EUS-guided stent removal in buried lumen-apposing metal stent syndrome: a case series

Abstract

Background and Aims: Lumen-apposing metal stents (LAMSs) play an increasing role in transgastric and transduodenal drainage of pancreatic fluid collections and allow novel EUS-guided interventions. Alongside the main adverse events of bleeding and occlusion, LAMSs can be overgrown by mucosa, which leads to the inability to visualize the stent in endoscopy. Methods: We describe a series of 4 cases of buried LAMSs that were removed under EUS guidance for identification of the stent followed by removal with rat-tooth forceps. Results: The median in situ time of the LAMSs in the reported 4 cases was 53 days. All stents could no longer be visualized endoscopically when drainage of necrosis was complete. All 4 buried LAMSs could be identified by EUS and were removed successfully with forceps. In 1 case, balloon dilation of the stent tract was performed before stent removal. No adverse events were observed after the procedure. Conclusions: Buried stent syndrome is a rare adverse event of LAMSs. Here we describe a safe and effective approach for stent identification and removal without prior mucosal dissection. (VideoGIE 2019;5:37-40.

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

“…Longer indwell times have been previously reported as a risk factor for embedment, using a 4-week threshold 12 23 . We identified a slightly longer threshold, with a 3.1 % embedment rate in the first 6 weeks and a 15.9 % risk in the following 6 weeks.…”

Endoscopic ultrasound-guided stent-in-stent bridging for a late buried gastroenteric lumen-apposing metal stent

“…LAMS bypass of the tumor generally decreases the risk of ingrowth 3 . The approach we describe here to address recurrent GOO caused by a late buried LAMS involves a combination of the previously reported EUS-guided removal of a LAMS buried in walled-off necrosis 4 , together with stent bridging as used in type I and II acute stent misdeployment 5 . In our case, the technically simpler choice of duodenal stenting that was initially used failed to relieve the GOO; however, EUS-guided stent-in-stent bridging was highly effective in both the short and longer term.…”

Endoscopic transmural drainage and necrosectomy in acute necrotizing pancreatitis: A review

“…Their characteristics and associated adverse events are listed in Table 1. [38][39][40][41][42][43][44][45][46][47][48] These three types of stents are used extensively in practice. There have been limited studies comparing their clinical efficacy and safety, and produced inconsistent results, leaving stent selection a contentious topic.…”

“…Another worrisome complication of LAMS is buried stent syndrome, which can make it difficult to remove a stent, introducing a risk of perforation and bleeding on removal. [46] De Angelis CG et al [47] analyzed all eligible articles reporting timing and complications of LAMS removal. Their conclusion supported the 4-week timing for LAMS removal, as recommended by European Society of Gastrointestinal Endoscopy (ESGE) guidelines.…”