Endoscopy 2020; 52(S 01): S314
DOI: 10.1055/s-0040-1705011
ESGE Days 2020 ePoster presentations
Thursday, April 23, 2020 09:00 – 17:00 Endoscopic ultrasound ePoster area
© Georg Thieme Verlag KG Stuttgart · New York

OFF-LABEL ENDOSCOPIC ULTRASOUND (EUS) APPLICATIONS OF ELECTROCAUTERY-ENHANCED LUMEN APPOSING METAL STENT (ECE-LAMS) IN GASTROINTESTINAL ENDOSCOPY (GIE): A SINGLE CENTER CASE SERIES EXPERIENCE

M Amata
1   ISMETT - IRCCS - UPMC ITAY, Digestive Endoscopy Service, Palermo, Italy
,
I Tarantino
1   ISMETT - IRCCS - UPMC ITAY, Digestive Endoscopy Service, Palermo, Italy
,
D Ligresti
1   ISMETT - IRCCS - UPMC ITAY, Digestive Endoscopy Service, Palermo, Italy
,
L Barresi
1   ISMETT - IRCCS - UPMC ITAY, Digestive Endoscopy Service, Palermo, Italy
,
A Granata
1   ISMETT - IRCCS - UPMC ITAY, Digestive Endoscopy Service, Palermo, Italy
,
M Traina
1   ISMETT - IRCCS - UPMC ITAY, Digestive Endoscopy Service, Palermo, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

 

Aims Advancements in endoscopic equipmentaccessories and technical improvements of endoscopists have permitted a worldwide expansion of EUS-guided procedures with progressive rise of its indications in gastrointestinal (GI) diseases, stole from more invasive interventions including surgery and intervention radiology. Recently, ECE-LAMS (Electrocautery enhanced delivery system - Lumen apposing metal stent) allowed a single-step exchange-free apposition of two hollow cavity, creating endoscopic anastomosis or transluminal drainages [1-3].

Methods We conducted a single-center, retrospective review of 105 adult patients requiring ECE-LAMS placement for multiple indications between May 2017 to September 2019 at IRCCS-ISMETT Palermo. 10 patients (M:F 5:5) with off-label EUS-applications were enrolled: gastro-jejunal anastomosis for malignant gastric outlet obstruction (GOO) (n = 7), malignant afferent loop syndrome treatment by creating afferent-efferent loops anastomosis (n = 1), gastro-gastro-anastomosis directed ERCP inpatient with gastric-by-pass (n = 1) and pelvic abscesses drainage (n = 1) (Table 1). All procedures were performed under general anesthesia by expertskilled endoscopists with radiologicalEUS assistance. We used the balloon-assisted technique for GOO management (Video 1) and the free-hand fashion in the other cases (video 2).

Results ECE-LAMS size were: 15 × 10 mm (n = 5) and 20 × 10 mm (n = 5). Technical success was 100%. Adverse events were: 1 maldeployment case successfully treated by LAMS-in-LAMS technique and 1 early-bleeding case managed endoscopically. Oral feeding with soft diet was resumed after 24 hours in all upper indications. Clinical success was 100%. 2/8 oncological patients were successively candidate to pancreaticoduodenectomy with good outcome. LAMS removal was executed after 4 weeks in benign etiology and left in place for palliative ones.

Conclusions EUS-guided interventions with ECE-LAMS are feasible and safe for off-label applications, allowing to replicate surgical anastomosis with advantage of minimal invasiveness.