Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Dec 16, 2017; 9(12): 571-578
Published online Dec 16, 2017. doi: 10.4253/wjge.v9.i12.571
Lumen-apposing metal stents for benign gastrointestinal tract strictures: An international multicenter experience
Javier Santos-Fernandez, Christopher Paiji, Mohammad Shakhatreh, Irene Becerro-Gonzalez, Ramon Sanchez-Ocana, Paul Yeaton, Jason Samarasena, Manuel Perez-Miranda
Javier Santos-Fernandez, Irene Becerro-Gonzalez, Ramon Sanchez-Ocana, Manuel Perez-Miranda, Gastroenterology Department, Hospital Universitario Rio Hortega, Valladolid 47012, Spain
Christopher Paiji, Jason Samarasena, Division of Gastroenterology and Hepatology, University of California - Irvine, Orange, CA 92697, United States
Mohammad Shakhatreh, Paul Yeaton, Section of Gastroenterology and Hepatology, Virginia Tech Carilion School of Medicine and Research Institute, Roanoke, VI 24016, United States
Author contributions: Santos-Fernandez J, Shakhatreh M, Yeaton P, Samarasena J and Perez-Miranda M contributed to study conception and design; Santos-Fernandez J, Paiji C, Shakhatreh M, Becerro-Gonzalez I, Sanchez-Ocana R, Yeaton P, Samarasena J and Perez-Miranda M contributed to data acquisition, data analysis and interpretation, and writing of article; Santos-Fernandez J, Paiji C, Shakhatreh M, Samarasena J and Perez-Miranda M contributed to editing, reviewing and final approval of article.
Institutional review board statement: The study was approved by Hospital Universitario Rio Hortega.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: Santos-Fernandez J, Paiji C, Shakhatreh M, Becerro-Gonzalez I, Sanchez-Ocana R, Yeaton P, Samarasena J and Perez-Miranda M report no conflicts-of-interest.
Data sharing statement: There is no additional data available at this time. Please contact corresponding author at mperezmiranda@saludcastillayleon.es for additional information.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Manuel Perez-Miranda, MD, PhD, Gastroenterology Department, Hospital Universitario Rio Hortega, Calle Antonio Lorenzo Hurtado 2, Valladolid 47012, Spain. mperezmiranda@saludcastillayleon.es
Telephone: +34-98-3420400-85701
Received: May 12, 2017
Peer-review started: May 17, 2017
First decision: June 16, 2017
Revised: August 28, 2017
Accepted: September 14, 2017
Article in press: September 15, 2017
Published online: December 16, 2017
Processing time: 208 Days and 12.5 Hours
Abstract
AIM

To investigate technical feasibility, outcomes and adverse events of the lumen-apposing metal stent (LAMS) for benign gastrointestinal (GI) tract strictures.

METHODS

Between July 2015 and January 2017, patients undergoing treatment by LAMS for benign GI strictures at three tertiary referral centers were included in this study. Primary outcomes included technical success, short-term clinical success, long-term clinical success, and adverse events. Short-term clinical success was defined as symptom resolution at 30 d after stent placement. Long-term clinical success was defined by symptom resolution at 60 d in patients who continued to have indwelling stent, or continued symptom resolution at 30 d after elective stent removal.

RESULTS

A total of 21 patients (mean age 62.6 years, 47.6% males) underwent placement of LAMS for benign GI strictures. A 15 mm × 10 mm LAMS was placed in 16 patients, a 10 mm × 10 mm LAMS was placed in 2 patients, and a 16 mm × 30 mm LAMS was placed in 3 patients. Technical success was obtained in all cases. Short-term clinical success was achieved in 19 out of 21 cases (90.5%), and long-term clinical success was achieved in 12 out of 18 (66.7%). Mean (range) stent indwell time was 107.2 (28-370) d. After a mean (range) dwell time of 104.3 (28-306) d, 9 LAMSs were removed due to the following complications: ulceration at stent site (n = 1), angulation (n = 2), migration (n = 4) and stricture overgrowth (n = 2). Migration occurred in 4 cases (19.0%), and it was associated with stricture resolution in one case. Median (range) follow-up period was 119 (31-422) d.

CONCLUSION

Utilization of LAMS for benign strictures has shown to be technically feasible and safe, but adverse events highlight the need for further study of its indications.

Keywords: Endoscopy; Stent; Gastrointestinal diseases; Stricture; Biomedical technology

Core tip: Treatment of benign short gastrointestinal (GI) tract strictures has primarily involved endoscopic balloon dilation, intralesional steroid injection and the conventional fully-covered metal stent. The lumen-apposing metal stent (LAMS), which has been used to drain pancreatic fluid collections, may serve as a more effective alternative. This study measures technical feasibility and potential short and long-term effectiveness of LAMS for benign GI strictures at three tertiary referral centers. Although results are promising, complications include angulation, stricture overgrowth and ulceration at stent site. These highlight the need for further study to better specify which patients should receive LAMS and how to minimize burden of complications.