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OUTCOMES OF LUMEN APPOSING METAL STENT PLACEMENT IN PATIENTS WITH SURGICALLY ALTERED ANATOMY: A MULTICENTER INTERNATIONAL EXPERIENCE

Benedetto Pio Mangiavillano 1, Daryl Ramai 2, Michel Kahaleh 3, Amy Tyberg 4, Haroon Shahid 5, Avik Sarkar 6, Jayanta Samanta 7, Jahnvi Dhar 7, Michiel Bronswijk 8, Schalk van der Merwe 9, Pierre Henri Deprez 10, Jorge Vargas-Madrigal 11, Giuseppe Vanella 12, Paolo Giorgio Arcidiacono 13, Carlos Robles-Medranda 14, Juan Alcivar-Vasquez 14, Martha Graciela Arevalo Mora 15, Alessandro Fugazza 16, Andrea Lisotti 17, Pietro Fusaroli 18, Massimiliano Mutignani 19, Edoardo Forti 19, Alberto Larghi 20, Gianenrico Rizzatti 21, Domenico Galasso 22, Carmelo Barbera 23, Francesco Di Matteo 24, Serena Stigliano 25, Cecilia Binda 26, Carlo Fabbri 27, Khanh Do-Cong Pham 28, Roberto Di Mitri 29, Michele Amata 29, Stefano Francesco Crinò 30, Andrew Ofosu 31, Luca De Luca 32, Abed Al-Lehibi 33, Francesco Auriemma 1, Danilo Paduano 34, Carmine Gentile 1, Federica Calabrese 1, Matteo Fiacca 1, Cesare Hassan 35, Alessandro Repici 36, Antonio Facciorusso 37

Affiliations

1 Humanitas Mater Domini, Castellanza, Italy

2 University of Utah Health, Salt Lake City, United States

3 Robert Wood Johnson Medical School Rutgers University, New Brunswick, United States

4 Rutgers Robert Wood Johnson, New Brunswick, United States

5 Hackensack Meridian Hospital,, New Jersey, United States

6 Postgraduate Institute of Medical Education and Research,, Chandigarh,, India

7 Post Graduate Institute of Medical Education and Research, Chandigarh, Kolkata, India

8 Imelda Hospital Bonheiden and University Hospitals Leuven, Keerbergen, Belgium

9 UZ Leuven, Leuven, Belgium

10 Cliniques Universitaire Saint-Luc, Université de Louvain - Dept. de Hepato-gastroenterologie, Cliniq, Brussels, Belgium

11 Hospital San Juan de Dios, San Jose, Costa Rica

12 IRCCS San Raffaele Institute, Milan, Italy

13 Ospedale San Raffaele, Milan, Italy

14 Instituto Ecuatoriano De Enfermedades Digestivas (IECED), Guayaquil, Ecuador

15 Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador

16 Humanitas Research Hospital, Rozzano, Milan, Italy, Milano, Italy

17 Hospital of Imola, University of Bologna, Bologna, Italy

18 University of Bologna, Imola, Italy

19 Ospedale Niguarda, Milano, Italy

20 Policlinico Universitario A. Gemelli IRCSS, Rome, Italy

21 Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy

22 Hopital Riviera Chablais Gastroenterologie, Rennaz, Switzerland

23 Ospedale di Teramo, Teramo, Italy

24 Campus Bio-Medico Of Rome, Roma, Italy

25 Campus Biomedico, Roma, Italy

26 AUSL Romagna, Forlì, Italy

27 AUSL romagna, Forlì-Cesena gastroenterology, Bologna, Italy

28 Haukeland University Hospital, Bergen, Norway

29 ARNAS Civico-Di Cristina-Benfratelli, Palermo, Italy

30 University of Verona, Verona, Italy

31 University of Cincinnati, Cincinnati, United States

32 ASST Santi Paolo E Carlo, Milano, Italy

33 King Fahad Medical City, Riyadh, Saudi Arabia

34 Humanitas - Mater Domini, Castellanza, Italy

35 Humanitas University, Pieve Emanuele MI, Italy

36 Ist. Clinico Humanitas Rozzano Dept. of Gastroenterology, Milano, Italy

37 University of Foggia, Foggia, Italy

Summary

AI Generated

A multicenter study of 255 patients with surgically altered anatomy undergoing lumen-apposing metal stent placement found technical and clinical success rates ranging from 50% to 100% with an overall adverse event rate of 10.6%.

The study included 255 patients across 25 tertiary-care centers with various types of surgically altered anatomy, most commonly Roux-en-Y gastric bypass (41.6%) and pancreaticoduodenectomy (28.2%).
Indications for LAMS placement included endoscopic ultrasound-directed transgastric ERCP (32.2%), EUS-guided creation of enteric anastomoses (29.0%), drainage of peri-pancreatic fluid collections (18.0%), malignant biliary obstruction (12.5%), and cholecystitis (4.7%).
Technical and clinical success rates varied widely between 50% and 100% depending on indication and anatomy type.
Adverse events occurred in 10.6% of cases (27 of 255 patients).
The authors conclude these procedures should be performed by expert endoscopists at tertiary centers given the notable adverse event rate.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Lumen-apposing metal stents (LAMS) provide a conduit to access lumens close to the gastrointestinal tract to perform various interventions. While outcomes of LAMS placement in native anatomy have been reported, data on LAMS placement in surgically altered anatomy (SAA) is sparse.

Aims & Methods

We aim to assess technical, clinical, and safety outcomes of LAMS placement in patients with SAA for different indications. This was an international multicenter retrospective observational study at 25 tertiary-care centers through November 2023. Consecutive patients with SAA who underwent LAMS placement under endoscopic ultrasound guidance were included. Primary outcome was technical success defined as correct placement of LAMS. Secondary outcomes were clinical success and safety.

Results

255 patients with SAA (118 males; average age 61 ± 15 years) underwent LAMS placement. Surgical anatomy included total gastrectomy (n=3; 1.2%) subtotal gastrectomy (n=8; 3.1%), billroth I (n=19; 7.5%) billroth II (n=23; 9.0%), sleeve gastrectomy (n=16; 6.3%), pancreaticoduodenectomy (n=72; 28.2%), total pancreatectomy (n=3; 1.2%), roux-en-y gastric bypass (n=106; 41.6%), partial gastrectomy with roux-en-y (n=3; 1.2%); esophagectomy with partial gastrectomy (n=2; 0.8%). Indications were malignant biliary obstruction (n=32; 12.5%), cholecystitis (n=12; 4.7%), drainage of peri-pancreatic fluid collections (n=46; 18.0%); EUS- guided creation of enteric anastomoses (n=74; 29.0%); endoscopic ultrasound-directed transgastric ERCP (EDGE) (n=82; 32.2%); others (n=9; 3.5%). Both technical and clinical success ranged between 50% to 100%. Overall adverse event rate was 10.6% (n=27/255).

Conclusion

This study shows that placement of LAMS is associated with varying technical and clinical success rates in patients with SAA. The rate of adverse events is noteworthy, and thus, these procedures should be performed by expert endoscopists at tertiary centers.

Conference

UEG Week Vienna 2024

Topics

Hepatobiliary

Submission format

Abstract

Session

Endoscopic techniques (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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