Lumen Apposing Metal Stents: How Far Are We From Standardization? An Italian Survey

Aims Aim of the survey is to investigate procedural and peri-procedural aspects of Lumen-Apposing Metal Stent (LAMS) placement nationwide.

Methods 48 questions, grouped under five sections (expertise, peri-/intra-procedural aspects, budget/refund, future perspectives), were submitted to Italian pancreatobiliary centers. Practice of more or less experienced endoscopists were compared. Statistical analyzer was SPSS.

Results 36 centers completed the survey. Among specialists, 42 % have >15 years of endoscopic experience, 61 % placed overall <20 LAMS.

1. Indications for LAMS positioning are: 97 % pancreatic fluid collection drainage (PFCD), 80 % biliary drainage (BD), 75 % gallbladder drainage (GBD), 20 % gastroentero-anastomosis (GE-A). 78 % of endoscopists perform only on-label procedures. Concerning the training, 39 % attended a preliminary course, 28 % were just supported by an expert, 22 % had both the opportunities, 8 % didn’t do any of them.

2. Management of antiplatelets therapy is very disomogeneous. Only half of the partecipants discusses the case in a multidisciplinary meeting and, during follow-up, only 30 % evaluate these patients in a specialized clinic. After PFCD, 66 % of endoscopists carry on proton pump inhibitors therapy. Type and timing of post-procedural imaging varies widely. No significant differences were found among more or less experienced endoscopists about on- vs on-/off-label indications, perception of technical complexity and post-procedural imaging request (p > 0.05).

3. 8 % of endoscopists work without fluoroscopy. Sedation protocol is very different among centers.

4. Refund for LAMS is mostly not guaranteed.

5. Main future growing indications appear to be BD, GBD and GEA (70 %, 55 %, 55 % respectively). Most of partecipants consider necessary an experience in all kind of interventional endoscopic procedures for training.

Conclusions This is the first survey assessing the state of the art on LAMS almost 10 years after their introduction in interventional endoscopic ultrasonography. There are currently wide variations in practice nationwide, which demonstrates a pressing need to define technical, qualitative and peri-procedural requirements, towards a standardization.

Citation Fabbri C, Coluccio C, Binda C et al. eP418 LUMEN APPOSING METAL STENTS: HOW FAR ARE WE FROM STANDARDIZATION? AN ITALIAN SURVEY. Endoscopy 2021; 53: S233.

Publication History

Article published online:
19 March 2021