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Endoscopic gastrointestinal anastomoses with lumen-apposing metal stents: predictors of technical success

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Abstract

Background

Lumen-apposing metal stents (LAMS) may be inserted to create gastrointestinal anastomoses under endoscopic ultrasound (EUS) guidance. This new technique has mostly been evaluated as treatment for gastric outlet obstruction (GOO), especially of malignant origin. Technical success was high in the few and small available studies. Aim of this study was to report our experience with this technique and to identify predictors of success in the setting of a large teaching hospital in Germany.

Methods

All subsequent patients who underwent EUS-guided gastrointestinal anastomosis with LAMS from 02/2016 to 08/2019 were included. We performed a retrospective chart analysis including technical procedural details, basic demographic, and health characteristics. Technical success was defined as successful insertion of LAMS. In patients with GOO, the GOO Scoring System was used; an improvement ≥ 1 point was defined as clinical success.

Results

Thirty-five patients (22 female, median age: 79 years) were included. Indication for the anastomosis was malignant GOO in 33 patients. In ten patients LAMS was inserted over a guidewire, in 22 patients direct puncture with the electrocautery delivery system of LAMS was performed, and other techniques were used in two patients. Technical success rate was 80.0%. Adverse events occurred in 14.3%. Clinical success rate was 74.3%. Technical success increased and procedure time decreased significantly during the study period. Distance between the two lumina connected with LAMS was significantly shorter (median: 9 mm) in patients with technical success compared to those without (median: 20 mm, P = 0.004). This distance was identified as predictor of success on multivariate analysis.

Conclusions

EUS-guided gastrointestinal anastomosis with LAMS is an emerging technique. Its success mainly depends on the distance between the two lumina that are going to be connected by the LAMS and is influenced by the endoscopist’s experience.

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Abbreviations

LAMS:

Lumen-apposing metal stent

EUS:

Endoscopic ultrasound

GOO:

Gastric outlet obstruction

GOOSS:

Gastric outlet obstruction scoring system

ERCP:

Endoscopic retrograde cholangiopancreatography

CT scan:

Computed tomography scan

OTSC:

Over-the-scope clip

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Author notes

  1. Andreas Wannhoff and Nadine Ruh have contributed equally to this work.

Authors and Affiliations

  1. Department of Internal Medicine and Gastroenterology, Hospital Ludwigsburg, Ludwigsburg, Germany

    Andreas Wannhoff, Nadine Ruh, Benjamin Meier, Bettina Riecken & Karel Caca

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  1. Andreas Wannhoff
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  2. Nadine Ruh
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  3. Benjamin Meier
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  4. Bettina Riecken
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  5. Karel Caca
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Corresponding author

Correspondence to Karel Caca.

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Drs. Wannhoff, Ruh, Meier, Riecken, and Caca have no conflicts of interest or financial ties to disclose.

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Wannhoff, A., Ruh, N., Meier, B. et al. Endoscopic gastrointestinal anastomoses with lumen-apposing metal stents: predictors of technical success. Surg Endosc 35, 1997–2004 (2021). https://doi.org/10.1007/s00464-020-07594-5

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  • DOI: https://doi.org/10.1007/s00464-020-07594-5

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