Efficacy of lumen-apposing metal stents for the management of benign gastrointestinal stricture: a systematic review and meta-analysis

Abstract

Background Lumen-apposing metal stents (LAMS) are an evolving option for the management of benign gastrointestinal (GI) strictures. Multiple studies have reported on the efficacy and safety of LAMS for benign GI strictures, but were limited by their small sample size. Hence, we conducted this meta-analysis to assess the critical role of LAMS for the management of benign GI strictures. Methods A literature search of various databases from inception until October 2022 was conducted for studies evaluating the outcome of LAMS in patients with benign GI strictures. The outcomes assessed included technical and clinical success, adverse events including stent migration, and reintervention. Pooled event rates across studies were expressed with summative statistics. Results A total of 18 studies (527 patients) were included in the present analysis. The pooled event rates for technical, short-term and long-term clinical success were 99.9% (95% confidence interval [CI] 99.1-100.0), 93.9% (95%CI 90.7-100.0), and 72.8% (95%CI 55.7-90.0), respectively. The pooled incidence of adverse events and stent migration with LAMS for benign GI strictures was 13.5% (95%CI 8.6-18.5) and 10.6% (95%CI 6.0-15.2), respectively. The pooled event rate for reintervention with LAMS for GI strictures was 23.0% (95%CI 15.7-30.3). In a subgroup analysis focusing only on anastomotic strictures there was no significant difference in the pooled event rates for various outcomes. Conclusions LAMS have a high technical and short-term clinical success rate, with an acceptable safety profile for the management of benign GI strictures. Further studies are needed to determine the appropriate duration of stent therapy and long-term outcomes.

A Successful 12-Month Trial of a Lumen-Apposing Self-Expandable Metallic Stent on a Benign Recalcitrant After Surgical Stricture

“…A meta-analysis noted a relatively low pooled major and minor adverse event rate of 13.5% for use in benign strictures. 8 Major events included fistulation to an adjacent organ (1.8%), ulceration (0.5%), bleeding (2.3%), and perforation (0.1%). Minor events included periprocedural heartburn (11.1%) and pain (5.7%).…”

“…Minor events included periprocedural heartburn (11.1%) and pain (5.7%). 8 However, evidence for its long-term efficacy has been inconsistent. Technical success, defined as stent deployment across a stricture with endoscopically confirmed patency, is typically > 95%.…”