Systematic Reviews
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 7, 2023; 29(21): 3341-3361
Published online Jun 7, 2023. doi: 10.3748/wjg.v29.i21.3341
Lumen-apposing-metal stent misdeployment in endoscopic ultrasound-guided drainages: A systematic review focusing on issues and rescue management
Elia Armellini, Flavio Metelli, Andrea Anderloni, Anna Cominardi, Giovanni Aragona, Michele Marini, Fabio Pace
Elia Armellini, Flavio Metelli, Fabio Pace, Department of Gastroenterology, ASST-Bergamoest, Seriate 24068, Bergamo, Italy
Andrea Anderloni, Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia 27100, Italy
Anna Cominardi, Giovanni Aragona, Department of Gastroenterology, “Guglielmo da Saliceto” Hospital, Piacenza 29121, Italy
Michele Marini, Department of General Surgery, ASST-Bergamoest, Seriate 24068, Italy
Author contributions: Armellini E contributed to the concept, design, drafting of the article, and approved final revision; Metelli F and Marini M involved in the acquisition, statistical analysis, or interpretation of data for biliary duct and pancreatic fluid collection section, and contribution to drafting the article; Cominardi A and Aragona G contributed to the acquisition and statistical analysis, or interpretation of data for gallbladder section; Anderloni A and Pace F revised the manuscript critically for intellectual content; and all the authors approved the version to be published.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article. Andrea Anderloni is consultant for BSCI, Olympus.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Elia Armellini, MD, Department of Gastroenterology, ASST-Bergamoest, Via Paderno 21, Seriate 24068, Bergamo, Italy. elia_armellini@hotmail.com
Received: December 29, 2022
Peer-review started: January 1, 2023
First decision: January 10, 2023
Revised: February 1, 2023
Accepted: May 6, 2023
Article in press: May 6, 2023
Published online: June 7, 2023
Processing time: 153 Days and 23.5 Hours
ARTICLE HIGHLIGHTS
Research background

Scant data are available about rescue techniques in cases of lumen-apposing metal stents (LAMS) misdeployment which is the main cause of technical failure in endoscopic ultrasound (EUS)-guided drainage procedures. We performed a systematic review of the literature about LAMS misdeployment and rescue techniques in the biliopancreatic setting, focusing on technical aspects and success rate of endoscopic maneuvers.

Research motivation

LAMS misdeployment is a relatively common adverse event in EUS-guided drainages. There is no consensus on the best rescue approach in these cases and the choice is often made by the endoscopist relying upon the clinical scenario, anatomical characteristics, and local expertise.

Research objectives

The overall technical success rate of EUS-guided choledochoduodenostomy (EUS-CDS), gallbladder drainage (EUS-GBD) and pancreatic fluid collections drainage (EUS-PFC) was 93.7%, 96.1%, and 98.1% respectively. Significant rates of LAMS misdeployment have been reported for EUS-CDS, EUS-GBD and EUS-PFC drainage, respectively 5.8%, 3.4%, and 2.0%. Endoscopic rescue treatment was feasible in 86.8%, 80%, and 96.8% of cases. Non endoscopic rescue strategies were required only in 10.3%, 16% and 3.2% for EUS-CDS, EUS-GBD, and EUS-PFC.

Research methods

We conducted a systematic review of the literature on PubMed searching for studies published up to October 2022 about on-label EUS-guided procedures namely EUS-CDS, EUS-GBD and EUS-PFC. The search was carried out using the exploded medical subject heading terms ‘lumen apposing metal stent’, ‘LAMS’, ‘endoscopic ultrasound’ and “choledochoduodenostomy” or “gallbladder” or “pancreatic fluid collections”.

Research results

The overall technical success rate of EUS-CDS, EUS-GBD and EUS-PFC was 93.7%, 96.1%, and 98.1% respectively. Significant rates of LAMS misdeployment have been reported for EUS-CDS, EUS-GBD and EUS-PFC drainage, 5.8%, 3.4%, and 2.0%, respectively. Endoscopic rescue treatment was feasible in 86.8%, 80%, and 96.8% of cases. Non endoscopic rescue strategies were required only in 10.3%, 16% and 3.2% for EUS-CDS, EUS-GBD, and EUS-PFC. The endoscopic rescue techniques described were over-the-wire deployment of a new stent through the created fistula tract in 44.1%, 8% and 64.5% and stent-in-stent in 23.5%, 60%, and 12.9%, respectively for EUS-CDS, EUS-GBD, and EUS-PFC. Further therapeutic option were endoscopic rendezvous in 11.8% of EUS-CDS and repeated procedure of EUS-guided drainage in 16.1% of EUS-PFC.

Research conclusions

Stent misdeployment can be managed successfully by endoscopic rescue maneuvers to allow the completion of the procedure. In accordance with our results endoscopic rescue techniques are feasible in most cases (up to 96.8%). Three endoscopic rescue strategies have been identified: Gaining wire access to the target through the created fistula and completing the procedure; placement of a new stent through the misdeployed LAMS to the target (“stent-in-stent”) and repeated drainage procedures (ex novo or rendezvous).

Research perspectives

LAMS misdeployment is the main cause of technical failure of EUS-drainages and it is potentially harmful to the patient. Knowledge of risk factors, classification of misdeployment and of endoscopic rescue techniques is useful to improve patient outcome and the safety of the procedure. Further prospective studies describing these issues are expected.