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31.10.2022 | Original Article

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

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

Erschienen in: Surgical Endoscopy | Ausgabe 3/2023

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Abstract

Background

Lumen-apposing metal stents (LAMS) are an alternative therapeutic option for benign gastrointestinal (GI) tract strictures. Our study aimed to evaluate the safety and efficacy of LAMS for the management of benign GI strictures.

Methods

Consecutive patients who underwent a LAMS placement for benign luminal GI strictures at a tertiary care center between January 2014 and July 2021 were reviewed. Primary outcomes included technical success, early clinical success, and adverse events (AEs). Other outcomes included rates of stent migration and re-intervention after LAMS removal.

Results

One hundred and nine patients who underwent 128 LAMS placements (67.9% female, mean age of 54.3 ± 14.2 years) were included, and 70.6% of the patients had failed prior endoscopic treatments. The majority of strictures (83.5%) were anastomotic, and the most common stricture site was the gastrojejunal anastomosis (65.9%). Technical success was achieved in 100% of procedures, while early clinical success was achieved in 98.4%. The overall stent-related AE rate was 25%. The migration rate was 27.3% (35/128). Of these, five stents were successfully repositioned endoscopically. The median stent dwell time was 119 days [interquartile range (IQR) 68–189 days], and the median follow-up duration was 668.5 days [IQR: 285.5–1441.5 days]. The re-intervention rate after LAMS removal was 58.3%.

Conclusions

LAMS is an effective therapeutic option for benign GI strictures, offering high technical and early clinical success. However, the re-intervention rate after LAMS removal was high. In select cases, using LAMS placement as destination therapy with close surveillance is a reasonable option.
Literatur
1.
Zurück zum Zitat Kochhar R, Poornachandra KS (2010) Intralesional steroid injection therapy in the management of resistant gastrointestinal strictures. World J Gastrointest Endosc 2:61–68CrossRefPubMedPubMedCentral Kochhar R, Poornachandra KS (2010) Intralesional steroid injection therapy in the management of resistant gastrointestinal strictures. World J Gastrointest Endosc 2:61–68CrossRefPubMedPubMedCentral
2.
Zurück zum Zitat Larson B, Adler DG (2019) Lumen-apposing metal stents for gastrointestinal luminal strictures: current use and future directions. Ann Gastroenterol 32:141–146PubMed Larson B, Adler DG (2019) Lumen-apposing metal stents for gastrointestinal luminal strictures: current use and future directions. Ann Gastroenterol 32:141–146PubMed
3.
Zurück zum Zitat Bazerbachi F, Heffley JD, Abu Dayyeh BK, Nieto J, Vargas EJ, Sawas T, Zaghlol R, Buttar NS, Topazian MD, Wong Kee Song LM, Levy M, Keilin S, Cai Q, Willingham FF (2017) Safety and efficacy of coaxial lumen-apposing metal stents in the management of refractory gastrointestinal luminal strictures: a multicenter study. Endosc Int Open 5:E861-e867CrossRefPubMedPubMedCentral Bazerbachi F, Heffley JD, Abu Dayyeh BK, Nieto J, Vargas EJ, Sawas T, Zaghlol R, Buttar NS, Topazian MD, Wong Kee Song LM, Levy M, Keilin S, Cai Q, Willingham FF (2017) Safety and efficacy of coaxial lumen-apposing metal stents in the management of refractory gastrointestinal luminal strictures: a multicenter study. Endosc Int Open 5:E861-e867CrossRefPubMedPubMedCentral
4.
Zurück zum Zitat Jain D, Patel U, Ali S, Sharma A, Shah M, Singhal S (2018) Efficacy and safety of lumen-apposing metal stent for benign gastrointestinal stricture. Ann Gastroenterol 31:425–438PubMedPubMedCentral Jain D, Patel U, Ali S, Sharma A, Shah M, Singhal S (2018) Efficacy and safety of lumen-apposing metal stent for benign gastrointestinal stricture. Ann Gastroenterol 31:425–438PubMedPubMedCentral
5.
Zurück zum Zitat Kochhar R, Kochhar S (2010) Endoscopic balloon dilation for benign gastric outlet obstruction in adults. World J Gastroint Endosc 2:29–35CrossRef Kochhar R, Kochhar S (2010) Endoscopic balloon dilation for benign gastric outlet obstruction in adults. World J Gastroint Endosc 2:29–35CrossRef
6.
Zurück zum Zitat Santos-Fernandez J, Paiji C, Shakhatreh M, Becerro-Gonzalez I, Sanchez-Ocana R, Yeaton P, Samarasena J, Perez-Miranda M (2017) Lumen-apposing metal stents for benign gastrointestinal tract strictures: an international multicenter experience. World J Gastroint Endosc 9:571–578CrossRef Santos-Fernandez J, Paiji C, Shakhatreh M, Becerro-Gonzalez I, Sanchez-Ocana R, Yeaton P, Samarasena J, Perez-Miranda M (2017) Lumen-apposing metal stents for benign gastrointestinal tract strictures: an international multicenter experience. World J Gastroint Endosc 9:571–578CrossRef
7.
Zurück zum Zitat Hirdes MM, Siersema PD, Vleggaar FP (2012) A new fully covered metal stent for the treatment of benign and malignant dysphagia: a prospective follow-up study. Gastrointest Endosc 75:712–718CrossRefPubMed Hirdes MM, Siersema PD, Vleggaar FP (2012) A new fully covered metal stent for the treatment of benign and malignant dysphagia: a prospective follow-up study. Gastrointest Endosc 75:712–718CrossRefPubMed
8.
9.
Zurück zum Zitat Spaander MCW, van der Bogt RD, Baron TH, Albers D, Blero D, de Ceglie A, Conio M, Czakó L, Everett S, Garcia-Pagán JC, Ginès A, Jovani M, Repici A, Rodrigues-Pinto E, Siersema PD, Fuccio L, van Hooft JE (2021) Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2021. Endoscopy 53:751–762CrossRefPubMed Spaander MCW, van der Bogt RD, Baron TH, Albers D, Blero D, de Ceglie A, Conio M, Czakó L, Everett S, Garcia-Pagán JC, Ginès A, Jovani M, Repici A, Rodrigues-Pinto E, Siersema PD, Fuccio L, van Hooft JE (2021) Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2021. Endoscopy 53:751–762CrossRefPubMed
10.
Zurück zum Zitat Suzuki T, Siddiqui A, Taylor LJ, Cox K, Hasan RA, Laique SN, Mathew A, Wrobel P, Adler DG (2016) Clinical outcomes, efficacy, and adverse events in patients undergoing esophageal stent placement for benign indications: a large multicenter study. J Clin Gastroenterol 50:373–378CrossRefPubMed Suzuki T, Siddiqui A, Taylor LJ, Cox K, Hasan RA, Laique SN, Mathew A, Wrobel P, Adler DG (2016) Clinical outcomes, efficacy, and adverse events in patients undergoing esophageal stent placement for benign indications: a large multicenter study. J Clin Gastroenterol 50:373–378CrossRefPubMed
11.
Zurück zum Zitat Little AG, Naunheim KS, Ferguson MK, Skinner DB (1988) Surgical management of esophageal structures. Ann Thorac Surg 45:144–147CrossRefPubMed Little AG, Naunheim KS, Ferguson MK, Skinner DB (1988) Surgical management of esophageal structures. Ann Thorac Surg 45:144–147CrossRefPubMed
12.
Zurück zum Zitat Jue TL, Storm AC, Naveed M, Fishman DS, Qumseya BJ, McRee AJ, Truty MJ, Khashab MA, Agrawal D, Al-Haddad M, Amateau SK, Buxbaum JL, Calderwood AH, DeWitt J, DiMaio CJ, Fujii-Lau LL, Gurudu SR, Jamil LH, Kwon RS, Law JK, Lee JK, Pawa S, Sawhney MS, Thosani NC, Yang J, Wani SB (2021) ASGE guideline on the role of endoscopy in the management of benign and malignant gastroduodenal obstruction. Gastrointest Endosc 93:309-322.e304CrossRefPubMed Jue TL, Storm AC, Naveed M, Fishman DS, Qumseya BJ, McRee AJ, Truty MJ, Khashab MA, Agrawal D, Al-Haddad M, Amateau SK, Buxbaum JL, Calderwood AH, DeWitt J, DiMaio CJ, Fujii-Lau LL, Gurudu SR, Jamil LH, Kwon RS, Law JK, Lee JK, Pawa S, Sawhney MS, Thosani NC, Yang J, Wani SB (2021) ASGE guideline on the role of endoscopy in the management of benign and malignant gastroduodenal obstruction. Gastrointest Endosc 93:309-322.e304CrossRefPubMed
13.
Zurück zum Zitat Sharma P, McCarty TR, Chhoda A, Costantino A, Loeser C, Muniraj T, Ryou M, Thompson CC (2020) Alternative uses of lumen apposing metal stents. World J Gastroenterol 26:2715–2728CrossRefPubMedPubMedCentral Sharma P, McCarty TR, Chhoda A, Costantino A, Loeser C, Muniraj T, Ryou M, Thompson CC (2020) Alternative uses of lumen apposing metal stents. World J Gastroenterol 26:2715–2728CrossRefPubMedPubMedCentral
14.
Zurück zum Zitat Adler DG, Lanke G (2020) Clinical update on the role of EUS in pelvic abscess. Pract Gastroenterol 44:32–41 Adler DG, Lanke G (2020) Clinical update on the role of EUS in pelvic abscess. Pract Gastroenterol 44:32–41
15.
Zurück zum Zitat Mansoor MS, Tejada J, Parsa NA, Yoon E, Hida S (2018) Off label use of lumen-apposing metal stent for persistent gastro-jejunal anastomotic stricture. World J Gastroint Endosc 10:117–120CrossRef Mansoor MS, Tejada J, Parsa NA, Yoon E, Hida S (2018) Off label use of lumen-apposing metal stent for persistent gastro-jejunal anastomotic stricture. World J Gastroint Endosc 10:117–120CrossRef
16.
Zurück zum Zitat Bazerbachi F, Visrodia KH, Mavrogenis G, Song LMWK, Buttar NS (2020) Extrabiliary applications of fully covered antimigration biliary metal stents. VideoGIE 5:437–441CrossRefPubMedPubMedCentral Bazerbachi F, Visrodia KH, Mavrogenis G, Song LMWK, Buttar NS (2020) Extrabiliary applications of fully covered antimigration biliary metal stents. VideoGIE 5:437–441CrossRefPubMedPubMedCentral
17.
Zurück zum Zitat Cotton PB, Eisen GM, Aabakken L, Baron TH, Hutter MM, Jacobson BC, Mergener K, Nemcek A Jr, Petersen BT, Petrini JL, Pike IM, Rabeneck L, Romagnuolo J, Vargo JJ (2010) A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 71:446–454CrossRefPubMed Cotton PB, Eisen GM, Aabakken L, Baron TH, Hutter MM, Jacobson BC, Mergener K, Nemcek A Jr, Petersen BT, Petrini JL, Pike IM, Rabeneck L, Romagnuolo J, Vargo JJ (2010) A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 71:446–454CrossRefPubMed
18.
Zurück zum Zitat Rodrigues-Pinto E, Baron TH (2016) Evaluation of the AXIOS stent for the treatment of pancreatic fluid collections. Expert Rev Med Dev 13:793–805CrossRef Rodrigues-Pinto E, Baron TH (2016) Evaluation of the AXIOS stent for the treatment of pancreatic fluid collections. Expert Rev Med Dev 13:793–805CrossRef
19.
Zurück zum Zitat Gerzic ZB, Knezevic JB, Milicevic MN, Jovanovic BK (1990) Esophagocoloplasty in the management of postcorrosive strictures of the esophagus. Ann Surg 211:329–336CrossRefPubMedPubMedCentral Gerzic ZB, Knezevic JB, Milicevic MN, Jovanovic BK (1990) Esophagocoloplasty in the management of postcorrosive strictures of the esophagus. Ann Surg 211:329–336CrossRefPubMedPubMedCentral
20.
Zurück zum Zitat Yang D, Nieto JM, Siddiqui A, Riff BP, DiMaio CJ, Nagula S, Ismail AM, Ngamreungphong S, Khashab MA, Wagh MS, Tzimas D, Buscaglia JM, Strand DS, Wang AY, Chauhan SS, Forsmark CE, Draganov PV (2017) Lumen-apposing covered self-expandable metal stents for short benign gastrointestinal strictures: a multicenter study. Endoscopy 49:327–333CrossRefPubMed Yang D, Nieto JM, Siddiqui A, Riff BP, DiMaio CJ, Nagula S, Ismail AM, Ngamreungphong S, Khashab MA, Wagh MS, Tzimas D, Buscaglia JM, Strand DS, Wang AY, Chauhan SS, Forsmark CE, Draganov PV (2017) Lumen-apposing covered self-expandable metal stents for short benign gastrointestinal strictures: a multicenter study. Endoscopy 49:327–333CrossRefPubMed
21.
Zurück zum Zitat Hakim S, Khan Z, Shrivastava A, Koroglu E, Patil P, Akyuz F, Akyuz U, Ramireddy S, Badillo R, DaVee T, Thosani N (2021) Endoscopic Gastrointestinal Anastomosis Using Lumen-apposing Metal Stent (LAMS) for benign or malignant etiologies: a systematic review and meta-analysis. J Clin Gastroenterol 55:e56–e65PubMed Hakim S, Khan Z, Shrivastava A, Koroglu E, Patil P, Akyuz F, Akyuz U, Ramireddy S, Badillo R, DaVee T, Thosani N (2021) Endoscopic Gastrointestinal Anastomosis Using Lumen-apposing Metal Stent (LAMS) for benign or malignant etiologies: a systematic review and meta-analysis. J Clin Gastroenterol 55:e56–e65PubMed
22.
Zurück zum Zitat Dan DT, Gannavarapu B, Lee JG, Chang K, Muthusamy VR (2014) Removable esophageal stents have poor efficacy for the treatment of refractory benign esophageal strictures (Rbes). Dis Esophagus 27:511–517CrossRefPubMed Dan DT, Gannavarapu B, Lee JG, Chang K, Muthusamy VR (2014) Removable esophageal stents have poor efficacy for the treatment of refractory benign esophageal strictures (Rbes). Dis Esophagus 27:511–517CrossRefPubMed
23.
Zurück zum Zitat Fujii LL, Bonin EA, Baron TH, Gostout CJ, Wong Kee Song LM (2013) Utility of an endoscopic suturing system for prevention of covered luminal stent migration in the upper GI tract. Gastrointest Endosc 78:787–793CrossRefPubMed Fujii LL, Bonin EA, Baron TH, Gostout CJ, Wong Kee Song LM (2013) Utility of an endoscopic suturing system for prevention of covered luminal stent migration in the upper GI tract. Gastrointest Endosc 78:787–793CrossRefPubMed
24.
Zurück zum Zitat Jaganmohan S, Raju GS (2008) Tissue ingrowth in a fully covered self-expandable metallic stent (with videos). Gastrointest Endosc 68:602–604CrossRefPubMed Jaganmohan S, Raju GS (2008) Tissue ingrowth in a fully covered self-expandable metallic stent (with videos). Gastrointest Endosc 68:602–604CrossRefPubMed
25.
Zurück zum Zitat Wander P, Bartel MJ (2021) Endoscopic suturing device trapped in an esophageal stent: an adverse event and its resolution. Gastrointest Endosc 94:1143–1144CrossRefPubMed Wander P, Bartel MJ (2021) Endoscopic suturing device trapped in an esophageal stent: an adverse event and its resolution. Gastrointest Endosc 94:1143–1144CrossRefPubMed
26.
Zurück zum Zitat Wadhwa RP, Kozarek RA, France RE, Brandabur JJ, Gluck M, Low DE, Traverso WL, Moonka R (2003) Use of self-expandable metallic stents in benign GI diseases. Gastrointest Endosc 58:207–212CrossRefPubMed Wadhwa RP, Kozarek RA, France RE, Brandabur JJ, Gluck M, Low DE, Traverso WL, Moonka R (2003) Use of self-expandable metallic stents in benign GI diseases. Gastrointest Endosc 58:207–212CrossRefPubMed
27.
Zurück zum Zitat Chandrasekhara V, Topazian M, Abu Dayyeh BK, Levy MJ (2018) Re-deployment of a dislodged lumen-apposing metal stent (LAMS): avoiding the sacrificial LAMS. Endoscopy 50:E233-e234CrossRefPubMed Chandrasekhara V, Topazian M, Abu Dayyeh BK, Levy MJ (2018) Re-deployment of a dislodged lumen-apposing metal stent (LAMS): avoiding the sacrificial LAMS. Endoscopy 50:E233-e234CrossRefPubMed
28.
Zurück zum Zitat Gulati R, Rustagi T (2021) Endoscopic removal and replacement of the same lumen-apposing metal stent for multiple endoscopic necrosectomy sessions. Endoscopy 53:71–74CrossRefPubMed Gulati R, Rustagi T (2021) Endoscopic removal and replacement of the same lumen-apposing metal stent for multiple endoscopic necrosectomy sessions. Endoscopy 53:71–74CrossRefPubMed
29.
Zurück zum Zitat Hallac A, Srikureja W, Liu E, Dhumal P, Thatte A, Puri N (2018) Economical effect of lumen apposing metal stents for treating benign foregut strictures. World J Gastroint Endosc 10:294–300CrossRef Hallac A, Srikureja W, Liu E, Dhumal P, Thatte A, Puri N (2018) Economical effect of lumen apposing metal stents for treating benign foregut strictures. World J Gastroint Endosc 10:294–300CrossRef
30.
Zurück zum Zitat Pasricha S, Li N, Bulsiewicz WJ, Rothstein RI, Infantolino A, Ertan A, Camara DS, Dellon ES, Triadafilopoulos G, Lightdale CJ, Madanick RD, Lyday WD, Muthusamy RV, Overholt BF, Shaheen NJ (2015) Sex and race and/or ethnicity differences in patients undergoing radiofrequency ablation for Barrett’s esophagus: results from the U.S. RFA Registry. Gastroint Endosc 82:276–284CrossRef Pasricha S, Li N, Bulsiewicz WJ, Rothstein RI, Infantolino A, Ertan A, Camara DS, Dellon ES, Triadafilopoulos G, Lightdale CJ, Madanick RD, Lyday WD, Muthusamy RV, Overholt BF, Shaheen NJ (2015) Sex and race and/or ethnicity differences in patients undergoing radiofrequency ablation for Barrett’s esophagus: results from the U.S. RFA Registry. Gastroint Endosc 82:276–284CrossRef
Metadaten
Titel
Lumen-apposing metal stents for the treatment of benign gastrointestinal tract strictures: a single-center experience and proposed treatment algorithm
verfasst von
Tala Mahmoud
Azizullah Beran
Fateh Bazerbachi
Reem Matar
Veeravich Jaruvongvanich
Farah Abdul Razzak
Donna Maria Abboud
Eric J. Vargas
John A. Martin
Todd A. Kellogg
Omar M. Ghanem
Bret T. Petersen
Michael J. Levy
Ryan J. Law
Vinay Chandrasekhara
Andrew C. Storm
Louis M. Wong Kee Song
Navtej S. Buttar
Barham K. Abu Dayyeh
Publikationsdatum
31.10.2022
Verlag
Springer US
Erschienen in
Surgical Endoscopy / Ausgabe 3/2023
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-022-09715-8

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