Lumen-apposing metal stents for approved and off-label indications: a single-centre experience
- PDF / 910,752 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 22 Downloads / 171 Views
and Other Interventional Techniques
Lumen‑apposing metal stents for approved and off‑label indications: a single‑centre experience Pieter Hindryckx1 · Helena Degroote1 Received: 20 June 2020 / Accepted: 3 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background and study aims Lumen-apposing stents (LAMS) are approved to treat peripancreatic collections and for gallbladder and bile duct drainage. Over the last years, LAMS have also been used for off-label indications including gastrojejunostomy, gastro-gastrostomy and drainage of postsurgical collections. We aimed to analyze indications, technical/clinical success rates and complications of all LAMS placed over the last 2 years. Patients and methods Data from 61 consecutive LAMS (Hot Axios, Boston Scientific) in 57 patients were analyzed. Technical success was defined as successful deployment of the LAMS in the desired position. Clinical success was defined as follows: for pancreatic collections: resolution without the need for non-endoscopic interventions; for choledochoduodenostomy: ≥ 50% drop in baseline serum bilirubin within 2 weeks AND patient can receive chemotherapy if indicated; for gastrojejunostomy: resolution of gastric outlet obstruction and successful re-initiation of oral intake; for gastro-gastrostomy: successful endoscopic access to the excluded stomach; for gallbladder or postsurgical collection drainage: resolution of sepsis. Results Indications were drainage of peripancreatic collections in 24 cases (39.3%), choledochoduodenostomy in 13 (21.3%), gastrojejunostomy in 6 (9.8%), gastro-gastrostomy in 13 (21.3%), gallbladder drainage in 1 (1.6%) and postsurgical collection drainage in 4 (6.6%). Overall technical and clinical success rates were high (57/61; 93.4% and 54/61; 88.5%, respectively). Clinical success rate for non-approved indications was 95.6% (22/23 cases). Complications occurred in 13 patients (21.3%, 4 serious). Conclusions LAMS are increasingly used in interventional endoscopy. In our cohort, more than one third of LAMS are placed for off-label indications, with a high success rate and acceptable complication rate. Keywords Lumen-apposing metal stents · Endoscopic ultrasound · Off-label Lumen-apposing metal stents (LAMS) are short, fully covered, self-expanding stents with a large diameter and both proximal and distal anchor flanges. They were originally developed to facilitate drainage of pancreatic fluid collections [1]. Later on, they got approved for galbladder drainage (for non-surgical candidates) and bile duct drainage (in case of failed ERCP or malignant distal biliary obstruction). Electrocautery-enhanced (“hot”) LAMS have now largely replaced the older “cold” version due to their simplicity of use (by obviating the need for multiple procedural steps). Currently, two electrocautery-enhanced LAMS are on * Pieter Hindryckx [email protected] 1
Department of Gastroenterology and Hepatology, University Hospital of Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium
Data Loading...
