Alternative uses of lumen apposing metal stents

Figure 1 Types of lumen-apposing metal stents. (All stent images available on manufacturer website).

Figure 2 Endoscopic drainage via a transmural or transpapillary approach. A: Endoscopic ultrasound-guided transmural gallbladder drainage using lumen apposing metal stent; B: Endoscopic ultrasound-guided transpapillary drainage of gallbladder. LAMS: Lumen apposing metal stent.

Figure 3 Transmural approach. A: Endoscopic ultrasound-guided gallbladder drainage with proximal lumen apposing metal stent (LAMS) deployment in gallbladder; B: Endoscopic view status post LAMS placement; C: Dilation of the LAMS with through-the-scope balloon; D: Successful endoscopic ultrasound-guided cholecystogastric fistula formation using LAMS.

Figure 4 The lumen of the stent is dilated up to the diameter of the stent lumen, thereby allowing for easy passage of any wider endoscope to access the remnant stomach to complete the desired procedure. A: Normal Roux-en-Y gastric bypass (RYGB) anatomy showing long endoscopic route to be traversed to access the biliary system; B: Lumen apposing metal stent (LAMS) placement between gastric pouch and remnant stomach in RYGB anatomy; C: LAMS placement between blind limb and remnant stomach in RYGB anatomy; D: LAMS placement between Roux Limb and remnant stomach in RYGB anatomy. LAMS: Lumen apposing metal stent.

Figure 5 An attractive procedure to treat patients with gastric outlet obstruction as an alternative to surgery. A: Initial computed tomography demonstrating gastric outlet obstruction; B: Fluoroscopy with duodenal stenosis and distal filling with contrast diluted in sterile water; C: Endoscopic ultrasound-guided gastroenterostomy demonstrating filling of distal bowel; D: Successful placement of lumen apposing metal stent (LAMS); E: Endoscopic image of gastroenterostomy placement with LAMS; F: Follow-up radiograph demonstrating successful LAMS placement to achieve gastroenterostomy.