Endoscopy 2018; 50(04): S38-S39
DOI: 10.1055/s-0038-1637141
ESGE Days 2018 oral presentations
20.04.2018 – EUS: pancreas therapeutic
Georg Thieme Verlag KG Stuttgart · New York

TECHNICAL ISSUES (TIS) DURING EUS-GUIDED INSERTION OF LUMEN APPOSING METAL STENTS (LAMS): CLASSIFICATION, ANALYSIS OF THEIR EFFECT ON PROCEDURE OUTCOMES, RISK FACTORS AND SALVAGE TECHNIQUES

S Sevilla Ribota
1   Hospital Rio Hortega, Valladolid, Spain
,
J García-Alonso
1   Hospital Rio Hortega, Valladolid, Spain
,
R Sánchez-Ocaña Hernández
1   Hospital Rio Hortega, Valladolid, Spain
,
I Peñas Herrero
1   Hospital Rio Hortega, Valladolid, Spain
,
N Mora
1   Hospital Rio Hortega, Valladolid, Spain
,
R Torres Yuste
1   Hospital Rio Hortega, Valladolid, Spain
,
M Cimavilla
1   Hospital Rio Hortega, Valladolid, Spain
,
S Bazaga Pérez de Rozas
1   Hospital Rio Hortega, Valladolid, Spain
,
C de la Serna Higueras
1   Hospital Rio Hortega, Valladolid, Spain
,
M Pérez-Miranda Castillo
1   Hospital Rio Hortega, Valladolid, Spain
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

 

Aims:

LAMS have been recently introduced, presenting promising results in intraabdominal drainages and endoscopic anastomoses. A variety of TIs might appear but we lack a common terminology to address them and their consequences on outcomes are unknown.

Methods:

All consecutive patients undergoing an endoscopic procedure which included in its planning the deployment of a LAMS between May 2011 and June 2017 at a single tertiary center were prospectively enrolled (table 1). We propose a novel classification of TIs, categorized in dislodgment, access failure, liberation failures and misplacements. We analyzed their incidence, risk factors, management and effect on outcomes

Results:

A total of 289 procedures (47.4% pancreatic fluid collections, 22.2% gallbladder drainages, 13.8% enteric anastomoses, 16.6% others) were analyzed. TI developed in 27% of them, significantly decreasing the technical (99.5% vs. 52.6%, p < 0.001), procedural (100% vs. 82.1%, p < 0.001) and clinical success rates (88% vs. 77.9%, p = 0.03). Distal (25.6%) and proximal flange misplacements (17.9%) and complete liberation failures (17.9%) were the most frequently encountered. Forceps repositioning, placement of coaxial stents and deploying a different type of stent were the most frequent salvage techniques (83.3% of all the TIs). A larger stent saddle (OR: 3.32 (1.05 – 10.56)) and malignant disease (OR: 1.98 (1.07 – 3.65)) were associated to the development of TI on multivariate analysis. Enteric anastomoses (OR 3.42 (1.22 – 9.62)) and malignant disease (OR: 2.8 (1.04 – 7.51)) were associated to the development of distal flange misplacement.

Tab. 1:

Characteristics of the study population and the pr

Age, median (IQR)

71.6 (58.3 – 83.5)

Male sex, n (%)

184 (63.7%)

Malignant disease, n (%)

75 (26%)

Access, n (%)

Stomach

Duodenum

Jejunum

Esophagus

Missing

215 (74.4%)

63 (21.8%)

6 (2.1%)

3 (1%)

2 (0.7%)

LAMS type, n (%)

Hot

Cold

Missing

170 (58.8%)

116 (40.1%)

3 (1%)

Conclusions:

The transmural insertion of PAL Axios EUS-guided is associated in one of every four cases to various Tis, typically distal flange misplacement in the mobile targets. 83.3% of these Tis can be rescued, mainly through the insertion of another stent.