EUS-guided colo-entero-anastomosis with Lumen Apposing Metal Stent (LAMS) as a rescue treatment for malignant bowel occlusions: a multicentre study

Aims Malignant bowel obstruction (MBO) is a relevant problem for patients with advanced malignancy. Surgery is the first-choice treatment, however many patients are deemed inoperable. Endoscopic ultrasound (EUS) guided colo-entero-anastomosis with lumen apposing metal stents (LAMS) could represent a new effective palliative treatment option. We aimed to assess the technical success and the safety of EUS guided colo-entero-anastomosis, symptoms relief, time of re-feeding, hospital stay and overall survival.

Methods All consecutive patients undergoing EUS guided colo-entero-anastomosis for MBO from November 2021 to September 2023 were retrospectively enrolled at four tertiary referral European centres. All cases were discussed in a multidisciplinary meeting and patients declared unfit for surgery and colonic stent placement or spontaneously refused surgery. Demographic and clinical data, the type and size of LAMS used for the procedures, the clinical outcome and adverse events were recorded. Data were expressed as median [range] and comparisons were made by using the χ2 test, Student t-test, or Mann–Whitney u-test, as appropriate.

Results Twelve patients were enrolled (58.3% female, median age 72.5 [42-85]). In 75% of cases the primary tumour was colonic adenocarcinoma, 91.7% of patients had a Stage IV disease and 50% were in chemotherapy treatment. In 83.3% of the procedures the LAMS used was the Hot AXIOS from Boston Scientific and in 16.7% the Hot SPAXUS from Taewoong. Technical success was achieved in all procedures (100%). No LAMS misdeployment or other immediate post procedure adverse events were observed. Delayed post-procedural complications were recorded in 3 (25%) patients, however direct correlation with the procedure could not be ascertained. Clinical success was reached in 10 (83.3%) patients and the median time of oral diet resumption was 1 [1-2] day. The median post-procedure hospital stay was 9 [1-20] days and the overall median survival was 47.5 [2-270] days.

Conclusions EUS guided colo-entero-anastomosis is a feasible and safe technique, and can be considered as a valid alternative to standard approaches in highly selected patients.

Conflicts of interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
15 April 2024