Coaxial Double-Pigtail Stent Placement: A Simple Solution to Decrease Bleeding Risk Associated With Lumen-Apposing Metal Stent?

Aslam, Shehroz; Ansari, Zaid; Alani, Mustafa; Srinivasan, Indu; Chuang, Keng–Yu

doi:10.7759/cureus.15981

Cited by 3 publications

(3 citation statements)

References 16 publications

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“…In a study by Garcia-Alonzo et al, LAMS migration in patients undergoing PFC drainage was 21% 16 . A strategy that has been reported in the literature to decrease the risk of stent migration is placing a double-pigtail stent within the LAMS to help anchor the stent 18 19 . Shamah et al in a retrospective analysis of 68 patients comparing 35 patients with LAMS and DPS versus 33 patients with LAMS alone found no significant difference in AEs or clinical outcomes between the two groups 20 .…”

Section: Discussionmentioning

confidence: 99%

Analysis of adverse events with lumen apposing metal stents for drainage of pancreatic fluid collections

Pawa,

Dorrell,

Nguyen

et al. 2023

Endosc Int Open

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Background and study aims Innovations in endoscopic management of pancreatic fluid collections (PFCs) using lumen apposing metal stents (LAMS) have rendered it a preferred approach for drainage of PFCs. These advances have not come without concern for adverse events (AEs). We present our experience with LAMS for drainage of PFCs and analyze factors that contribute to LAMS-related AEs. Patients and methods From November 2015 to October 2021, a retrospective analysis was performed of patients undergoing endoscopic management of PFCs using LAMS. All AEs were classified as either early (<48 hours) or late (>48 hours). Univariate and multivariate analysis were performed using logistic regression to assess the relationship between independent variables and AEs. Results A total of 119 patients with symptomatic PFCs underwent endoscopic drainage with LAMS. There were 16 AEs (12.4%). These included systemic inflammatory response syndrome (SIRS) (n=2), stent occlusion (n=5), bleeding (n=7), and stent migration (n=2). Univariate analysis of risk of AEs showed that no variables approached statistical significance. Of the seven patients who developed bleeding, five had pseudoaneurysms following LAMS placement and underwent angioembolization by an interventional radiologist. The average time to bleeding was 9.3 days (standard deviation 7.3) with all bleeding events occurring within 3 weeks. In a multivariate model, pseudocysts and presence of paracolic gutter extension were associated with an increased risk of bleeding. Conclusions Endoscopists should be aware of the risk factors for LAMS-related bleeding and tailor their drainage strategy, including utilization of plastic stents for drainage of pseudocysts and adherence to a strict imaging interval and follow-up protocol.

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Section: Discussionmentioning

confidence: 99%

Analysis of adverse events with lumen apposing metal stents for drainage of pancreatic fluid collections

Pawa,

Dorrell,

Nguyen

et al. 2023

Endosc Int Open

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“…In recent years, use of coaxial DPS in LAMS has been suggested to minimize risk of bleeding complication reported with LAMS use for drainage of (peri)pancreatic collections. Theoretically, this technique might help by preventing direct contact of mucosa and surrounding blood vessels following collapse of (peri)pancreatic collection cavity and thus minimizing risk of vessel erosion and subsequent bleeding [ 43 ]. However, high-quality evidence to support its use is lacking, and retrospective studies with small sizes have reported conflicting results.…”

Section: Coaxial Dps In Lamsmentioning

confidence: 99%

Endoscopic step up: When and how

Jearth

Rana

2022

Surgery Open Science

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“…The LAMS provides better anchorage, possibly reducing the migration rate, and allows access to the collections with the gastroscope through the stent to perform direct endoscopic necrosectomy. Furthermore, the use of the LAMS is safe with high clinical and technical success [ 5 , 6 ]. Among the various options of LAMS, the Hot-AxiosT system [ 7 ] is a practical and quick option for EUS drainage with a delivery system that allows the implantation of the stent in a short procedure time.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Treatment of Complex Walled-Off Necrosis in Necrotizing Pancreatitis With Two Simultaneous Lumen-Apposing Metal Stents: A Case Report

Santos¹,

Proença²,

Sasso³

et al. 2022

Cureus

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Organized pancreatic and peripancreatic collections are complications of pancreatitis and should be treated when symptomatic or complicated. When feasible, the endoscopic ultrasound approach presents high efficacy and low morbidity and mortality, making it the first likely option. Among the available accessories for endoscopic drainage, the lumen-apposing metal stent can be a better option, with a low migration rate; furthermore, it allows endoscopic necrosectomy. Here, we present the case of complex walled-off necrosis treated with two lumen-apposing metal stents in the same procedure.A 41-year-old male patient with walled-off necrosis presented with delayed gastric emptying and obstruction of the main biliary duct. Magnetic resonance imaging and endoscopic ultrasound revealed two non-communicating collections. We opted for endoscopic ultrasound-guided drainage with the deployment of two simultaneous lumen-apposing metal stents: one transduodenal and the other transgastric, with clinical improvement. After three weeks, endoscopic retrograde cholangiopancreatography showed a biliary fistula communicating with the periduodenal collection, which was treated with a biliary plastic stent. An endoscopic necrosectomy was performed, and the metal stents were removed. Control magnetic resonance imaging demonstrated improvement. The patient was asymptomatic at the six-month follow-up.The treatment of symptomatic complex walled-off necrosis remains a challenge and may require multiple endoscopic approaches; moreover, surgical treatment may be necessary in case of failure. In the present report, we demonstrate that the deployment of two lumen-apposing metal stents in the same procedure is feasible when necessary as it was associated with technical success and short-term clinical success.

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Coaxial Double-Pigtail Stent Placement: A Simple Solution to Decrease Bleeding Risk Associated With Lumen-Apposing Metal Stent?

Cited by 3 publications

References 16 publications

Analysis of adverse events with lumen apposing metal stents for drainage of pancreatic fluid collections

Analysis of adverse events with lumen apposing metal stents for drainage of pancreatic fluid collections

Endoscopic step up: When and how

Endoscopic Treatment of Complex Walled-Off Necrosis in Necrotizing Pancreatitis With Two Simultaneous Lumen-Apposing Metal Stents: A Case Report

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