Endoscopic removal of lumen-apposing metal stents - risk factors for stent embedment, complex removals, and adverse events: analysis from a multicenter prospective case series.

Autor:	Bazaga S; Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain.; Universitat Autònoma de Barcelona, Barcelona, Spain., García-Alonso FJ; Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain., Aparicio Tormo JR; Hospital General Universitario de Alicante, Alicante, Spain., Martinez Moreno B; Hospital General Universitario de Alicante, Alicante, Spain., Sanchiz V; Hospital Clínico Universitario de Valencia, Valencia, Spain., Suria C; Hospital Clínico Universitario de Valencia, Valencia, Spain., Garcia-Sumalla A; Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain., Gornals JB; Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain., Chavarría C; Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain., Loras C; Department of Gastroenterology, Hospital Universitari Mútua Terrassa, Fundació per la Recerca Mútua Terrassa, Barcelona, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain., García-Fernandez FJ; Hospital Universitario Virgen del Rocío, Seville, Spain., Terán Á; Hospital Universitario Marqués de Valdecilla, Santander, Spain., Vazquez-Sequeiros E; Endoscopy Unit, Department of Gastroenterology and Hepatology, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain., Pedraza Sanz R; Hospital General Universitario de Castellón, Castellón, Spain., Pérez-Carazo L; Hospital General Universitario Gregorio Marañon, Madrid, Spain., Súbtil JC; Department of Gastroenterology, Endoscopy Unit, University of Navarra Clinic, University of Navarra, Pamplona, Spain., Pérez-Millan A; Hospital General Río Carrión, Palencia, Spain., Uceda Porta F; Hospital General Universitario de Elche, Alicante, Spain., Busto Bea V; Complejo Hospitalario de Navarra, Pamplona, Spain., de la Serna-Higuera C; Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain., Pinto Garcia I; Hospital Regional de Málaga, Málaga, Spain., Colán-Hernández J; Hospital Universitari Germans Trias i Pujol, Badalona, Spain., Huertas C; Hospital Universitari de Girona Josep Trueta, Girona, Spain., Guarner-Argente C; Universitat Autònoma de Barcelona, Barcelona, Spain.; Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain., Perez-Miranda M; Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain.
Jazyk:	angličtina
Zdroj:	Endoscopy [Endoscopy] 2023 Jul; Vol. 55 (7), pp. 591-598. Date of Electronic Publication: 2023 Mar 07.
DOI:	10.1055/a-2030-4158
Abstrakt:	Background: Removing lumen-apposing metal stents (LAMSs) may be difficult and even harmful, but these features have seldom been analyzed. We aimed to generate a comprehensive assessment of the feasibility and safety of LAMS retrieval procedures. Methods: A prospective multicenter case series including all technically successfully deployed LAMSs between January 2019 and January 2020 that underwent endoscopic stent removal. All retrieval-related data were prospectively recorded using standardized telephone questionnaires as part of centralized follow-up that ended after stent removal had been performed. Multivariable logistic regression models assessed the potential risk factors for complex removal. Results: For the 407 LAMSs included, removal was attempted in 158 (38.8 %) after an indwell time of 46.5 days (interquartile range [IQR] 31-70). The median (IQR) removal time was 2 (1-4) minutes. Removal was labelled as complex in 13 procedures (8.2 %), although advanced endoscopic maneuvers were required in only two (1.3 %). Complex removal risk factors were stent embedment (relative risk [RR] 5.84, 95 %CI 2.14-15.89; P  = 0.001), over-the-wire deployment (RR 4.66, 95 %CI 1.60-13.56; P  = 0.01), and longer indwell times (RR 1.14, 95 %CI 1.03-1.27; P  = 0.01). Partial and complete embedment were observed in 14 (8.9 %) and five cases (3.2 %), respectively. The embedment rate during the first 6 weeks was 3.1 % (2/65), reaching 15.9 % (10/63) during the following 6 weeks ( P  = 0.02). The adverse event rate was 5.1 %, including seven gastrointestinal bleeds (5 mild, 2 moderate). Conclusions: LAMS removal is a safe procedure, mostly requiring basic endoscopic techniques attainable in conventional endoscopy rooms. Referral to advanced endoscopy units should be considered for stents with known embedment or long indwell times, which may require more technically demanding procedures. Competing Interests: M. Perez-Miranda is a consultant for Boston Scientific, Olympus, Medtronic, and M.I.Tech. The remaining authors declare that they have no conflict of interest. (Thieme. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu