Endoscopic treatment of refractory benign digestive stricture using endoluminal lumen apposing metal stent

Aims Endoscopic dilatation is the first line treatment for benign endoluminal digestive stricture. The use of full covered metallic stent (FC-SEMS) is recommended by ESGE as a second line in the presence of refractory benign stricture. However, the clinical efficacy of these FC-SEMS rarely approaches 50%. This low success rate is probably due to stent migration rate approaching 30%. The use of stent fixation methods such as Over the scope clip or endoscopic suturing device reduces the risk of migration. Another alternative could be to use a lumen apposing metal stent (LAMS). The use of an endoluminal LAMS in the treatment of benign refractory stenosis could reduce the migration rate and increase clinical success rate. The aim of the study was to evaluate endoluminal LAMS to treat refractory benign endoluminal digestive stricture.

Methods This is a retrospective study with prospective follow-up. Patients who underwent endoluminal 15 or 20 mm LAMS for the treatment of refractory benign digestive stricture between November 2023 and August 2024 were included. The LAMS was placed endoscopically for a minimum of 4 weeks. An Endoscopic control was performed every 4 to 6 weeks to determine if the LAMS was either removed or left in place depending on clinical tolerance or tissue overgrowth or ingrowth in the LAMS. Clinical success was assessed at one month after removal. The primary objective was to evaluate the migration rate of the LAMS. The secondary objectives were technical success, safety and clinical success.

Results A total of 15 patients were included (53.3% women, mean age 56.1+/-12 years) using 20 LAMS. The aetiology of refractory stenosis was anastomotic stricture in 86.7% (13/15) of cases. The 20 mm LAMS was used in 60% of patients (9/15). The technical success rate was 100%. The first endoscopic control was performed on average at 49+/-11 days. The LAMS migration rate was 0%. The adverse events rate was 25% (5/21). All adverse events were graded AGREE I (minor complication). The LAMS was removed at the first endoscopic control in 46.5% (6/15) and replaced by a larger caliber LAMS in 13% (2/15). The LAMS was removed on average 124+/-50 days after initial insertion in 5 patients. Clinical success at one month post removal was assessed in 10 patients (one death secondary to other pathology and four with LAMS still present). The clinical success rate was 60% (6/10). The clinical success rate in patients whose LAMS was maintained for more than 60 days was significantly better than whose LAMS was present for less than 60 days (100% vs 25% respectively, p=0.05).

Conclusions The migration rate of LAMS in the treatment of refractory benign digestive stenosis is zero allowing permanent anastomotic calibration. Maintenance of the LAMS for more than 4 weeks depends on clinical tolerance of the LAMS. It would be appear that placing a LAMS for more than 60 days improves clinical success. Randomised controlled trials are needed to confirm these interesting results.

Publication History

Article published online:
27 March 2025