Fast endoscopic rendezvous to the rescue after maldeployment of lumen-apposing metal stent during endoscopic ultrasound-guided choledochoduodenostomy

Armellini, Elia; Metelli, Flavio; Albani, Antonio Piazzini; Vescovi, Lorenzo; Spinelli, Luisella; Pace, F.

doi:10.1055/a-1929-9148

Cited by 1 publication

(2 citation statements)

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“…As reported in literature, the most common causes of LAMS misdeployment are related to difficult scope position[ 17 , 28 , 39 ] and small CBD diameter (< 15 mm)[ 21 , 27 , 34 ]. In a retrospective analysis by Jacques et al [ 23 ] involving 52 patients who underwent LAMS placement using various techniques, the technical and clinical success rates were 88.5% and 100%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Wire access into the CBD could be regained in some cases, allowing endoscopic rescue maneuvers to be performed, even in cases of non-identifiable CBD on EUS imaging[ 28 , 35 ]. Our data show that over-the-wire deployment of a tubular stent, particularly a biliary SEMS, was the preferred rescue procedure for LAMS misdeployment during EUS-CDS (44.1%).…”

Section: Discussionmentioning

confidence: 99%

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Lumen-apposing-metal stent misdeployment in endoscopic ultrasound-guided drainages: A systematic review focusing on issues and rescue management

Armellini¹,

Metelli²,

Anderloni³

et al. 2023

World J Gastroenterol

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BACKGROUND The introduction of lumen-apposing metal stents (LAMS) for endoscopic ultrasound (EUS)-guided drainages has marked a turning point in the field of interventional ultrasound and it is gathering worldwide diffusion in different clinical settings. Nevertheless, the procedure may conceal unexpected pitfalls. LAMS misdeployment is the most frequent cause of technical failure and it can be considered a procedure-related adverse event when it hampers the conclusion of the planned procedure or results in significant clinical consequences. Stent misdeployment can be managed successfully by endoscopic rescue maneuvers to allow the completion of the procedure. To date, no standardized indication is available to guide an appropriate rescue strategy depending on the type of procedure or of misdeployment. AIM To evaluate the incidence of LAMS misdeployment during EUS-guided choledochoduodenostomy (EUS-CDS), gallbladder drainage (EUS-GBD) and pancreatic fluid collections drainage (EUS-PFC) and to describe the endoscopic rescue strategies adopted under the circumstance. METHODS We conducted a systematic review of the literature on PubMed by searching for studies published up to October 2022. The search was carried out using the exploded medical subject heading terms “lumen apposing metal stent”, “LAMS”, “endoscopic ultrasound” and “choledochoduodenostomy” or “gallbladder” or “pancreatic fluid collections”. We included in the review on-label EUS-guided procedures namely EUS-CDS, EUS-GBD and EUS-PFC. Only those publications reporting EUS-guided LAMS positioning were considered. The studies reporting a technical success rate of 100% and other procedure-related adverse events were considered to calculate the overall rate of LAMS misdeployment, while studies not reporting the causes of technical failure were excluded. Case reports were considered only for the extraction of data regarding the issues of misdeployment and rescue techniques. The following data were collected from each study: Author, year of publication, study design, study population, clinical indication, technical success, reported number of misdeployment, stent type and size, flange misdeployed and type of rescue strategy. RESULTS The overall technical success rate of EUS-CDS, EUS-GBD and EUS-PFC was 93.7%, 96.1%, and 98.1% respectively. Significant rates of LAMS misdeployment have been reported for EUS-CDS, EUS-GBD and EUS-PFC drainage, respectively 5.8%, 3.4%, and 2.0%. Endoscopic rescue treatment was feasible in 86.8%, 80%, and 96.8% of cases. Non endoscopic rescue strategies were required only in 10.3%, 16% and 3.2% for EUS-CDS, EUS-GBD, and EUS-PFC. The endoscopic rescue techniques described were over-the-wire deployment of a new stent through the created fistula tract in 44.1%, 8% and 64.5% and stent-in-stent in 23.5%, 60%, and 12.9%, respectively for EUS-CDS, EUS-GBD, and EUS-PFC. Further therapeutic option were endoscopic rendezvous in 11.8% of EU...

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