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Safety and efficacy of coaxial lumen-apposing metal stents in the management of refractory gastrointestinal luminal strictures: a multicenter study
- Source :
- Endoscopy International Open, Vol 05, Iss 09, Pp E861-E867 (2017), Endoscopy International Open
- Publication Year :
- 2017
- Publisher :
- Georg Thieme Verlag KG, 2017.
-
Abstract
- Background and aims Benign gastrointestinal (GI) strictures are often refractory to standard endoscopic interventions. Fully covered coaxial lumen-apposing metal stents (LAMS) have emerged as a novel therapy for these strictures. The aim of this study was to evaluate the safety and efficacy of LAMS for refractory GI strictures. Patients and methods A retrospective analysis was performed for patients who underwent LAMS placement for benign luminal strictures in three US centers between January 2014 and December 2016. The primary outcomes were technical success and initial clinical success of LAMS placement. Secondary outcomes were stent migration, rate of re-intervention, and adverse events. Results A total of 49 patients underwent 56 LAMS placement procedures. Previous treatment had failed in 39 patients (79.6 %), and anastomotic strictures were the indication in 77.6 % (38/49), with the most common site being gastrojejunal (34.7 % [17/49]). Technical success was achieved in all procedures and initial clinical success was achieved in 96.4 % of all procedures (54/56). Patient initial clinical success was 95.9 % (47/49). Stent migration occurred in 17.9 % of procedures, and was more likely to occur at sites in the lower GI tract (P = 0.02). The mean stent dwell time was 100.6 days, and the mean follow-up was 169.8 days. Minor adverse events, not requiring hospitalization, occurred in 33.9 % of procedures, including subsequent stricture progression (10.7 %). In cases where LAMS were removed, mean follow-up time was 102.2 days. The re-intervention rate was 75 % at 300 days follow-up after stent removal. Of the LAMS placed at anastomotic strictures, 36.4 % required re-intervention, with approximately two-thirds of these re-interventions requiring placement of a new stent or surgery. Conclusion LAMS placement was successful for the management of refractory GI strictures, with good technical and initial clinical success rates. However, re-intervention rates after LAMS removal were high, and many strictures were not resolved by an extended period of stenting with these coaxial stents. LAMS placement offers additional therapeutic options and in selected cases might be considered a destination therapy for patients with recalcitrant benign strictures.
- Subjects :
- medicine.medical_specialty
Original article
business.industry
medicine.medical_treatment
Technical success
Lumen (anatomy)
Stent
Anastomosis
Surgery
03 medical and health sciences
0302 clinical medicine
Multicenter study
Stent removal
030220 oncology & carcinogenesis
medicine
030211 gastroenterology & hepatology
Pharmacology (medical)
lcsh:Diseases of the digestive system. Gastroenterology
lcsh:RC799-869
business
Adverse effect
Destination therapy
Subjects
Details
- Language :
- English
- ISSN :
- 21969736 and 23643722
- Issue :
- 09
- Database :
- OpenAIRE
- Journal :
- Endoscopy International Open
- Accession number :
- edsair.doi.dedup.....76a2d8f3d27f5c28f9f96fc442299648