CUMULATIVE RISKS OF STENT MIGRATION AND UPPER GASTROINTESTINAL BLEEDING IN PATIENTS WITH LUMEN APPOSING METAL STENTS

Aims:

Gastrointestinal bleeding and stent migration are lumen apposing metal stents (LAMS) related adverse events which might appear with a significant delay after stent deployment. Our objective was to address the cumulative risk of migration and upper gastrointestinal bleeding associated with the deployment of LAMS.

Methods:

All consecutive patients undergoing the placement of a LAMS between May 2011 and June 2017 at a single tertiary center were prospectively included. Cumulative risk of migration and LAMS related GI bleeding were estimated according to the life-table method. We used Cox proportional hazards models to assess potential risk predictors.

Results:

A total of 250 patients, 64.8% males, with a median age of 71.6 (IQR: 57.9 – 83.6) and a median follow-up of 78.5 days (IQR: 31 – 246.5) were included. Most frequent indications were pancreatic fluid collections (124) and gallbladder drainages (56). Thirty-four stent migrations were identified after a median 90.5 days (IQR: 37 – 219; range 1 – 1871), 5 (14.7%) of them symptomatic, none requiring surgery. Nasocystic drains (Hazard ratio (HR): 6.5, 95% CI: 2.2 – 19.3), pancreatic fluid collections (HR: 4.2, (1.8 – 10.1)) and deployment of double-pigtail plastic stents (HR: 2.4, (1.2 – 4.9)) were associated with LAMS migration on multivariable analysis. Twelve months after deployment, overall cumulative migration risk was 25.5% (95% CI: 17.9 – 35.7%), significantly higher in pancreatic fluid collections 48.9% (33.4 – 66.9%) compared with other indications 8.4% (4.9 – 17.5%), p < 0.001. There were 13 (5.2%) episodes of LAMS related bleeding, 2 of them fatal, presenting 3 days (IQR: 1 – 9, range: 0 – 394) after stent deployment. Cumulative risk of bleeding 12 months after deployment was 6.9% (3.6 – 12.7%).

Conclusions:

We observed a low risk of delayed bleeding, although one fatal hemorrhage presented more than 1 year after stent deployment. Late migrations were very frequent in pancreatic fluid collections, while potential long-term stents (enteroanastomoses, biliary duct and gallbladder drainages) presented an 8.4% cumulative risk of stent migration 2 years after deployment.