Skip to main content
SpringerLink
Log in

Lumen-apposing metal stents for approved and off-label indications: a single-centre experience

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background and study aims

Lumen-apposing stents (LAMS) are approved to treat peripancreatic collections and for gallbladder and bile duct drainage. Over the last years, LAMS have also been used for off-label indications including gastrojejunostomy, gastro-gastrostomy and drainage of postsurgical collections. We aimed to analyze indications, technical/clinical success rates and complications of all LAMS placed over the last 2 years.

Patients and methods

Data from 61 consecutive LAMS (Hot Axios, Boston Scientific) in 57 patients were analyzed. Technical success was defined as successful deployment of the LAMS in the desired position. Clinical success was defined as follows: for pancreatic collections: resolution without the need for non-endoscopic interventions; for choledochoduodenostomy: ≥ 50% drop in baseline serum bilirubin within 2 weeks AND patient can receive chemotherapy if indicated; for gastrojejunostomy: resolution of gastric outlet obstruction and successful re-initiation of oral intake; for gastro-gastrostomy: successful endoscopic access to the excluded stomach; for gallbladder or postsurgical collection drainage: resolution of sepsis.

Results

Indications were drainage of peripancreatic collections in 24 cases (39.3%), choledochoduodenostomy in 13 (21.3%), gastrojejunostomy in 6 (9.8%), gastro-gastrostomy in 13 (21.3%), gallbladder drainage in 1 (1.6%) and postsurgical collection drainage in 4 (6.6%). Overall technical and clinical success rates were high (57/61; 93.4% and 54/61; 88.5%, respectively). Clinical success rate for non-approved indications was 95.6% (22/23 cases). Complications occurred in 13 patients (21.3%, 4 serious).

Conclusions

LAMS are increasingly used in interventional endoscopy. In our cohort, more than one third of LAMS are placed for off-label indications, with a high success rate and acceptable complication rate.

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

Similar content being viewed by others

References

  1. Wrobel PS, Kaplan J, Siddiqui A (2014) A new lumen-apposing metal stent for endoscopic transluminal drainage of peripancreatic fluid collections. Endosc Ultrasound 3:203–204

    Article  Google Scholar 

  2. Leung Ki EL, Napoleon B (2019) EUS-specific stents: available designs and probable lacunae. Endosc Ultrasound 8:S17–S27

    PubMed  PubMed Central  Google Scholar 

  3. Mussetto A, Fugazza A, Fuccio L, Triossi O, Repici A, Anderloni A (2018) Current uses and outcomes of lumen-apposing metal stents. Ann Gastroenterol 31:535–540

    PubMed  PubMed Central  Google Scholar 

  4. Siddiqui AA, Adler DG, Nieto J, Shah JN, Binmoeller KF, Kane S, Yan L, Laique SN, Kowalski T, Loren DE, Taylor LJ, Munigala S, Bhat YM (2016) EUS-guided drainage of peripancreatic fluid collections and necrosis by using a novel lumen-apposing stent: a large retrospective, multicenter U.S. experience (with videos). Gastrointest Endosc 83:699–707

    Article  Google Scholar 

  5. Anderloni A, Fabbri C, Nieto J, Uwe W, Dollhopf M, Aparicio JR, Perez-Miranda M, Tarantino I, Arlt A, Vleggaar F, Vanbiervliet G, Hampe J, Kahaleh M, Vila JJ, Dayyeh BKA, Storm AC, Fugazza A, Binda C, Charachon A, Sevilla-Ribota S, Tyberg A, Robert M, Wani S, Repici A, Sethi A, Khashab MA, Kunda R (2020) The safety and efficacy of a new 20-mm lumen apposing metal stent (lams) for the endoscopic treatment of pancreatic and peripancreatic fluid collections: a large international, multicenter study. Surg Endosc. Online ahead of print.

  6. Parsa N, Nieto JM, Powers P, Mitsuhashi S, Abdelqader A, Hadzinakos G, Anderloni AA, Fugazza A, James TW, Arlt A, Ellrichmann M, Aparicio JR, Trindade AJ, Stevens TK, Chahal P, Shah SL, Messallam AA, Lang G, Fejleh MP, Benias PC, Sejpal DV, Jones J, Mir FF, Aghaie Meybodi M, Ichkhanian Y, Vosoughi K, Novikov AA, Irani SS, Pawa R, Ahmed AM, Sedarat A, Hsueh W, Hampe J, Sharaiha RZ, Berzin TM, Willingham FF, Kushnir VM, Brewer Gutierrez OI, Ngamruengphong S, Huggett MT, Baron TH, Repici A, Adler DG, Nasr JT, Kowalski TE, Kumbhari V, Singh VK, Khashab MA (2020) Endoscopic ultrasound-guided drainage of pancreatic walled-off necrosis using 20-mm versus 15-mm lumen-apposing metal stents: an international, multicenter, case-matched study. Endoscopy 52:211–219

    Article  Google Scholar 

  7. Yachimski P (2017) Can we now recommend hydrogen peroxide for pancreatic necrosectomy? Time for controlled data. Endosc Int Open 05:E854–E855

    Article  Google Scholar 

  8. Kunda R, Pérez-Miranda M, Will U (2016) EUS-guided Choledochoduodenostomy for malignant distal biliary obstruction using a lumen-apposing fully covered metal stent after failed ERCP. Surg Endosc 30:5002–5008

    Article  Google Scholar 

  9. Krishnamoorthi R, Dasari CS, Thoguluva Chandrasekar V, Priyan H, Jayaraj M, Law J, Larsen M, Kozarek R, Ross A, Irani S (2020) Effectiveness and safety of EUS-guided choledochoduodenostomy using lumen-apposing metal stents (LAMS): a systematic review and meta-analysis. Surg Endosc 34:2866–2877

    Article  Google Scholar 

  10. Siddiqui A, Kunda R, Tyberg A, Arain MA, Noor A, Mumtaz T, Iqbal U, Loren DE, Kowalski TE, Adler DG, Saumoy M, Gaidhane M, Mallery S, Christiansen EM, Nieto J, Kahaleh M (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, Multicenter Study. Surg Endosc 33:1260–1270

    Article  Google Scholar 

  11. Khan MA, Atiq O, Kubiliun N, Ali B, Kamal F, Nollan R, Ismail MK, Tombazzi C, Kahaleh M, Baron TH (2017) Efficacy and safety of endoscopic gallbladder drainage in acute cholecystitis: is it better than percutaneous gallbladder drainage? Gastrointest Endosc 85:76–87

    Article  Google Scholar 

  12. Kedia P, Kumta NA, Widmer J, Sundararajan S, Cerefice M, Gaidhane M, Sharaiha R, Kahaleh M (2015) Endoscopic ultrasound-directed transgastric ERCP (EDGE) for Roux-en-Y anatomy: a novel technique. Endoscopy 47:159–163

    Article  Google Scholar 

  13. Wang TJ, Thompson CC, Ryou M (2019) Gastric access temporary for endoscopy (GATE): A Proposed Algorithm for EUS-directed transgastric ERCP in gastric bypass patients. Surg Endosc 33:2024–2033

    Article  Google Scholar 

  14. Tyberg A, Nieto J, Salgado S, Weaver K, Kedia P, Sharaiha RZ, Gaidhane M, Kahaleh M (2017) Endoscopic ultrasound (EUS)-directed transgastric endoscopic retrograde cholangiopancreatography or EUS: mid-term analysis of an emerging procedure. Clin Endosc 50:185–190

    Article  Google Scholar 

  15. Kochhar GS, Mohy-Ud-Din N, Grover A, Carleton N, Kulkarni A, Farah K, Dhawan M, Thakkar S (2020) EUS-directed transgastric endoscopic retrograde cholangiopancreatography versus laparoscopic-assisted ERCP versus deep enteroscopy-assisted ERCP for patients with RYGB. Endosc Int Open 8:E877–E882

    Article  Google Scholar 

  16. James TW, Baron TH (2019) Endoscopic ultrasound-directed transgastric ERCP (EDGE): a single-center us experience with follow-up data on fistula closure. Obes Surg 29:451–456

    Article  Google Scholar 

  17. Rimbas M, Larghi A, Costamagna G (2017) Endoscopic ultrasound-guided gastroenterostomy: are we ready for prime time? Endosc Ultrasound 6:235–240

    Article  Google Scholar 

  18. Irani S, Itoi T, Baron TH, Khashab M (2019) EUS-guided gastroenterostomy: techniques from East to West. VideoGIE 5:48–50

    Article  Google Scholar 

  19. Carbajo AY, Kahaleh M, Tyberg A (2020) Review of EUS-guided gastroenterostomy (EUS-GE) (EUS-GE). J Clin Gastroenterol 54:1–7

    Article  Google Scholar 

  20. Perez-Miranda M, Tyberg A, Poletto D, Toscano E, Gaidhane M, Desai AP, Kumta NA, Fayad L, Nieto J, Barthet M, Shah R, Brauer BC, Sharaiha RZ, Kahaleh M (2017) EUS-guided gastrojejunostomy versus laparoscopic gastrojejunostomy: an International Collaborative Study. J Clin Gastroenterol 51:896–899

    Article  Google Scholar 

  21. Chen YI, James TW, Agarwal A (2018) EUS-guided gastroenterostomy in management of benign gastric outlet obstruction. Endosc Int Open 6:E363–E368

    Article  Google Scholar 

  22. Mudireddy PR, Sethi A, Siddiqui AA et al (2018) EUS-guided drainage of postsurgical fluid collections using lumen-apposing metal stents: a multicenter study. Gastrointest Endosc 87:1256–1262

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, University Hospital of Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium

    Pieter Hindryckx & Helena Degroote

Authors
  1. Pieter Hindryckx
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Helena Degroote
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pieter Hindryckx.

Ethics declarations

Disclosures

Pieter Hindryckx has received consultancy fees from Medtronic, Fresenius, Takeda and Janssen; lecture fees from Medwork, Abbvie, Janssen, Takeda. Helena Degroote has received lecture fees from Bayer.

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

Hindryckx, P., Degroote, H. Lumen-apposing metal stents for approved and off-label indications: a single-centre experience. Surg Endosc 35, 6013–6020 (2021). https://doi.org/10.1007/s00464-020-08090-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-020-08090-6

Keywords

Search

Navigation