Cumulative risks of stent migration and gastrointestinal bleeding in patients with lumen-apposing metal stents
| Autor: | Ramon Sanchez-Ocana, Manuel Perez-Miranda, Ryan Law, Francisco Javier García-Alonso, Irene Penas-Herrero, Paula Gil-Simon, Carlos de la Serna Higuera, Sergio Sevilla-Ribota, Raúl Torres-Yuste |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Gastrointestinal bleeding Time Factors medicine.medical_treatment Lumen (anatomy) Risk Assessment 03 medical and health sciences 0302 clinical medicine Interquartile range Risk Factors medicine Humans Aged Proportional Hazards Models Retrospective Studies Aged 80 and over Proportional hazards model business.industry Hazard ratio Gastroenterology Stent Pancreatic Diseases Retrospective cohort study Equipment Design Middle Aged medicine.disease Confidence interval Surgery Prosthesis Failure Metals 030220 oncology & carcinogenesis Drainage 030211 gastroenterology & hepatology Female Stents business Gastrointestinal Hemorrhage Follow-Up Studies |
| Zdroj: | Endoscopy. 50(4) |
| ISSN: | 1438-8812 |
| Popis: | Background: Delayed gastrointestinal (GI) bleeding and stent migration are known adverse events which may occur following placement of lumen-apposing metal stents (LAMSs). Methods: All consecutive patients who underwent LAMS placement between May 2011 and June 2017 at a single tertiary medical center were included. Demographics and procedural details were prospectively collected. Post-procedure follow-up and outcome measures were retrospectively collected. The cumulative risks of migration and LAMS-related GI bleeding were estimated using the life-table method. Risk predictors were assessed using Cox proportional hazards models. Results: We analyzed 250 patients (64.8 % men; median age 71.6 [interquartile range (IQR) 57.9 – 83.6]). Median follow-up was 78.5 days (IQR 31 – 246.5 days). Thirty-four stent migrations (13.6 %) occurred (5 symptomatic). On multivariable analysis, associations with migration included nasocystic drains (hazard ratio [HR] 6.5, 95 % confidence interval [CI] 2.2 – 19.3), pancreatic fluid collections (PFCs; HR 4.2, 95 %CI 1.8 – 10.1), and double-pigtail stents (HR 2.4, 95 %CI 1.2 – 4.9). Migration risk at 12 months was 25.5 % (95 %CI 17.9 % – 35.7 %) and was higher for PFCs 48.9 % (33.4 % – 66.9 %) than other indications 8.4 % (4.9 % – 17.5 %; P Conclusions: LAMS migration occurs in 1 out of 7 cases and is most common when treating PFCs. Bleeding related to LAMS placement occurs much less commonly but can be life-threatening. |
| Databáze: | OpenAIRE |
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