title: Lumen-apposing covered self-expandable metal stents for short benign gastrointestinal strictures: a multicenter study.
abstract: Background and study aimUse of the fully covered self-expandable metal stent (SEMS) for benign luminal gastrointestinal (GI) stricture (BLGS) has been limited by the migration rate. The role of the lumen-apposing metal stent (LAMS) for BLGS is not well defined. We assessed the safety, feasibility, and efficacy of LAMS for the treatment of BLGS.Patients and methodsThis was an observational, open-label, retrospective, single-arm, multicenter consecutive case series of patients undergoing LAMS placement for BLGS. Technical success was defined as successful placement of the LAMS. Short- and long-term clinical success rates were defined as symptom improvement/resolution with indwelling stent and after stent removal, respectively. All adverse events and additional interventions were recorded.ResultsA total of 30 patients (mean age 51.6 years; 63.3 % women) underwent LAMS placement for GI strictures (83.9 % anastomotic). Median stricture diameter and length were 4.5 mm (range 2 - 10 mm) and 8 mm (range 5 - 10 mm), respectively. Technical success was achieved in 29 patients (96.7 %), with an adverse event rate of 13.3 %. The stent migration rate was 8.0 % (2/25) on follow-up endoscopy. Short-term clinical success was achieved in 90.0 % (27/30) at a median of 60 days (interquartile range [IQR] 40 - 90 days). Most patients (19/23; 82.6 %) experienced sustained symptom improvement/resolution without the need for additional interventions at a median follow-up of 100 days (IQR 60 - 139 days) after LAMS removal.ConclusionThis multicenter study demonstrated that LAMS placement represents a safe, feasible, and effective therapeutic option for patients with BLGS and is associated with a low stent migration rate. Our initial findings suggest that future prospective comparative studies are needed on the use of LAMS, endoscopic dilation, and conventional SEMS. .
authors.affiliation: Division of Gastroenterology, University of Florida College of Medicine, Gainesville, Florida, United States.
authors.forename: Dennis
authors.initials: D
authors.lastname: Yang
authors.affiliation: Borland-Groover Clinic, Jacksonville, Florida, United States.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Nieto
authors.affiliation: Jefferson University Hospitals, Division of Gastroenterology and Hepatology, Philadelphia, Pennsylvania, United States.
authors.forename: Ali
authors.initials: A
authors.lastname: Siddiqui
authors.affiliation: Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, United States.
authors.forename: Brian P
authors.initials: BP
authors.lastname: Riff
authors.affiliation: Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, United States.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: DiMaio
authors.affiliation: Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, United States.
authors.forename: Satish
authors.initials: S
authors.lastname: Nagula
authors.affiliation: Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States.
authors.forename: Amr M
authors.initials: AM
authors.lastname: Ismail
authors.affiliation: Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States.
authors.forename: Saowanee
authors.initials: S
authors.lastname: Ngamreungphong
authors.affiliation: Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States.
authors.forename: Mouen A
authors.initials: MA
authors.lastname: Khashab
authors.affiliation: Division of Gastroenterology, University of Colorado School of Medicine, Aurora, Colorado, United States.
authors.forename: Mihir S
authors.initials: MS
authors.lastname: Wagh
authors.affiliation: Division of Gastroenterology and Hepatology, Stony Brook University School of Medicine, Stony Brook, New York, United States.
authors.forename: Demetrios
authors.initials: D
authors.lastname: Tzimas
authors.affiliation: Division of Gastroenterology and Hepatology, Stony Brook University School of Medicine, Stony Brook, New York, United States.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Buscaglia
authors.affiliation: Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, Virginia, United States.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Strand
authors.affiliation: Division of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, Virginia, United States.
authors.forename: Andrew Y
authors.initials: AY
authors.lastname: Wang
authors.affiliation: CHS Digestive Health, Carolinas Medical Center, Charlotte, North Carolina, United States.
authors.forename: Shailendra S
authors.initials: SS
authors.lastname: Chauhan
authors.affiliation: Division of Gastroenterology, University of Florida College of Medicine, Gainesville, Florida, United States.
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Forsmark
authors.affiliation: Division of Gastroenterology, University of Florida College of Medicine, Gainesville, Florida, United States.
authors.forename: Peter V
authors.initials: PV
authors.lastname: Draganov
mesh_terms: D000328:Adult; D000368:Aged; D003251:Constriction, Pathologic / Q000628:therapy; D016099:Endoscopy, Gastrointestinal; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure / Q000209:etiology; D012189:Retrospective Studies; D000069322:Self Expandable Metallic Stents / Q000009:adverse effects*; D016896:Treatment Outcome