A retrospective, multicenter analysis of incidents associated with Axios� lumen-apposing stents

Rozas, Sergio Bazaga Pérez de; Carbajo, Ana Yaiza; García‐Alonso, Francisco Javier; Martí, David; Soler, V. Sanchiz; Moreno, Belén Martínez; Tormo, José Ramón Aparicio; Sanz, Rafael Pedraza; Vila, Juan J.; Vázquez-Sequeiros, Enrique; Hernández, Rosanna Villanueva; Castro, Jeimy; Palacios, Marcos Jiménez; Higuera, Carlos de la Serna; Castillo, Manuel Pérez-Miranda

doi:10.17235/reed.2019.6147/2018

Cited by 8 publications

(6 citation statements)

References 21 publications

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“…dran et al identified a 6 % rate among 54 PFCs [21], and two other retrospective multicenter studies reported meagre embedment rates: 0.9 % (1/116 patients) among PFCs with a median indwell time of 7 weeks; 1.1 % (1/93) in a Spanish case series including different procedures with a median indwell time of 8.3 weeks [11,22]. However, a randomized trial comparing LAMSs and plastic stents in WONs reported a significantly higher rate of buried stents (6.5 % [2/31]), all of which required complex withdrawal maneuvers [9].…”

Section: Embedded Lams (N = 19)mentioning

confidence: 94%

“…While there are many published papers assessing LAMSrelated adverse events (AEs) [6][7][8][9], data regarding the safety of their removal are scarce and mainly retrospective. A retrospective single center study including 104 stent retrievals reported an 8.7 % AE rate, all of which were moderate or mild events [10]; another retrospective multicenter study involving 93 stent retrievals reported a 5.4 % retrieval-related AE rate, with two severe AEs (SAEs): a hemorrhage treated by embolization and a perforation that required surgical treatment [11].…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic removal of lumen-apposing metal stents – risk factors for stent embedment, complex removals, and adverse events: analysis from a multicenter prospective case series

et al. 2023

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Background Removing lumen-apposing metal stents (LAMSs) may be difficult and even harmful, but these features have seldom been analyzed. We aimed to generate a comprehensive assessment of the feasibility and safety of LAMS retrieval procedures. Methods A prospective multicenter case series including all technically successfully deployed LAMSs between January 2019 and January 2020 that underwent endoscopic stent removal. All retrieval-related data were prospectively recorded using standardized telephone questionnaires as part of centralized follow-up that ended after stent removal had been performed. Multivariable logistic regression models assessed the potential risk factors for complex removal. Results For the 407 LAMSs included, removal was attempted in 158 (38.8 %) after an indwell time of 46.5 days (interquartile range [IQR] 31–70). The median (IQR) removal time was 2 (1–4) minutes. Removal was labelled as complex in 13 procedures (8.2 %), although advanced endoscopic maneuvers were required in only two (1.3 %). Complex removal risk factors were stent embedment (relative risk [RR] 5.84, 95 %CI 2.14–15.89; P = 0.001), over-the-wire deployment (RR 4.66, 95 %CI 1.60–13.56; P = 0.01), and longer indwell times (RR 1.14, 95 %CI 1.03–1.27; P = 0.01). Partial and complete embedment were observed in 14 (8.9 %) and five cases (3.2 %), respectively. The embedment rate during the first 6 weeks was 3.1 % (2/65), reaching 15.9 % (10/63) during the following 6 weeks (P = 0.02). The adverse event rate was 5.1 %, including seven gastrointestinal bleeds (5 mild, 2 moderate). Conclusions LAMS removal is a safe procedure, mostly requiring basic endoscopic techniques attainable in conventional endoscopy rooms. Referral to advanced endoscopy units should be considered for stents with known embedment or long indwell times, which may require more technically demanding procedures.

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Section: Embedded Lams (N = 19)mentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Endoscopic removal of lumen-apposing metal stents – risk factors for stent embedment, complex removals, and adverse events: analysis from a multicenter prospective case series

et al. 2023

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“…The rate of adverse events ranges from 10.9% to 32.3%. 13,14 Bleeding or pseudoaneurysm formation is not uncommon, with rates ranging from 3.8% to 15.5%. 11,15 One study 11 did find an increased bleeding risk in LAMS compared with double-pigtail stents (DPS) [odds ratio (OR), 10.0; 95% confidence interval (CI), 1.…”

Section: Discussionmentioning

confidence: 99%

“…Complications associated with LAMS include stent occlusion, stent migration, gastric perforation, and bleeding or pseudoaneurysm formation. The rate of adverse events ranges from 10.9% to 32.3% 13,14. Bleeding or pseudoaneurysm formation is not uncommon, with rates ranging from 3.8% to 15.5% 11,15.…”

Section: Discussionmentioning

confidence: 99%

Interventional Radiology Management of Vascular Complications From Gastrointestinal Interventions

Narayanan¹,

Naidu²,

Alzubaidi³

et al. 2023

Contemporary Diagnostic Radiology

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Recent advances in gastrointestinal interventions have ledto the development of percutaneous and endoscopic procedures that can be performed in minimally invasive manner as an alternate to invasive surgery. Although the vast majority of these procedures have successful outcomes, there are potential complications. The diagnosis of these complications is often elusive. Interventional radiology can offer minimally invasive management of such complications. This educational activity aims to illustrate this through a review of several cases encountered at our institution.

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“…If the stent is deployed close to the pylorus, the stent lumen opens into the direction of food passage and the inner stent flange can obliterate the pylorus. [ 20 ] Several solutions can be used if this situation arises. One solution would be to apply a feeding tube to bypass the flange and avoid solid food intake as long as the clearance of the cavity is ongoing.…”

Section: Stent Maldeployment/stent Migrationmentioning

confidence: 99%

Mishaps with EUS–guided lumen-apposing metal stents in therapeutic pancreatic EUS: management and prevention

Braden,

Hocke,

Selvaraj

et al. 2023

Endosc Ultrasound

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EUS–guided interventions have become widely accepted therapeutic management options for drainage of peripancreatic fluid collections. Apart from endosonographic skills, EUS interventions require knowledge of the endoscopic stenting techniques and familiarity with the available stents and deployment systems. Although generally safe and effective, technical failure of correct stent positioning or serious adverse events can occur, even in experts' hands. In this article, we address common and rare adverse events in transmural EUS-guided stenting, ways to prevent them, and management options when they occur. Knowing the risks of what can go wrong combined with clinical expertise, high levels of technical skills, and adequate training allows for the safe performance of EUS-guided drainage procedures. Discussing the procedural risks and their likelihood with the patient is a fundamental part of the consenting process.

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A retrospective, multicenter analysis of incidents associated with Axios� lumen-apposing stents

Cited by 8 publications

References 21 publications

Endoscopic removal of lumen-apposing metal stents – risk factors for stent embedment, complex removals, and adverse events: analysis from a multicenter prospective case series

Endoscopic removal of lumen-apposing metal stents – risk factors for stent embedment, complex removals, and adverse events: analysis from a multicenter prospective case series

Interventional Radiology Management of Vascular Complications From Gastrointestinal Interventions

Mishaps with EUS–guided lumen-apposing metal stents in therapeutic pancreatic EUS: management and prevention

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