CC BY-NC-ND 4.0 · Endosc Int Open 2017; 05(09): E861-E867
DOI: 10.1055/s-0043-114665
Original article
Eigentümer und Copyright ©Georg Thieme Verlag KG 2017

Safety and efficacy of coaxial lumen-apposing metal stents in the management of refractory gastrointestinal luminal strictures: a multicenter study

Fateh Bazerbachi
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
,
Jason D. Heffley
Division of Digestive Diseases, Department of Medicine, Emory University, Atlanta, Georgia, United States
,
Barham K. Abu Dayyeh
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
,
Jose Nieto
Borland-Groover Clinic, Jacksonville, Florida, United States
,
Eric J. Vargas
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
,
Tarek Sawas
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
,
Raja Zaghlol
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
,
Navtej S. Buttar
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
,
Mark D. Topazian
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
,
Louis M. Wong Kee Song
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
,
Michael Levy
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
,
Steve Keilin
Division of Digestive Diseases, Department of Medicine, Emory University, Atlanta, Georgia, United States
,
Qiang Cai
Division of Digestive Diseases, Department of Medicine, Emory University, Atlanta, Georgia, United States
,
Field F. Willingham
Division of Digestive Diseases, Department of Medicine, Emory University, Atlanta, Georgia, United States
› Author Affiliations
Further Information

Publication History

submitted 09 March 2017

accepted after revision 29 May 2017

Publication Date:
12 September 2017 (online)

Abstract

Background and aims Benign gastrointestinal (GI) strictures are often refractory to standard endoscopic interventions. Fully covered coaxial lumen-apposing metal stents (LAMS) have emerged as a novel therapy for these strictures. The aim of this study was to evaluate the safety and efficacy of LAMS for refractory GI strictures.

Patients and methods A retrospective analysis was performed for patients who underwent LAMS placement for benign luminal strictures in three US centers between January 2014 and December 2016. The primary outcomes were technical success and initial clinical success of LAMS placement. Secondary outcomes were stent migration, rate of re-intervention, and adverse events.

Results A total of 49 patients underwent 56 LAMS placement procedures. Previous treatment had failed in 39 patients (79.6 %), and anastomotic strictures were the indication in 77.6 % (38/49), with the most common site being gastrojejunal (34.7 % [17/49]). Technical success was achieved in all procedures and initial clinical success was achieved in 96.4 % of all procedures (54/56). Patient initial clinical success was 95.9 % (47/49). Stent migration occurred in 17.9 % of procedures, and was more likely to occur at sites in the lower GI tract (P = 0.02). The mean stent dwell time was 100.6 days, and the mean follow-up was 169.8 days. Minor adverse events, not requiring hospitalization, occurred in 33.9 % of procedures, including subsequent stricture progression (10.7 %). In cases where LAMS were removed, mean follow-up time was 102.2 days. The re-intervention rate was 75 % at 300 days follow-up after stent removal. Of the LAMS placed at anastomotic strictures, 36.4 % required re-intervention, with approximately two-thirds of these re-interventions requiring placement of a new stent or surgery.

Conclusion LAMS placement was successful for the management of refractory GI strictures, with good technical and initial clinical success rates. However, re-intervention rates after LAMS removal were high, and many strictures were not resolved by an extended period of stenting with these coaxial stents. LAMS placement offers additional therapeutic options and in selected cases might be considered a destination therapy for patients with recalcitrant benign strictures.