Lumen-apposing metal stents provide early and late clinical benefits for the management of benign gastrointestinal strictures: Is there a role for definitive therapy?

Autor: Pollack E; Department of Internal Medicine The University of Alabama at Birmingham Heersink School of Medicine Birmingham Alabama USA., Norwood D; Department of Internal Medicine UAB Minority Health and Health Equity Research Center The University of Alabama at Birmingham Heersink School of Medicine Birmingham Alabama USA., Caceres H; Department of Internal Medicine UAB Minority Health and Health Equity Research Center The University of Alabama at Birmingham Heersink School of Medicine Birmingham Alabama USA., Rapaka B; Department of Internal Medicine Division of Gastroenterology & Hepatology Basil I. Hirschowitz Endoscopic Center of Excellence The University of Alabama at Birmingham Heersink School of Medicine Birmingham Alabama USA., Perry IE; Department of Internal Medicine Division of Gastroenterology & Hepatology Basil I. Hirschowitz Endoscopic Center of Excellence The University of Alabama at Birmingham Heersink School of Medicine Birmingham Alabama USA., Barlass U; Department of Internal Medicine Division of Gastroenterology & Hepatology Basil I. Hirschowitz Endoscopic Center of Excellence The University of Alabama at Birmingham Heersink School of Medicine Birmingham Alabama USA., Mitchell R; Department of Internal Medicine Division of Gastroenterology & Hepatology Basil I. Hirschowitz Endoscopic Center of Excellence The University of Alabama at Birmingham Heersink School of Medicine Birmingham Alabama USA., McCreight J; Department of Internal Medicine Division of Gastroenterology & Hepatology Basil I. Hirschowitz Endoscopic Center of Excellence The University of Alabama at Birmingham Heersink School of Medicine Birmingham Alabama USA., Peter S; Department of Internal Medicine Division of Gastroenterology & Hepatology Basil I. Hirschowitz Endoscopic Center of Excellence The University of Alabama at Birmingham Heersink School of Medicine Birmingham Alabama USA., Mulki R; Department of Internal Medicine Division of Gastroenterology & Hepatology Basil I. Hirschowitz Endoscopic Center of Excellence The University of Alabama at Birmingham Heersink School of Medicine Birmingham Alabama USA., Ahmed A; Department of Internal Medicine Division of Gastroenterology & Hepatology Basil I. Hirschowitz Endoscopic Center of Excellence The University of Alabama at Birmingham Heersink School of Medicine Birmingham Alabama USA., Kyanam K; Department of Internal Medicine Division of Gastroenterology & Hepatology Basil I. Hirschowitz Endoscopic Center of Excellence The University of Alabama at Birmingham Heersink School of Medicine Birmingham Alabama USA., Sánchez-Luna SA; Department of Internal Medicine Division of Gastroenterology & Hepatology Basil I. Hirschowitz Endoscopic Center of Excellence The University of Alabama at Birmingham Heersink School of Medicine Birmingham Alabama USA.
Jazyk: angličtina
Zdroj: DEN open 2024 Sep 01; Vol. 5 (1), pp. e70005. Date of Electronic Publication: 2024 Sep 01 (Print Publication: 2025).
DOI: 10.1002/deo2.70005
Abstrakt: Objectives: This study aimed to characterize the clinical outcomes, safety, and efficacy of lumen-apposing metal stents (LAMS) in treating benign gastrointestinal strictures.
Methods: A single-center retrospective review of all patients who underwent LAMS placement for benign strictures from June 2017 to July 2023. Primary outcomes were technical success, early clinical success, late clinical success (LCS), and sustained post-LAMS clinical success (SPLCS). Secondary outcomes included stent dwell time, stenosis changes, adverse events, reintervention rates, and symptomatology evaluation.
Results: Thirty-five patients underwent placement of 42 LAMS (74% female, mean age: 54.2 ± 11.7 years). Anastomotic strictures accounted for 64% of cases ( N  = 27, 45% at the gastrojejunal anastomosis). The median STD was 91.0 days (interquartile range [IQR]: 55.0-132.0). Technical success was obtained in all cases. Early clinical successand LCS were achieved in 80% of cases overall. SPLCS was achieved in 45% ( n  = 15) of cases. The overall reintervention rate was 63%, with a median time to reintervention being 50.5 days (IQR: 24-105). adverse events occurred in 28% ( n  = 12) overall, with a 24% migration rate ( n  = 10). Follow-up was completed in 83% of cases with a median duration of 629 days (range: 192.0-1297.0). Overall symptom improvement occurred in 79% ( n  = 27) during indwelling LAMS versus 58% and 56% at 30- and 60-days post-removal, respectively.
Conclusions: LAMS for benign gastrointestinal strictures are associated with high technical and early clinical success/LCS rates, positive quality-of-life metrics, and a tolerable adverse event rate. Overall, recurrence of symptoms and high reintervention rates post-LAMS removal reinforce the difficulty in managing benign gastrointestinal strictures but also argue for LAMS as a definitive therapy in select cases.
Competing Interests: Dr. Sánchez‐Luna is the recipient of the 2021 American Society for Gastrointestinal Endoscopy (ASGE) Endoscopic Training Award by the ASGE and Fujifilm. This was not relevant to this study. The rest of the authors declare no conflict of interest.
(© 2024 The Author(s). DEN Open published by John Wiley & Sons Australia, Ltd on behalf of Japan Gastroenterological Endoscopy Society.)
Databáze: MEDLINE
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