Efficacy and safety of electrocautery-enhanced lumen-apposing metal stents (EC-LAMSs) in EUS-guided procedures: 7-year experience from 3 tertiary referral centers in Greece

Aims Interventional EUS is increasingly used for the management of several pancreaticobiliary conditions. These include drainage of pancreatic fluid collections (PFCs), biliary drainage of unresectable malignant distal biliary obstruction with choledochoduodenostomy (EUS-CDS) and gallbladder drainage (EUS-GBD) for acute cholecystitis in patients unfit for surgery. Although the applicability of EC-LAMS is steadily expanding, there remains a paucity of data concerning their efficacy and safety, particularly in Greece. This study aimed to evaluate the efficacy and safety of EUS-guided EC-LAMS performed over a 7-year period in 3 tertiary referral centers in Greece.

Methods We conducted a multicenter, retrospective study on 104 patients who underwent EUS-guided procedures by using the EC-LAMS at 3 Greek tertiary care centers between September 2017 and November 2024. Primary outcome measures were technical and clinical success. Technical success was defined as an adequate patency of the LAMS between the walls of the gastrointestinal lumen and the target organ or cavity. Clinical success was defined as alleviation of clinical symptoms combined with>50% reduction of PFC diameter after 60 days of drainage. For EUS-CDS, it was defined as>15% reduction of bilirubin levels at 24 hours and for EUS-GBD as clinical and biochemical improvement of cholecystitis.

Results A total of 104 patients were included (mean age 63.8±14.7 years, 62% males). Eighty (76.9%) patients underwent drainage of PCFs, of whom 49 (47%) had walled-off necrosis (median 2.5 necrosectomies performed, range: 1-7) and 31 (30%) had pancreatic pseudocysts; 19 (18%) underwent EUS-CDS and 5 (5%) EUS-GBD. The mean diameter of PFCs was 10.42±3.9 and the vast majority (75%) were complications of acute pancreatitis. The main indications for drainage of PFCs were residual abdominal pain (53%) and infection (30%). Overall, technical success was achieved in 102 (98%) and clinical success in 95 (91%) patients. Complications occurred in a total of 12 (11.5%) patients, including 4 (3.8%) cases of bleeding and 3 (2.9%) perforations, that were successfully managed conservatively. Moreover, stent migration occurred in 1 (1%) case and stent blocking in 4 (3.8%) cases, all managed endoscopically.

Conclusions Our study showed that EUS-guided placement of EC-LAMS for various therapeutic indications is associated with high technical and clinical success rates, harboring an acceptable rate of complications.

Publication History

Article published online:
27 March 2025