Expanding Role of Lumen-Apposing Metal Stents in the GI Tract.

Purpose of review: Lumen-apposing metal stents (LAMS) are fully covered self-expandable metal stents specifically designed for the endoscopic drainage of pancreatic fluid collections. Initially utilized for pancreatic fluid collections, LAMS are increasingly being applied for various other indications like endoscopic gastroenterostomy, choledochoduodenostomy, drainage of gall bladder, facilitation of ERCP in surgically altered anatomy, and management of refractory gastrointestinal strictures. The availability of electrocautery-enhanced version has simplified the deployment of LAMS and paved the way for their use in these off-label indications. This review summarizes the current evidence regarding the expanding indications of LAMS in the gastrointestinal tract. Recent findings: Endoscopic ultrasound (EUS)-guided biliary drainage using LAMS is a safe and effective alternative to ERCP with the advantage of lower post-ERCP pancreatitis and less re-interventions due to higher stent patency. EUS-guided gastroenterostomy with LAMS provides effective palliation in cases with malignant gastric outlet obstruction. Preliminary data suggests their superiority over enteral stenting, and the results may improve further with the use of large caliber LAMS (20 mm). EUS-directed transgastric ERCP is feasible and safe in cases with surgically altered anatomy. The risk of LAMS migration during ERCP may be reduced by stent fixation using endosuturing and using a larger caliber LAMS (20 mm). LAMS may be effective in selected cases with refractory gastrointestinal strictures (mainly anastomotic). However, encouraging results in the short term may be offset by a high rate of re-interventions on long-term follow-up. Summary: LAMS are potentially useful for a wide range of indications in gastrointestinal tract. While, the role of LAMS has been established for pancreatic fluid collections, EUS-biliary drainage, and gastroenterostomy, their use for other indications like transgastric ERCP and benign strictures is still evolving. [ABSTRACT FROM AUTHOR]