Off-label use of lumen apposing metal stents for treatment of short benign biliary strictures: a single tertiary center experience

Aims Endoscopic stenting is considered the mainstay of biliary treatment for benign biliary strictures; temporary insertion of multiple plastic stents or of a fully covered self-expandable metal stent (FC-SEMS) are the preferred methods due to their favorable results. However, there is a not-negligible rate of stricture recurrence and spontaneous stent migration, the latter being a leading cause of treatment failure. Lumen-apposing metal stents (LAMS), developed for transluminal drainages, have a unique design with short length, large diameter and wide flanges which make them less prone to migration. LAMS have recently been proposed as a novel modality for treating short benign gastrointestinal strictures. Aim of our study was to describe the intraluminal use of LAMS to treat short benign biliary strictures.

Methods This was a retrospective, single-arm, single Centre study. All consecutive patients who underwent retrograde LAMS placement for benign biliary strictures, from October 2016 to July 2022, were included. Clinical data, including stricture etiology, previous upper-GI or hepatobiliary surgery, previous treatments for biliary stricture and type of LAMS used were collected from medical records. Primary outcomes were evaluation of technical success, as performance of effective endoscopic treatment, and stricture resolution; secondary outcomes were the retrospective evaluation of follow-up in order to determine long-term success and stricture recurrence.

Results During the study period, seventy patients (35 male, mean age 67, range 27-90 years) underwent retrograde LAMS placement for benign biliary strictures; anastomotic stricture was the most common etiology (n=34), followed by distal non-anastomotic stricture (n=22) and post-surgical non-anastomotic stricture (n=14). LAMS placement was a second-line therapy, after failure of other methods, in 39 patients (55.7%). A 16-mm LAMS was used in 43 patients and a 12-mm LAMS in 27 (NAGI stent, Taewoong Medical, South Korea). Technical and clinical success were obtained in 100% and 85.7% of patients, respectively. Adverse events were 12 (17.1%), among them, stent migration occurred in 8 (11.4%) of cases, 3 of which determined failure. We found a higher success rate in patients with post-surgical non-anastomotic stricture then patients with anastomotic stricture (100% vs 79.4%, p=0.03) or with distal non-anastomotic stricture (100% vs 86.3%, p=0.07). Adverse events rate was higher in group who underwent the treatment as a first line then who underwent the treatment as a second line (25.8% vs 10.2%, p=0.04) in light of similar clinical success (83.8% vs 87.1%, p=0.3). During follow-up of patients who obtained clinical success, stricture recurred in 10 patients (12.5%) within a median of 13.5 months onset (IQR 7-23 months) with no statistical differences between groups. [1] [2]

Conclusions LAMS placement could be a safe and effective treatment for short benign biliary strictures in selected patients in which pre-procedure assessment reveals a significant caliber disproportion between stricture and the biliary duct above.

Conflicts of interest

Authors do not have any conflict of interest to disclose.

• References

• 1 Hoon Lee T.. Efficacy of a modified short fully covered self-expandable metal stent for perihilar benign biliary strictures. J Gastroenterol Hepatol 2021
• 2 Sharma P.. et al. Alternative uses of lumen apposing metal stents. WJG 2020

Publication History

Article published online:
15 April 2024