Treatment of a benign, anastomotic refractory rectal stricture with an AXIOS stent

Alcalá, Felipe Martínez; García, Felipe R. Martínez-Alcalá; Sánchez-Yagüe, Andrés; García, A Martínez-Alcalá; Avila, Jose; Pozo, José Manuel Pérez

doi:10.1055/s-0034-1392676

Cited by 11 publications

(13 citation statements)

References 2 publications

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“…Twelve original articles were included in this review [ 1 , 11 , 13 - 22 ]. Two retrospective multicenter studies from the USA [ 1 , 11 ]; 9 case reports, 7 from the USA [ 13 - 16 , 18 , 20 , 21 ] and 2 from Spain [ 17 , 19 ]; and 1 case series from the USA [ 22 ] were included in the review. In this article, we reviewed 70 patients from the 12 original studies who received LAMS for refractory (68/70) or treatment-naïve (2/70) benign GI strictures.…”

Section: Resultsmentioning

confidence: 99%

“…These strictures were distributed along the entire GI tract. Of the 70 strictures, 8 were at an esophagogastric anastomotic site [ 1 , 11 ], 32 were at a gastrojejunal anastomotic site [ 1 , 11 , 13 , 14 , 18 , 21 , 22 ], 13 were at the pylorus [ 1 , 11 , 16 , 22 ], 7 were at a colon anastomotic site [ 11 , 22 ], 2 were at a rectal anastomotic site [ 19 , 20 ], while 1 stricture was located at each of the following locations: ileorectal anastomotic site [ 1 ], gastric [ 1 ], esophageal anastomotic site [ 14 ], colorectal anastomotic site (Crohn’s disease) [ 15 ], esophagogastric junction [ 11 ], colon [ 11 ], rectosigmoid anastomotic site [ 20 ], and gastrojejunostomy site [ 22 ]. The majority of the strictures were post-surgical anastomotic strictures [ 1 , 13 - 15 , 17 - 22 ], but there were also strictures secondary to long-standing inflammation, such as peptic ulcer disease [ 11 , 16 , 18 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…Only a few authors reported the length and/or diameter of the stricture and this varied widely across different studies and within each study [ 1 , 11 , 14 , 15 , 19 , 21 , 22 ]. The longest stricture was reported to be 4 cm in length at a gastrojejunal anastomosis [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

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Efficacy and safety of lumen-apposing metal stent for benign gastrointestinal stricture

Jain

Patel

Ali

et al. 2018

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Management of benign gastrointestinal (GI) strictures refractory to primary (balloon and savary dilation) and secondary (steroid injection, fully covered self-expanding metal stent, incision therapy) treatment modalities remains a challenge. Lumen-apposing metal stents (LAMSs), originally designed for the management of pancreatic fluid collections, are an attractive option for GI stricture because of their anti-migratory property, attributable to their saddle-shaped design. In this article, we reviewed 70 patients from 12 original studies who received LAMS for refractory (68/70) or treatment-naïve (2/70) benign GI stricture. The technical and clinical success rates were 98.6% (69/70) and 79.7% (55/69), respectively. Endoscopic placement, with or without fluoroscopic guidance, was generally successful, with only a minority requiring endoscopic ultrasound (EUS) guidance where the lumen was completely obscured. The majority of the strictures were short (≤1 cm), but comparable technical and clinical success was noted in isolated cases with long strictures, where 2 overlapping LAMSs were placed. For the overall population, a failure rate of 21.5% (14/69) was noted and was attributed to either lack of follow up, or to persistent or de novo symptoms requiring stent removal/exchange or surgical referral. One perforation (1.4%), five stent migration events (7.1%), two bleeding events (2.9%) and two de novo strictures proximal to the LAMS (2.9%) were reported for the entire study cohort. No mortality was attributable to LAMS placement. Although experience is still evolving, LAMS placement guided by esophagogastroduodenoscopy or EUS is a technically feasible and safe procedure with good clinical outcomes for benign refractory GI strictures.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Efficacy and safety of lumen-apposing metal stent for benign gastrointestinal stricture

Jain

Patel

Ali

et al. 2018

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“…Diagnosis is usually made with imaging and confirmed via endoscopy. A total of 138 patients were reviewed in the 4 retrospective studies and 13 case reports [13][14][15][16][17][18][19][20][21][22][23][24]. The patients were predominantly female, with ages ranging from 18-86 years.…”

Section: Discussionmentioning

confidence: 99%

“…A total of 11 patients in the reviewed literature had a LAMS used to treat a colonic stricture [14][15][16]23]. Ten patients had colonic anastomotic strictures and 1 other patient had a colonic stricture with the etiology unreported.…”

Section: Colonic/rectal Stricturesmentioning

confidence: 99%

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

Larson¹

2019

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The management of short-segment benign gastrointestinal (GI) strictures refractory to currently available endoscopic treatments (endoscopic balloon dilation, intralesional steroid injection, incisional therapy and fully covered self-expanding metal stents) proves to be challenging. Lumenapposing metal stents (LAMS), originally developed for access to and drainage of pancreatic fluid collections, are being used in an off-label manner for the treatment of short GI luminal strictures. The short length and wide flanges make LAMS potentially suitable for this indication and may reduce complications and improve patient tolerance. In this article we review the published literature, including 138 patients from 4 retrospective studies and 13 case reports who received a LAMS for the treatment of a short GI luminal stricture. In the reviewed literature only 2 of the 138 cases had immediate adverse events warranting hospitalization: perforation and postoperative GI bleed. A total adverse event rate of 32.5% (45 of 138 cases) was reported. Migration was the most common adverse event, accounting for 40% of the total. Nearly 58% of reported patients had symptom and stricture resolution after stent removal in the reviewed studies. Follow up varied from 28-352 days after stent removal. Although more data are needed to determine their long-term safety and efficacy, LAMS represent an important alternative to traditional endoscopic options when approaching patients with short GI luminal strictures.

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Lumen Apposition: A Changing Landscape in Therapeutic Endoscopy

McCarty

Thompson

2022

Dig Dis Sci

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Treatment of a benign, anastomotic refractory rectal stricture with an AXIOS stent

Cited by 11 publications

References 2 publications

Efficacy and safety of lumen-apposing metal stent for benign gastrointestinal stricture

Efficacy and safety of lumen-apposing metal stent for benign gastrointestinal stricture

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

Lumen Apposition: A Changing Landscape in Therapeutic Endoscopy

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