Outcomes of lumen apposing metal stent placement in patients with surgically altered anatomy: Multicenter international experience.
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Mangiavillano Benedetto, Ramai Daryl, Kahaleh Michel, Tyberg Amy, Shahid Haroon, Sarkar Avik, Samanta Jayanta, Dhar Jahnvi, Bronswijk Michiel, Van der Merwe Schalk, Kouanda Abdul, Ji Hyun, Dai Sun-Chuan, Deprez Pierre, Vargas-Madrigal Jorge, Vanella Giuseppe, Roberto Leone, Arcidiacono Paolo Giorgio, Robles-Medranda Carlos, Alcivar Vasquez Juan, Arevalo-Mora Martha, Fugazza Alessandro, Ko Christopher, Morris John, Lisotti Andrea, Fusaroli Pietro, Dhaliwal Amaninder, Mutignani Massimiliano, Forti Edoardo, Cottone Irene, Larghi Alberto, Rizzatti Gianenrico, Galasso Domenico, Barbera Carmelo, Di Matteo Francesco Maria, Stigliano Serena, Binda Cecilia, Fabbri Carlo, Pham Khanh Do-Cong, Di Mitri Roberto, Amata Michele, Crinó Stefano Francesco, Ofosu Andrew, De Luca Luca, Al-Lehibi Abed, Auriemma Francesco, Paduano Danilo, Calabrese Federica, Gentile Carmine, Hassan Cesare, Repici Alessandro, Facciorusso Antonio
Аннотация
Background and study aims Although outcomes of lumen-apposing metal stents (LAMS) placement in native anatomy have been reported, data on LAMS placement in surgically altered anatomy (SAA) are sparse. We aimed to assess outcomes of LAMS placement in patients with SAA for different indications. Patients and methods This was an international, multicenter, retrospective, observational study at 25 tertiary care centers through November 2023. Consecutive patients with SAA who underwent LAMS placement were included. The primary outcome was technical success defined as correct placement of LAMS. Secondary outcomes were clinical success and safety. Results Two hundred and seventy patients (125 males; average age 61 ± 15 years) underwent LAMS placement with SAA. Procedures included EUS-directed transgastric ERCP (EDGE) and EUS-directed transenteric ERCP (EDEE) (n = 82), EUS-guided entero-enterostomy (n = 81), EUS-guided biliary drainage (n = 57), EUS-guided drainage of peri-pancreatic fluid collections (n = 48), and EUS-guided pancreaticogastrostomy (n = 2). Most cases utilized AXIOS stents (n = 255) compared with SPAXUS stents (n = 15). Overall, technical success was 98%, clinical success was 97%, and the adverse event (AE) rate was 12%. Using AGREE classification, five events were rated as Grade II, 21 events as Grade IIIa, and six events as IIIb. No difference in AEs were noted among stent types ( P = 0.52). 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 AEs is noteworthy, and thus, these procedures should be performed by expert endoscopists at tertiary centers.