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CC BY-NC-ND 4.0 · Endosc Int Open 2024; 12(10): E1143-E1149
DOI: 10.1055/a-2411-1814
Original article

Outcomes of lumen apposing metal stent placement in patients with surgically altered anatomy: Multicenter international experience

Benedetto Mangiavillano 
1   Gastrointestinal Endoscopy, Istituto Clinico Mater Domini Casa di Cura Privata SpA, Castellanza, Italy (Ringgold ID: RIN9348)
,
Daryl Ramai
2   Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, United States (Ringgold ID: RIN14434)
,
Michel Kahaleh 
3   Foundation of Interventional and Therapeutic Endoscopy, New Brunswick, United States
,
Amy Tyberg
4   Division of Gastroenterology, Hackensack Meridian Hospital, Hackensack, United States
,
Haroon Shahid
4   Division of Gastroenterology, Hackensack Meridian Hospital, Hackensack, United States
,
Avik Sarkar
4   Division of Gastroenterology, Hackensack Meridian Hospital, Hackensack, United States
,
Jayanta Samanta 
5   Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India (Ringgold ID: RIN29751)
,
Jahnvi Dhar
5   Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India (Ringgold ID: RIN29751)
,
Michiel Bronswijk 
6   Gastroenterology and Hepatology, KU Leuven University Hospitals Leuven, Leuven, Belgium
,
Schalk Van der Merwe
7   Hepatology and GI Research Laboratory, Department of Immunology, University of Pretoria, Pretoria, South Africa
8   Department of Hepatology and Biliopancreatic Disease, KU Leuven, Leuven, Belgium
,
Abdul Kouanda 
9   Gastroenterology, University of California San Francisco Medical Center at Parnassus, San Francisco, United States (Ringgold ID: RIN43166)
,
Hyun Ji
10   Gastroenterology, University of California San Francisco, San Francisco, United States (Ringgold ID: RIN8785)
,
Sun-Chuan Dai
11   Gastroenterology Division, University of California San Francisco Medical Center, San Francisco, United States
,
Pierre Deprez
12   Gastroenterology, Clin Univ St-Luc, Bruxelles, Belgium
,
Jorge Vargas-Madrigal
13   Gastroenterology Department, Enrique Baltodano Briceno Hospital, Liberia, Costa Rica, Costa Rica, Costa Rica
,
Giuseppe Vanella
14   Pancreato-BiliaryEndoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy, Milan, Italy
,
Roberto Leone
15   Medicine, Vita-Salute San Raffaele University, Milano, Italy (Ringgold ID: RIN18985)
,
Paolo Giorgio Arcidiacono 
16   Gastroenterology and Gastrointestinal Endoscopy, Vita-Salute-San Raffaele University - IRCCS San Raffaele Hospital, Milan, Italy
,
Carlos Robles-Medranda 
17   Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas - IECED, Guayaquil, Ecuador
18   Endoscopy, Omni Hospital, Guayaquil, Ecuador
,
Juan Alcivar Vasquez
17   Gastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas - IECED, Guayaquil, Ecuador
,
Martha Arevalo-Mora 
19   IECED, Instituto Ecuatoriano de Enfermedades Digestivas, Guayaquil, Ecuador
,
Alessandro Fugazza
20   Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano, Italy
,
Christopher Ko
2   Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, United States (Ringgold ID: RIN14434)
,
John Morris
2   Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, United States (Ringgold ID: RIN14434)
,
Andrea Lisotti 
21   Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola, Italy (Ringgold ID: RIN9296)
,
Pietro Fusaroli
21   Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola, Italy (Ringgold ID: RIN9296)
,
Amaninder Dhaliwal
22   Division of Gastroenterology, University of Nebraska Medical Center, Omaha, United States (Ringgold ID: RIN12284)
,
Massimiliano Mutignani
23   Surgical Department, U.O.C. Digestive Endoscopy Unit, Milano, Italy
,
Edoardo Forti
24   Digestive Endoscopy, Ospedale Niguarda-Ca' Granda, Milan, Italy
,
Irene Cottone
24   Digestive Endoscopy, Ospedale Niguarda-Ca' Granda, Milan, Italy
,
Alberto Larghi
25   Digestive Endoscopy Unit, Universita' Cattolica del Sacro Cuore, Rome, Italy
,
Gianenrico Rizzatti
26   Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
,
Domenico Galasso 
27   Department of Medicine, Gastroenterology Unit, Hôpital Riviera-Chablais, Rennaz, Switzerland (Ringgold ID: RIN30919)
,
Carmelo Barbera
28   Gastroenterology and Digestive Endoscopy Unit, Nuovo Ospedale Civile S.Agostino-Estense, Baggiovara di Modena (Mo), Italy
29   Gastroenterology and Digestive Endoscopy Unit, Azienda Unita Sanitaria Locale di Modena, Italy (Ringgold ID: RIN18067)
,
Francesco Maria Di Matteo
30   Operative Endoscopy Department, Campus Bio-Medico University Hospital, Roma, Italy (Ringgold ID: RIN220431)
,
Serena Stigliano
31   Therapeutic GI Endoscopy Unit, Campus Bio-Medico University Hospital, Roma, Italy (Ringgold ID: RIN220431)
,
Cecilia Binda 
32   Unit of Gastroenterology and Digestive Endoscopy, Morgagni-Pierantoni Hospital, Forli, Italy (Ringgold ID: RIN18568)
33   Unit of Gastroenterology and Digestive Endoscopy, Maurizio Bufalini Hospital, Cesena, Italy (Ringgold ID: RIN161128)
,
Carlo Fabbri
34   Digestive Endoscopy and Gastroenterology Unit, Forlì-Cesena Hospitals, Azienda Unita Sanitaria Locale della Romagna, Forlì-Cesena, Italy (Ringgold ID: RIN390233)
,
Khanh Do-Cong Pham
35   Medicine, Haukeland University Hospital, Bergen, Norway
36   Clinical medicine, K1, University of Bergen, Bergen, Norway
,
Roberto Di Mitri
37   Gastroenterology and Endoscopy Unit, A.R.N.A.S. Civico-Di Cristina-Benfratelli Hospital, Palermo, Italy
,
Michele Amata 
38   Gastroenterology, IsMeTT/UPMC, Palermo, Italy
,
Stefano Francesco Crinó 
39   Gastroenterology and Digestive Endoscopy Unit, Pancreas Institute, University of Verona, Verona, Italy (Ringgold ID: RIN19051)
,
Andrew Ofosu
40   Gastroenterology and Hepatology, Brooklyn Hospital Center, Brooklyn, United States (Ringgold ID: RIN24508)
,
Luca De Luca 
41   Gastroenterology and Digestive Endoscopy, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy (Ringgold ID: RIN18635)
,
Abed Al-Lehibi 
42   Gastroenterology & Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia (Ringgold ID: RIN37849)
,
Francesco Auriemma
43   Gastroenterologia, Università Federico II, Napoli, Italy
44   Digestive Endoscopy Unit, Division of Gastroenterology, Istituto Clinico Humanitas, Rozzano, Italy (Ringgold ID: RIN9268)
,
Danilo Paduano
45   Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza, Italy
,
Federica Calabrese
46   Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza, Varese, Italy
,
Carmine Gentile
46   Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza, Varese, Italy
,
Cesare Hassan 
47   Department of Biomedical Sciences, Humanitas University, Milan, Italy (Ringgold ID: RIN437807)
48   Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Milan, Italy
,
Alessandro Repici
49   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (Ringgold ID: RIN437807)
50   Digestive Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy (Ringgold ID: RIN9268)
,
Antonio Facciorusso 
51   Medical Sciences, Gastroenterology, Foggia, Italy
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Correction: Outcomes of lumen apposing metal stent placement in patients with surgically altered anatomy: Multicenter international experienceEndosc Int Open 2024; 12(10): C8-C8
DOI: 10.1055/a-2447-4371

Abstract

Background and study aims Although outcomes of lumen-apposing metal stents (LAMS) placement in native anatomy have been reported, data on LAMS placement in surgically altered anatomy (SAA) are sparse. We aimed to assess outcomes of LAMS placement in patients with SAA for different indications.

Patients and methods This was an international, multicenter, retrospective, observational study at 25 tertiary care centers through November 2023. Consecutive patients with SAA who underwent LAMS placement were included. The primary outcome was technical success defined as correct placement of LAMS. Secondary outcomes were clinical success and safety.

Results Two hundred and seventy patients (125 males; average age 61 ± 15 years) underwent LAMS placement with SAA. Procedures included EUS-directed transgastric ERCP (EDGE) and EUS-directed transenteric ERCP (EDEE) (n = 82), EUS-guided entero-enterostomy (n = 81), EUS-guided biliary drainage (n = 57), EUS-guided drainage of peri-pancreatic fluid collections (n = 48), and EUS-guided pancreaticogastrostomy (n = 2). Most cases utilized AXIOS stents (n = 255) compared with SPAXUS stents (n = 15). Overall, technical success was 98%, clinical success was 97%, and the adverse event (AE) rate was 12%. Using AGREE classification, five events were rated as Grade II, 21 events as Grade IIIa, and six events as IIIb. No difference in AEs were noted among stent types (P = 0.52).

Conclusions This study shows that placement of LAMS is associated with high technical and clinical success rates in patients with SAA. However, the rate of AEs is noteworthy, and thus, these procedures should be performed by expert endoscopists at tertiary centers.

Keywords

Endoscopy Lower GI Tract - Stenting - Endoscopy Small Bowel - Endoscopic ultrasonography


Publication History

Received: 26 June 2024

Accepted after revision: 06 September 2024

Accepted Manuscript online:
09 September 2024

Article published online:
10 October 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Sharma P, McCarty TR, Chhoda A. et al. Alternative uses of lumen apposing metal stents. World J Gastroenterol 2020; 26: 2715
    CrossrefPubMedSearch in Google Scholar
  • 2 Bhenswala P, Lakhana M, Gress FG. et al. Novel uses of lumen-apposing metal stents: a review of the literature. J Clin Gastroenterol 2021; 55: 641-651
    CrossrefPubMedSearch in Google Scholar
  • 3 Ichkhanian Y, Jovani M. Use of lumen apposing metal stents in patients with altered gastrointestinal anatomy. Curr Opin Gastroenterol 2023; 39: 348-355
    CrossrefPubMedSearch in Google Scholar
  • 4 Chowdhury SD, Diez-Redondo P, Pérez-Miranda M. Approach to biliary access in patients with altered anatomy. Tech Gastrointest Endosc 2016; 18: 98-106
    CrossrefPubMedSearch in Google Scholar
  • 5 Spadaccini M, Giacchetto CM, Fiacca M. et al. Endoscopic biliary drainage in surgically altered anatomy. Diagnostics 2023; 13: 3623
    CrossrefPubMedSearch in Google Scholar
  • 6 Nass KJ, Zwager LW, van der Vlugt M. et al. Novel classification for adverse events in GI endoscopy: the AGREE classification. Gastrointest Endosc 2022; 95: 1078-1085
    CrossrefPubMedSearch in Google Scholar
  • 7 Sharaiha RZ, Khan MA, Kamal F. et al. Efficacy and safety of EUS-guided biliary drainage in comparison with percutaneous biliary drainage when ERCP fails: a systematic review and meta-analysis. Gastrointest Endosc 2017; 85: 904-914
    CrossrefPubMedSearch in Google Scholar
  • 8 Tanisaka Y, Mizuide M, Fujita A. et al. Endoscopic ultrasound-guided biliary drainage in patients with surgically altered anatomy: A systematic review and Meta-analysis. Scand J Gastroenterol 2023; 58: 107-115
    CrossrefPubMedSearch in Google Scholar
  • 9 van der Merwe SW, van Wanrooij RLJ, Bronswijk M. et al. Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2022; 54: 185-205
    Thieme ConnectPubMedSearch in Google Scholar
  • 10 Koutlas NJ, Pawa S, Russell G. et al. Endoscopic ultrasound-guided gallbladder drainage: beyond cholecystitis. Diagnostics 2023; 13: 1933
    CrossrefPubMedSearch in Google Scholar
  • 11 Crino SF, Rimbaș M, Gabbrielli A. et al. Endoscopic ultrasound guided gallbladder interventions: a review of the current literature. J Gastrointestin Liver Dis 2019; 28: 339-347
    CrossrefPubMedSearch in Google Scholar
  • 12 Teoh AYB, Kitano M, Itoi T. et al. Endosonography-guided gallbladder drainage versus percutaneous cholecystostomy in very high-risk surgical patients with acute cholecystitis: an international randomised multicentre controlled superiority trial (DRAC 1). Gut 2020; 69: 1085-1091
    CrossrefPubMedSearch in Google Scholar
  • 13 Giri S, Harindranath S, Afzalpurkar S. et al. Does a coaxial double pigtail stent reduce adverse events after lumen apposing metal stent placement for pancreatic fluid collections? A systematic review and meta-analysis. Ther Advan Gastrointest Endosc 2023; 16
    CrossrefPubMedSearch in Google Scholar
  • 14 Kedia P, Sharaiha RZ, Kumta NA. et al. Internal EUS-directed transgastric ERCP (EDGE): game over. Gastroenterology 2014; 147: 566-568
    CrossrefPubMedSearch in Google Scholar
  • 15 Tyberg A, Kedia P, Tawadros A. et al. EUS-directed transgastric endoscopic retrograde cholangiopancreatography (EDGE): the first learning curve. J Clin Gastroenterol 2020; 54: 569-572
    CrossrefPubMedSearch in Google Scholar
  • 16 Runge TM, Chiang AL, Kowalski TE. et al. Endoscopic ultrasound-directed transgastric ERCP (EDGE): a retrospective multicenter study. Endoscopy 2021; 53: 611-618
    Thieme ConnectPubMedSearch in Google Scholar
  • 17 Deliwala SS, Mohan BP, Yarra P. et al. Efficacy & safety of EUS-directed transgastric endoscopic retrograde cholangiopacreatography (EDGE) in Roux-en-Y gastric bypass anatomy: a systematic review & meta-analysis. Surg Endosc 2023; 37: 4144-4158
    CrossrefPubMedSearch in Google Scholar
  • 18 Teoh AY, Lakhtakia S, Tarantino I. et al. Endoscopic ultrasonography-guided gastroenterostomy versus uncovered duodenal metal stenting for unresectable malignant gastric outlet obstruction (DRA-GOO): A multicentre randomised controlled trial. Lancet Gastroenterol Hepatol 2024; 9: 124-132
    CrossrefPubMedSearch in Google Scholar
  • 19 Amato A, Tarantino I, Facciorusso A. et al. Real-life multicentre study of lumen-apposing metal stent for EUS-guided drainage of pancreatic fluid collections. Gut 2022; 71: 1050-1052
    CrossrefPubMedSearch in Google Scholar
  • 20 Mangiavillano B, Moon JH, Crinò SF. et al. Safety and efficacy of a novel electrocautery-enhanced lumen-apposing metal stent in interventional EUS procedures (with video). Gastrointest Endosc 2022; 95: 115-122
    CrossrefPubMedSearch in Google Scholar
  • 21 Facciorusso A, Amato A, Crinò SF. et al. Definition of a hospital volume threshold to optimize outcomes after drainage of pancreatic fluid collections with lumen-apposing metal stents: a nationwide cohort study. Gastrointest Endosc 2022; 95: 1158-1172
    CrossrefPubMedSearch in Google Scholar
  • 22 Hayat U, Freeman ML, Trikudanathan G. et al. Endoscopic ultrasound-guided pancreatic duct intervention and pancreaticogastrostomy using a novel cross-platform technique with small-caliber devices. Endosc Int Open 2020; 8: E196-E202
    Thieme ConnectPubMedSearch in Google Scholar