Skip to main content

Advertisement

SpringerLink
Log in

Lumen-apposing metals stents in advanced endoscopic ultrasound-guided interventions: novel applications, potential complications and radiologic assessment

  • Review
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Endoscopic ultrasound (EUS)-guided drainage procedures are an increasingly utilized minimally invasive alternative to percutaneous or surgical management strategies, having been shown to decrease recovery time, cost, and duration of hospital stay. The current mainstay of EUS-guided drainage procedures is in pancreatic and peripancreatic collections in pancreatitis. Recent technological advancements and the development of specialized stents have allowed for novel applications in a growing variety of clinical scenarios, including biliary obstruction, cholecystitis and gastrointestinal obstruction. An overview is provided of standard EUS-guided lumen-apposing metal stent (LAMS) management in pancreatic collections, including the expected radiologic findings and appropriate post-treatment sequelae. Relevant parameters to report include presence of a walled-off collection, collection contents, proximity of the target collection to the gastrointestinal lumen, intervening vascular structures or vascular malformations, and presence of regional cystic structures. Novel stent applications in biliary and gastrointestinal drainage are summarized and examples are provided, including choledochoduodenostomy in biliary obstruction, cholecystogastrostomy in cholecystitis, and jejunogastrostomy in focal gastrointestinal obstruction. Finally, a pictorial review of imaging findings of complications including perforation, hemorrhage, displacement, occlusion, migration and mistargeting is provided. Minimally invasive EUS-guided endoluminal stenting is utilized in a growing variety of clinical applications. Radiologist familiarity with common and novel applications of EUS-guided stenting is invaluable in determining suitability for endoscopic management, evaluating treatment response and identifying potential complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14

Similar content being viewed by others

References

  1. Guniganti P, Kierans AS (2019) Advanced endoscopic procedures: an update for radiologists. AJR 213:332-342

  2. Tonolini M, Bareggi E, Gambitta P (2019) Advanced endoscopic interventions on the pancreas and pancreatic ductal system: a primer for radiologists. Insights Imaging 10:5. https://doi.org/10.1186/s13244-019-0689-7

  3. Bakker OJ, van Santvoort HC, van Brunschot S, et al (2012) Endoscopic transgastric vs surgical necrosectomy for infected necrotizing pancreatitis: a randomized trial. JAMA 307:1053–1061

  4. Varadarajulu S, Bang JY, Sutton BS, Trevino JM, Christein JD, Wilcox CM (2013) Equal efficacy of endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage in a randomized trial. Gastroenterology 145:583–590

  5. Tyberg A, Karia K, Gabr M et al (2016) Management of pancreatic fluid collections: a comprehensive review of the literature. World J Gastroenterol 22:2256–2270

  6. Patil R, Ona MA, Papafragkakis C, Anand S, Duddempudi S (2016) Endoscopic ultrasound-guided placement of AXIOS stent for drainage of pancreatic fluid collections. Ann Gastroenterol 29:168-173

  7. Bang JY, Hasan M, Navaneethan U, Hawes R, Varadarajulu (2017) Lumen-apposing metal stents (LAMS) for pancreatic fluid collection (PFC) drainage: may not be business as usual. Gut 66:2054-2056

  8. Case BM, Jensen KK, Bakis G et al (2018) Endoscopic interventions in acute pancreatitis: what the advanced endoscopist wants to know. RadioGraphics 38:2002-2018

  9. Banks PA, Bollen TL, Dervenis C, et al (2013) Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut 62:102-111

  10. Cui ML, Kim KH, Kim HG et al (2013) Incidence, risk factors and clinical course of pancreatic fluid collections in acute pancreatitis. Dig Dis Sci 59:1055-1062

  11. Trikudanathan G, Attam R, Arain MA et al (2014) Endoscopic interventions for necrotizing pancreatitis. Am J Gastroenterol 109:969-981

  12. Giovannini M (2018) Endoscopic ultrasound-guided drainage of pancreatic fluid collections. Gastrointest Endoscopy Clin N Am. 28:157-169

  13. Sharaiha, RZ, DeFilippis EM, Kedia P et al (2015) Metal versus plastic for pancreatic pseudocyst drainage: clinical outcomes and success. Gastrointest Endosc 82:758-765

  14. Han D, Inamdar S, Lee C et al (2018) Lumen apposing metal stents (LAMS) for drainage of pancreatic and gallbladder collections: a meta-analysis. J Clin Gastroenterol 52:835-844

  15. Shellock, FG and Spinazzi, A (2008) MRI safety update 2008: part 2, screening patients for MRI. AJR 191:1140-1149

  16. Sandrasegaran K, Heller MT, Panda A et al (2020) MRI in acute pancreatitis. Abdom Radiol 45:1232–1242

  17. Mukai S, Itoi T, Baron TH et al (2017) Indications and techniques of biliary drainage for acute cholangitis in updated Tokyo Guidelines 2018. J Hepatobiliary Pancreat Sci 280:522-523

  18. Moole H, Bechtold ML, Forcione D et al (2017) A meta-analysis and systematic review: success of endoscopic ultrasound guided biliary stenting in patients with inoperable malignant biliary strictures and a failed ERCP. Medicine(Baltimore). https://doi.org/10.1097/MD.0000000000005154

  19. Sharaiha RZ, Khan MA, Kamal F et al (2017) Efficacy and safety of EUS-guided biliary drainage in comparison with percutaneous biliary drainage when ERCP fails: a systematic review and meta-analysis. Gastrointest Endosc 85:904-914

  20. Lee TH, Choi JH, Park J et al (2016) Similar efficacies of endoscopic ultrasound-guided transmural and percutaneous drainage for malignant distal biliary obstruction. Clin Gastroenterol Hepatol 14:1011-1019

  21. Sugawara S, Sone M, Morita S et al (2020) Radiologic assessment for endoscopic US-guided biliary drainage. RadioGraphics. https://doi.org/10.1148/rg.2020190158

  22. Anderloni A, Fugazza A, Troncone E et al (2019) Single-stage EUS-guided choledochoduodenostomy using a lumen-apposing metal stent for malignant distal biliary obstruction. Gastrointest Endosc 89:69-76

  23. Siddiqui A, Kunda R, Arain MA et al (2019) Three-way comparative study of endoscopic ultrasound-guided transmural gallbladder drainage using lumen-apposing metal stents versus endoscopic transpapillary drainage versus percutaneous cholecystostomy for gallbladder drainage in high-risk surgical patients with acute cholecystitis: clinical outcomes and success in an international, multicentre study. Surg Endosc 33:1260-1270

  24. Irani S, Jalaj S, Ross A et al (2017) Use of a lumen-apposing metal stent to treat GI stricture (with videos). Gastrointest Endosc 85:1285-1289

  25. Santos-Fernandez J, Paiji C, Shakhatreh M et al (2017) Lumen-apposing metal stents for benign gastrointestinal tract strictures: an international multicenter experience. World J Gastrointest Endosc 9:571-578

  26. Mohan B, Chandan S, Garg R et al (2019) Lumen-apposing metal stents, fully covered self-expanding metal stents, and biodegradable stents in the management of benign GI strictures: a systematic review and meta-analysis. J Clin Gastroenterol 53: 560-573

  27. Khashab MA, Kumbhari V, Grimm IS et al (2015) EUS-guided gastroenterostomy: the first U.S. clinical experience. Gastrointest Endosc 82:932-938

  28. Majmudar K, Wagh MS (2016) EUS-guided jejuno-jejunostomy with lumen-apposing metal stent for complete jejunal obstruction after gastric bypass. Gastrointest Endosc 684:853-854

  29. Mai HD, Dubin E, Mavanur AA, Feldman M, Dutta S (2018) EUS-guided colo-enterostomy as a salvage drainage procedure in a high risk surgical patient with small bowel obstruction due to severe ileocolonic anastomotic stricture: a new application of lumen-apposing metal stent (LAMS). J Clin Gastroenterol 11:282-285

  30. Bang JY, Varadarajulu (2019) Lumen-apposing metal stents for endoscopic ultrasonography-guided interventions. Dig Endosc 31:619-626

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, Canada

    Jessica Li, Hamed Basseri & Alison Harris

  2. Division of Gastroenterology, Faculty of Medicine, University of British Columbia, Vancouver, Canada

    Fergal Donnellan

Authors
  1. Jessica Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hamed Basseri
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fergal Donnellan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alison Harris
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jessica Li.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, J., Basseri, H., Donnellan, F. et al. Lumen-apposing metals stents in advanced endoscopic ultrasound-guided interventions: novel applications, potential complications and radiologic assessment. Abdom Radiol 46, 776–791 (2021). https://doi.org/10.1007/s00261-020-02696-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-020-02696-z

Keywords

Search

Navigation