Current uses of electro-cautery lumen apposing metal stents in endoscopic ultrasound guided interventions

Abstract

The electro-cautery lumen apposing metal stent (EC-LAMS) is a newly developed device that integrates the electro-cautery cyctotome with the one-step metal stent delivery and releasing system in recent years. LAMS was first designed to complete the drainage of pancreatic fluid collection under endoscopic ultrasound guidance, and the technological innovation of EC-LAMS has made more off-labeled indications of endoscopic intervention for gastrointestinal diseases realized, such as abdominal fluid drainage, bile duct, or gallbladder drainage through stomach or duodenum, gastrointestinal anastomosis, and the establishment of fistulous channel for further endoscopic operation when necessary. The unique feature of this metal stent is that it has the design of a saddle shape and a large lumen, and can almost connect the adjacent structures to minimize the risk of perforation and leakage. Compared with traditional LAMS, EC-LAMS, an advanced integrated device, can greatly simplify the endoscopic process, shorten the procedure time and reduce the technical difficulty, thus it can help endoscopists complete more complex endoscopic interventions. In this review, we discuss the state of art with regard to EC-LAMS and its endoscopic process, current indications, outcomes, adverse events, and future application prospects.

Revealing Insights: A Comprehensive Overview of Gastric Outlet Obstruction Management, with Special Emphasis on EUS-Guided Gastroenterostomy

“…More recently, electrocautery-enhanced LAMS (EC-LAMS, HOT AXIOS) have been created: permitting incision, tract expansion, and stent deployment in a one-step procedure without the guidewire utilization, thus simplifying the procedure and reducing the risk of complications. Moreover, by avoiding the guidewire implementation, the risk of small bowel moving away from the stomach diminishes [28], thus reducing the risk of misdeployment of the distal flange.…”

Management of Malignant Gastric Outlet Obstruction: A Comprehensive Review on the Old, the Classic and the Innovative Approaches

“…Moreover, these stents are completely covered, which prevents leakage through the anastomosis and reduces the chances of tissue ingrowth. The introduction of the electrocautery-enhanced LAMS (EC-LAMS) allowed a single-step procedure with the direct passage of the catheter into the target structure without prior access and tract dilation, thus avoiding device exchange [46,47]. This approach potentially reduces the risk of complications and procedure failure by minimizing the number of steps required for device exchanges.…”

Endoscopic Ultrasound-Guided Biliary Drainage

“…In recent years, lumen-apposing metal stents (LAMS) have been increasingly used in EUS-CDS, which can improve anastomotic creation and anchoring between the enteric lumen and the biliary tree [ 12 , 20 , 21 ]. Electrocautery-enhanced LAMS, in particular, allows for a single-stage biliary puncture and stent placement and, thus, has the potential to decrease the procedure difficulty and complication risk [ 21 , 22 ].…”