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Endoscopy. 2017 Apr;49(4):327-333. doi: 10.1055/s-0042-122779. Epub 2017 Jan 23.

Lumen-apposing covered self-expandable metal stents for short benign gastrointestinal strictures: a multicenter study.

Author information

1
Division of Gastroenterology, University of Florida College of Medicine, Gainesville, Florida, United States.
2
Borland-Groover Clinic, Jacksonville, Florida, United States.
3
Jefferson University Hospitals, Division of Gastroenterology and Hepatology, Philadelphia, Pennsylvania, United States.
4
Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, United States.
5
Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States.
6
Division of Gastroenterology, University of Colorado School of Medicine, Aurora, Colorado, United States.
7
Division of Gastroenterology and Hepatology, Stony Brook University School of Medicine, Stony Brook, New York, United States.
8
Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, Virginia, United States.
9
CHS Digestive Health, Carolinas Medical Center, Charlotte, North Carolina, United States.

Abstract

Background and study aim Use of the fully covered self-expandable metal stent (SEMS) for benign luminal gastrointestinal (GI) stricture (BLGS) has been limited by the migration rate. The role of the lumen-apposing metal stent (LAMS) for BLGS is not well defined. We assessed the safety, feasibility, and efficacy of LAMS for the treatment of BLGS. Patients and methods This was an observational, open-label, retrospective, single-arm, multicenter consecutive case series of patients undergoing LAMS placement for BLGS. Technical success was defined as successful placement of the LAMS. Short- and long-term clinical success rates were defined as symptom improvement/resolution with indwelling stent and after stent removal, respectively. All adverse events and additional interventions were recorded. Results A total of 30 patients (mean age 51.6 years; 63.3 % women) underwent LAMS placement for GI strictures (83.9 % anastomotic). Median stricture diameter and length were 4.5 mm (range 2 - 10 mm) and 8 mm (range 5 - 10 mm), respectively. Technical success was achieved in 29 patients (96.7 %), with an adverse event rate of 13.3 %. The stent migration rate was 8.0 % (2/25) on follow-up endoscopy. Short-term clinical success was achieved in 90.0 % (27/30) at a median of 60 days (interquartile range [IQR] 40 - 90 days). Most patients (19/23; 82.6 %) experienced sustained symptom improvement/resolution without the need for additional interventions at a median follow-up of 100 days (IQR 60 - 139 days) after LAMS removal. Conclusion This multicenter study demonstrated that LAMS placement represents a safe, feasible, and effective therapeutic option for patients with BLGS and is associated with a low stent migration rate. Our initial findings suggest that future prospective comparative studies are needed on the use of LAMS, endoscopic dilation, and conventional SEMS. .

PMID:
28114688
DOI:
10.1055/s-0042-122779
[Indexed for MEDLINE]

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