Su1073 LUMEN APPOSING METAL STENT FOR GASTROINTESTINAL STRICTURES: EXPERIENCE FROM A TERTIARY CARE CENTER

Abstract

Background: Standard management of benign gastrointestinal strictures (GI) typically involves endoscopic balloon dilation. This method usually involves multiple endoscopic sessions for serial dilation of the strictures. With a greater number of invasive procedures comes increased risk of complications. Placing a covered metal stent is an option. But traditional covered metal stents are long and have a high migration rate. Lumen apposing metal stents (LAMS) are short (1 cm long) covered metal stents with a unique shape. LAMS has several advantages, including varying diameter (10 mm, 15 mm, 20 mm), a saddle-shaped design that decreases migration risk, and an easy deployment system allowing high technical success. We aimed to study the safety and efficacy of using LAMS (AXIOS, Boston Scientific, Marlborough, USA) in the treatment of gastrointestinal strictures. Methods: We retrospectively reviewed our endoscopic database to identify patients in whom LAMS was placed for management of gastrointestinal strictures in last 2 years. Patient demographics, location of the stricture, previous treatments, indication for the stent, size of the LAMS used, intraprocedural adverse events, post procedural adverse events, follow up data was collected. Technical success (successful placement of LAMS across the stricture), clinical success (complete resolution of the stricture on repeat endoscopy for benign strictures and being asymptomatic for malignant strictures), and intra-procedure and post-procedure adverse events were measured. Results: A total of 22 patients had LAMS placement for GI stricture. Most of the patients with benign strictures had failed prior conventional balloon dilations or were poor surgical candidates. Nineteen patients had benign strictures, 3 patients had malignant strictures. Technical success rate was 100% (22/ 22). Four patients were lost to follow up, and 2 are awaiting follow up endoscopy. In patients in whom follow up data is available, the clinical success rate is 87.5% (14/16). No intraprocedural or post procedural adverse events were noted. Please see Table 1 for details. Conclusion: LAMS can be successfully utilized as a safe and effective alternative for dilation of short segment benign GI strictures and as a palliative measure in malignant strictures. Larger studies are necessary to determine their overall long-term efficacy and safety.

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

“…A 15×10-mm LAMS was the most commonly used stent, with median stent dwell time varying from 60-119 days. Our study quality assessment found that 11 were of medium quality [ 14 - 18 , 21 , 22 , 24 , 26 - 28 ] and 7 were of low quality [ 11 - 13 , 19 , 20 , 23 , 25 ] ( ).…”