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

Abstract

The management of short-segment benign gastrointestinal (GI) strictures refractory to currently available endoscopic treatments (endoscopic balloon dilation, intralesional steroid injection, incisional therapy and fully covered self-expanding metal stents) proves to be challenging. Lumenapposing metal stents (LAMS), originally developed for access to and drainage of pancreatic fluid collections, are being used in an off-label manner for the treatment of short GI luminal strictures. The short length and wide flanges make LAMS potentially suitable for this indication and may reduce complications and improve patient tolerance. In this article we review the published literature, including 138 patients from 4 retrospective studies and 13 case reports who received a LAMS for the treatment of a short GI luminal stricture. In the reviewed literature only 2 of the 138 cases had immediate adverse events warranting hospitalization: perforation and postoperative GI bleed. A total adverse event rate of 32.5% (45 of 138 cases) was reported. Migration was the most common adverse event, accounting for 40% of the total. Nearly 58% of reported patients had symptom and stricture resolution after stent removal in the reviewed studies. Follow up varied from 28-352 days after stent removal. Although more data are needed to determine their long-term safety and efficacy, LAMS represent an important alternative to traditional endoscopic options when approaching patients with short GI luminal strictures.

Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021

“…It is believed that the typical wide flanges and short lengths of LAMSs may prevent stent migration. To date, LAMSs have only been investigated in mixed study populations restricted by small sample sizes [90][91][92][93][94]. More studies are needed to evaluate their potential benefit in RBES patients.…”

Use of lumen-apposing metal stents (LAMS) in the management of gastro jejunostomy stricture following Roux-en-Y Gastric Bypass for obesity: a prospective series

“…LAMS have been traditionally used for management of pancreatic pseudocysts [11], however they have been increasingly used for other Upper gastro intestinal luminal strictures [6]. They have also been used for low rectal strictures with some success [12].…”

“…Gastro jejunostomy strictures are relatively uncommon after RYGB. They present with dysphagia, nausea, abdominal pain and vomiting [6]. Some patients present with weight loss and hypoalbuminemia.…”

“…LAMS are designed for deployment through a therapeutic forward viewing endoscope [6]. The technique used was similar to deployment used in pancreatic pseudocysts [7].…”

Stents for benign esophageal strictures

“…Furthermore, some case reports have been published on the application of lumen apposing stents. This stent type-characterized by a saddle shape-may reduce the risk of stent migration, and has especially been used in patients with anastomotic strictures [35,36]. Although first results look promising, its application in benign esophageal strictures remains limited by its small barrel length [35,37,38].…”