Lumen-apposing metal stents for benign gastrointestinal tract strictures: An international multicenter experience

Abstract

AIMTo investigate technical feasibility, outcomes and adverse events of the lumen-apposing metal stent (LAMS) for benign gastrointestinal (GI) tract strictures.METHODSBetween July 2015 and January 2017, patients undergoing treatment by LAMS for benign GI strictures at three tertiary referral centers were included in this study. Primary outcomes included technical success, short-term clinical success, long-term clinical success, and adverse events. Short-term clinical success was defined as symptom resolution at 30 d after stent placement. Long-term clinical success was defined by symptom resolution at 60 d in patients who continued to have indwelling stent, or continued symptom resolution at 30 d after elective stent removal.RESULTSA total of 21 patients (mean age 62.6 years, 47.6% males) underwent placement of LAMS for benign GI strictures. A 15 mm × 10 mm LAMS was placed in 16 patients, a 10 mm × 10 mm LAMS was placed in 2 patients, and a 16 mm × 30 mm LAMS was placed in 3 patients. Technical success was obtained in all cases. Short-term clinical success was achieved in 19 out of 21 cases (90.5%), and long-term clinical success was achieved in 12 out of 18 (66.7%). Mean (range) stent indwell time was 107.2 (28-370) d. After a mean (range) dwell time of 104.3 (28-306) d, 9 LAMSs were removed due to the following complications: ulceration at stent site (n = 1), angulation (n = 2), migration (n = 4) and stricture overgrowth (n = 2). Migration occurred in 4 cases (19.0%), and it was associated with stricture resolution in one case. Median (range) follow-up period was 119 (31-422) d.CONCLUSIONUtilization of LAMS for benign strictures has shown to be technically feasible and safe, but adverse events highlight the need for further study of its indications.

Advances in the Treatment of Postsurgical Benign Colorectal Strictures

“…Other studies, such as those of Bazerbachi et al [37] or Santos-Fernandez et al [38], report higher stent migration rates (17.9 and 19%, respectively), at the expense of those implanted for colon strictures. Nonetheless, this complication is considerably less than that observed with conventional metal stents.…”

“…This characteristic led to its use in the treatment of benign strictures of the digestive tract. Several studies have assessed its usefulness, although with only a few patients and mostly concerning benign strictures of the upper digestive tract; however, some include postsurgical colon strictures [35][36][37][38]. The clinical success rate improves significantly as compared with the traditional covered metal stents, reducing the rate of stent migration and with a lower complication rate.…”

Lumen-apposing metal stents for gastrointestinal luminal strictures: current use and future directions

“…1). To date, 22 patients in the reviewed literature had a LAMS placed for an esophageal stricture [13][14][15][16]. Anastomotic strictures were the most common indication, seen in 17 of the 22 patients.…”

“…Santos-Fernandez et al reported 9 patients with esophageal strictures treated with a LAMS [14]. LAMS were left in place for 60 days or more and only 3 patients had symptom improvement or resolution after stent removal with the stent in place for longer than 60 days.…”

“…To date, 20 patients in the reviewed literature had a LAMS placed to treat a gastric stricture [14][15][16][17][18][19][20]. The etiology of the strictures included anastomotic strictures, caustic injury, peptic ulcer disease with resultant peptic stricture formation, pyloric stenosis and 1 case of malignant pyloric stenosis (Fig.…”