Outcomes Of Lumen Apposing Metal Stent Placement In Patients With Surgically Altered Anatomy: A Multicenter International Experience

Aims Lumen apposing metal stents (LAMS) have been increasingly used to manage patients with surgically altered anatomy (SAA), who would have otherwise required percutaneous or surgical interventions. Via the creation of de-novo anastomoses, LAMS provides a conduit to access distal parts of the gastrointestinal tract to perform various interventions.

We aim to assess technical, clinical, and safety outcomes of LAMS placement in patients with surgically altered anatomy for different indications.

Methods This was a retrospective study at 19 tertiary-care centers (Italy 9, USA 3, Belgium 2, Norway 1, Switzerland 1, Ecuador 1, Columbia 1, and India 1) through November 2023. Patients who underwent upper GI surgical procedures which resulted in altered anatomy as well as the placement of LAMS (AXIOS or SPAXUS stents) were included. The primary outcome was the technical success rate of stent placement. Secondary outcomes included rates of clinical success and safety including early or late bleeding, perforation, and stent migration.

Results 217 patients (106 males; median age 62±16 years) underwent LAMS placement with SAA. 34 patients underwent EUS bile duct or gallbladder drainage (see table 1). 44 patients underwent cystic fluid collection drainage. The average cyst size was significantly smaller at day 7 (79±28 mm before stent versus 14±10 mm after stent; p<0.001). 74 patients underwent EUS gastroenterostomy, jejunojejunostomy, jejunoduodenostomy, or gastroduodenostomy. 40 patients underwent the EDGE (Endoscopic Ultrasound-Directed Transgastric ERCP) procedure while 3 patients had EDEE (Endoscopic Ultrasound-Directed Transenteric ERCP). Other patients underwent EUS-guided hepaticogastrostomy, hepaticoduodenostomy, pancreatogastrostomy, and others. Technical success was achieved in 97.2% (211/217) of patients, and clinical success was 100% (217/217). Overall adverse event rate was 13%. Adverse events included bleeding (7), perforation/ misdeployment (8), stent migration (6), pulmonary embolism (1), jaundice (1), subhepatic fluid collection (1), fever (1), nausea & abdominal distention (1), gastrocolonic fistula (1), stent partial occlusion from GB stone (1).

Conclusions This study shows that placement of LAMS is associated with high technical and clinical success rates in patients with SAA. However, the rate of adverse events is noteworthy and thus these procedures should be placed by endoscopists with expertise.

Publication History

Article published online:
15 April 2024