the art with regard to LAMS and their indications, usage, and outcomes.

Safety and efficacy of lumen-apposing metal stents versus plastic stents to treat walled-off pancreatic necrosis: systematic review and meta-analysis

“…We excluded publications that did not use the 2012 Atlanta criteria for WON diagnosis, lacked information to allow evaluation of the Atlanta criteria 3 , used surgical or percutaneous drainage in addition to endoscopic drainage, represented interim analyses of ongoing studies, reported on ≤ 5 patients, or had study populations that were not mutually exclusive. With regard to LAMS, only publications that investigated the AXIOS TM stent (Boston Scientific, Marlborough, Massachusetts, United States) were included as this is the only globally available LAMS and is the LAMS most commonly described in the literature 16 . The primary analysis was limited to cases conducted under EUS guidance.…”

“…Recently, various studies assessing LAMS have published disparate safety findings, with overall adverse event (AE) rates ranging from 0 % to 50 % 9 10 11 12 . Specific adverse events (AEs) such as bleeding also have widely varying reported rates, ranging from 0 % to 25 %, with some studies (including those with small sample size) suggesting a higher rate of bleeding with LAMS compared to DPPS 9 13 14 15 16 . In addition, the relatively large variations in reported complication rates may be partially attributable to their different definitions 17 .…”

Endoscopic Ultrasound-Guided Drainage of Intramural Duodenal Abscess Caused by Foreign Body Ingestion

“… 3 These include gallbladder drainage, bile duct drainage, enteroenteric anastomoses, gastrointestinal strictures, and transgastric ERCP in patients with bypass surgery. 3 , 4 …”

Endoprosthetics for luminal obstruction

“…This stent was originally created for pancreatic fluid collection (PFC) drainage, because of its larger inner lumen diameter than either plastic or traditional self-expanding metal stents. In addition, it allows for an endoscope to pass into PFCs to perform direct necrosectomy [29]. Over time, many additional indications have been proposed such as biliary drainage after failed ERCP [30], gallbladder drainage [31], gastroentero anastomosis [32], or for benign gastrointestinal strictures [33].…”