Luminal-apposing stents for benign intraluminal strictures: a large United States multicenter study of clinical outcomes.
Lumen-apposing metal stent
gastrointestinal stricture
stent migration
Journal
Annals of gastroenterology
ISSN: 1108-7471
Titre abrégé: Ann Gastroenterol
Pays: Greece
ID NLM: 101121847
Informations de publication
Date de publication:
2021
2021
Historique:
received:
10
04
2020
accepted:
16
06
2020
entrez:
8
1
2021
pubmed:
9
1
2021
medline:
9
1
2021
Statut:
ppublish
Résumé
The use of fully covered lumen-apposing metal stents (LAMS) for benign short gastrointestinal (GI) strictures has been reported. This study aimed to evaluate the safety and efficacy of LAMS for refractory GI strictures. A retrospective analysis was performed of patients who underwent LAMS placement for benign GI strictures in 8 United States centers. The primary outcomes were technical success and initial clinical response. Secondary outcomes were reintervention rate and adverse events. A total of 51 patients underwent 61 LAMS placement procedures; 33 (64.7%) had failed previous treatments. The most common stricture location was the pylorus (n=17 patients). Various sizes of stents were used, with 15-mm LAMS placed in 45 procedures, 20-mm LAMS in 14 procedures, and 10-mm LAMS in 2 procedures. The overall technical success, short-term clinical response and reintervention rate after stent removal were 100%, 91.8% and 31.1%, respectively. Adverse events were reported in 17 (27.9%) procedures, with stent migration being the most common (13.1%). In subgroup analysis, both 15 mm and 20 mm stents had comparable short-term clinical response and adverse event rates. However, stent migration (15.6%) was the most common adverse event with 15-mm LAMS while pain (14.3%) was the most common with 20-mm LAMS. The reintervention rate was 80% at 200-day follow up after stent removal. Using LAMS for treatment of short benign GI strictures is safe and effective. Larger LAMS, such as the new 20 mm in diameter, may have a lower stent migration rate compared to smaller diameter LAMS.
Sections du résumé
BACKGROUND
BACKGROUND
The use of fully covered lumen-apposing metal stents (LAMS) for benign short gastrointestinal (GI) strictures has been reported. This study aimed to evaluate the safety and efficacy of LAMS for refractory GI strictures.
METHODS
METHODS
A retrospective analysis was performed of patients who underwent LAMS placement for benign GI strictures in 8 United States centers. The primary outcomes were technical success and initial clinical response. Secondary outcomes were reintervention rate and adverse events.
RESULTS
RESULTS
A total of 51 patients underwent 61 LAMS placement procedures; 33 (64.7%) had failed previous treatments. The most common stricture location was the pylorus (n=17 patients). Various sizes of stents were used, with 15-mm LAMS placed in 45 procedures, 20-mm LAMS in 14 procedures, and 10-mm LAMS in 2 procedures. The overall technical success, short-term clinical response and reintervention rate after stent removal were 100%, 91.8% and 31.1%, respectively. Adverse events were reported in 17 (27.9%) procedures, with stent migration being the most common (13.1%). In subgroup analysis, both 15 mm and 20 mm stents had comparable short-term clinical response and adverse event rates. However, stent migration (15.6%) was the most common adverse event with 15-mm LAMS while pain (14.3%) was the most common with 20-mm LAMS. The reintervention rate was 80% at 200-day follow up after stent removal.
CONCLUSIONS
CONCLUSIONS
Using LAMS for treatment of short benign GI strictures is safe and effective. Larger LAMS, such as the new 20 mm in diameter, may have a lower stent migration rate compared to smaller diameter LAMS.
Identifiants
pubmed: 33414619
doi: 10.20524/aog.2020.0538
pii: AnnGastroenterol-34-33
pmc: PMC7774669
doi:
Types de publication
Journal Article
Langues
eng
Pagination
33-38Informations de copyright
Copyright: © 2021 Hellenic Society of Gastroenterology.
Déclaration de conflit d'intérêts
Conflict of Interest: Meir Mizrahi: Boston Scientific – Consultant. Yazan Fahmawi indicated no relevant financial relationships. Manoj Kumar indicated no relevant financial relationships. Benjamin Tharian: Boston Scientific – Consultant. Salman Ali Khan indicated no relevant financial relationships. Sumant Inamdar indicated no relevant financial relationships. Neil Sharma: Boston Scientific – Consultant. Dushant Uppal indicated no relevant financial relationships. Vanessa Shami indicated no relevant financial relationships. Mahmood Syed Kashif indicated no relevant financial relationships. Moamen Gabr indicated no relevant financial relationships. Douglas Pleskow: Boston scientific – Consultant. Tyler Berzin: Boston Scientific – Consultant. Douglas Adler: Boston Scientific – Consultant
Références
Gastrointest Endosc. 2017 Jun;85(6):1285-1289
pubmed: 27633158
Endosc Int Open. 2017 Sep;5(9):E861-E867
pubmed: 28924591
World J Gastrointest Endosc. 2018 Oct 16;10(10):294-300
pubmed: 30364856
Can J Gastroenterol Hepatol. 2018 Apr 12;2018:7070961
pubmed: 29850458
Endoscopy. 2016 Feb;48(2):141-8
pubmed: 26528754
World J Gastrointest Endosc. 2017 Dec 16;9(12):571-578
pubmed: 29290912
World J Gastrointest Endosc. 2010 Jan 16;2(1):29-35
pubmed: 21160676
Am J Gastroenterol. 2005 Nov;100(11):2419-25
pubmed: 16279894
Endoscopy. 2015 Jan;47(1):63-7
pubmed: 25268308
Endoscopy. 2017 Apr;49(4):327-333
pubmed: 28114688
Ann Gastroenterol. 2017;30(5):473-485
pubmed: 28845102
J Clin Gastroenterol. 2019 Sep;53(8):560-573
pubmed: 31149932
Gastrointest Endosc. 2012 Apr;75(4):712-8
pubmed: 22284093
Gastrointest Endosc. 2013 Nov;78(5):787-93
pubmed: 23871095
Am J Gastroenterol. 1999 Jun;94(6):1497-501
pubmed: 10364013
Gastrointest Endosc. 2014 May;79(5):844-51
pubmed: 24472762
Gastroenterology. 2014 Sep;147(3):566-8
pubmed: 24975458