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Fardanesh A, George J, Hughes D, Stavropoulou-Tatla S, Mathur P. The use of self-expanding metallic stents in the management of benign colonic obstruction: a systematic review and meta-analysis. Tech Coloproctol 2024; 28:85. [PMID: 39028327 PMCID: PMC11271435 DOI: 10.1007/s10151-024-02959-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/08/2024] [Indexed: 07/20/2024]
Abstract
INTRODUCTION Patients presenting with large bowel obstruction (LBO) frequently undergo emergency surgery that is associated with significant morbidity. In malignant LBO, endoscopic approaches with placement is a self-expanding metal stent (SEMS), have been proposed to prevent emergency surgery and act as a bridge to an elective procedure-with the intention of avoiding a stoma and reducing morbidity. This systematic review aims to assess the quality and outcomes of data available on the use of SEMS in benign causes of colonic obstruction. METHODS This systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the protocol was registered on Prospero (ID: CRD42021239363). PUBMED, MEDLINE, HMIC, CINAHL, AMED, EMBASE, APA and Cochrane databases were searched. Studies were assessed for quality utilising the MINORS criteria. Pooled odds ratios with 95% confidence intervals (95% CI) were calculated using random effects models. RESULTS Sixteen studies were included for analysis. 300 patients were included with an average age of 68, and a male predominance of 57%. The quality of the papers included were at risk of bias. The pooled rate of technical success of procedure was 94.4% (95% CI 90.5-96.8%) The pooled rate of clinical success was 77.6% (95% CI: 66.6-85.7%). Adverse effects were low, with perforation 8.8% (4.5-16.6%), recurrence 26.5% (17.2-38.5%) and stent migration 22.5% (14.1-33.8%). DISCUSSION This systematic review demonstrated that SEMS for benign colonic obstruction can be a safe and successful procedure. The utilisation of SEMS in malignant disease as a bridge to surgery has been well documented. Whilst the limitations of the data interpreted are appreciated, we postulate that SEMS could be utilised to decompress patients acutely and allow pre-operative optimisation, leading to a more elective surgery with less subsequent morbidity.
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Affiliation(s)
- Armin Fardanesh
- Department of General Surgery, Royal London Hospital, Bart's Health NHS Foundation Trust, London, England, UK
| | - Jayan George
- Department of General Surgery, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Sheffield, England, UK.
- Division of Clinical Medicine, University of Sheffield, Sheffield, England, UK.
| | - Daniel Hughes
- Department of UGI Surgery, Royal Berkshire NHS Foundation Trust, Reading, England, UK
| | | | - Pawan Mathur
- Department of General Surgery, Royal Free London NHS Foundation Trust, Royal Free Hospital, London, England, UK
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2
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Kankotia RJ, Kwon RS, Philips GM, Regenbogen SE, Zacur GM, Wamsteker EJ, Schulman AR, Machicado JD. Comparison of lumen-apposing metal stents versus endoscopic balloon dilation for the management of benign colorectal anastomotic strictures. Gastrointest Endosc 2024; 100:136-139.e3. [PMID: 38462058 DOI: 10.1016/j.gie.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 02/07/2024] [Accepted: 03/06/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND AND AIMS Limited data exist evaluating lumen-apposing metal stents (LAMSs) with endoscopic balloon dilation (EBD) for the treatment of benign colorectal anastomotic strictures (BCASs). This study compares outcomes of both interventions. METHODS Patients with left-sided BCAS treated with LAMSs versus EBD were identified retrospectively. The primary outcome was a composite of crossover to another intervention to achieve clinical success or recurrence requiring reintervention. RESULTS Twenty-nine patients (11 LAMS and 18 EBD) were identified with longer follow-up in the EBD group (734 vs 142 days; P = .003). No significant differences were found in the composite outcome, technical success, clinical success, or components of composite outcome. With LAMS, there was a nonsignificant trend toward fewer procedures (2.4 vs 3.3; P = .06) and adverse events (0% vs 16.7%; P = .26). CONCLUSIONS LAMS appears to be as effective as EBD for the treatment of BCAS but may require fewer procedures and may be safer than EBD.
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Affiliation(s)
- Ravi J Kankotia
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Richard S Kwon
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - George M Philips
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Scott E Regenbogen
- Division of Colorectal Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - George M Zacur
- Division of Pediatric Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA
| | - Erik-Jan Wamsteker
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Allison R Schulman
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jorge D Machicado
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA.
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Bhowmick K, Habr F, Perera P. A Successful 12-Month Trial of a Lumen-Apposing Self-Expandable Metallic Stent on a Benign Recalcitrant After Surgical Stricture. ACG Case Rep J 2024; 11:e01298. [PMID: 38440353 PMCID: PMC10911520 DOI: 10.14309/crj.0000000000001298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/29/2024] [Indexed: 03/06/2024] Open
Abstract
Gastrojejunal anastomotic strictures are common postsurgical complications that may be treated endoscopically. In some cases, conventional endoscopic dilations may prove ineffective, prompting consideration of covered self-expandable metal stents as the next step. However, the efficacy of these stents may be limited by their risk of migration. Lumen-apposing self-expandable metallic stents pose a lower migration risk because of their unique design and offer a possible off-label solution for recalcitrant strictures. We describe a patient with a postsurgical, gastrojejunal anastomotic stricture refractory to several interventions, who achieved long-lasting remission of symptoms after a 12-month trial of lumen-apposing self-expandable metallic stent placement.
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Affiliation(s)
- Kuntal Bhowmick
- The Warren Alpert Medical School of Brown University, Providence, RI
- Rhode Island Hospital, Providence, RI
| | - Fadlallah Habr
- The Warren Alpert Medical School of Brown University, Providence, RI
- Rhode Island Hospital, Providence, RI
| | - Pranith Perera
- The Warren Alpert Medical School of Brown University, Providence, RI
- Rhode Island Hospital, Providence, RI
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4
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Xu A, Banerjee D, Barlass U, Sánchez-Luna SA. Long-term palliation of a malignant colonic anastomotic stricture using a lumen-apposing metal stent (LAMS). BMJ Case Rep 2024; 17:e257706. [PMID: 38182169 PMCID: PMC10773299 DOI: 10.1136/bcr-2023-257706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024] Open
Abstract
Malignant recurrent colonic strictures at the anastomotic site are difficult to treat long term with traditional uncovered metal stents due to the location and risk for tumour ingrowth. We present a case with the use of a lumen-apposing metal stent (LAMS) to successfully palliate a high-grade obstruction at an anastomotic site without recurrence of obstructive symptoms for 14 months.
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Affiliation(s)
- Alice Xu
- Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Debdeep Banerjee
- Department of Internal Medicine, Division of Gastroenterology & Hepatology, Basil I. Hirschowitz Endoscopic Center of Excellence, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Usman Barlass
- Department of Internal Medicine, Division of Gastroenterology & Hepatology, Basil I. Hirschowitz Endoscopic Center of Excellence, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Sergio A Sánchez-Luna
- Department of Internal Medicine, Division of Gastroenterology & Hepatology, Basil I. Hirschowitz Endoscopic Center of Excellence, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
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Kasapidis P, Mavrogenis G, Mandrekas D, Bazerbachi F. Short benign ileocolonic anastomotic strictures - management with bi-flanged metal stents: Six case reports and review of literature. World J Clin Cases 2022; 10:10162-10171. [PMID: 36246813 PMCID: PMC9561585 DOI: 10.12998/wjcc.v10.i28.10162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/19/2022] [Accepted: 08/25/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The endoscopic management of benign short post-anastomotic ileocolonic stricture (PAICS) that is refractory to primary and secondary treatment modalities remains challenging. The lumen-apposing metal stent (LAMS) is a novel device recently developed for therapeutic gastrointestinal endoscopy. LAMSs have demonstrated significantly better results with regard to stent migration than fully covered self-expandable metal stents (FCSEMSs).
CASE SUMMARY This article presents six cases of symptomatic PAICS successfully treated with a LAMS and a review of the relevant literature. We report a life-saving technique not previously documented and the use of technology to improve patient outcomes. The six patients (median age, 75 years) suffered from vomiting, constipation and recurrent abdominal pain, with symptoms starting 23-25 wk post-surgery. The median stricture length was 1.83 cm. All six patients underwent successful and uneventful bi-flanged metal stent (BFMS)-LAMS placement for benign PAICS. All patients remained asymptomatic during the three months of stent indwelling and up to a median of 7 mo after stent removal. According to the literature, the application of LAMS for PAICS is associated with a < 10% risk of migration and a < 5% risk of bleeding. Conversely, FCSEMS has a high migration rate (15%-50%).
CONCLUSION The evolving role of interventional endoscopy and the availability of LAMSs provide patients with minimally invasive treatment options, allowing them to avoid more invasive surgical interventions. The BFMS (NAGI stent) is longer and larger than the prototype AXIOS-LAMS, which should be considered in the management of short ileocolonic post-anastomotic strictures longer than 10 mm and shorter than 30 mm.
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Affiliation(s)
- Panagiotis Kasapidis
- Department of Gastroenterology and Endoscopy Unit, Central Clinic of Athens, Athens 10680, Greece
| | - Georgios Mavrogenis
- Department of Gastroenterology, Mediterraneo Hospital, Glyfada, Athens 16685, Greece
| | - Dimitrios Mandrekas
- Department of Surgery, National and Kapodistrian University of Athens, Athens 11527, Greece
- Department of Surgery, Attendant of Central Clinic of Athens, Athens 10680, Greece
| | - Fateh Bazerbachi
- CentraCare, Interventional Endoscopy Program, St Cloud Hospital, St Cloud, MN 56301, United States
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Chandan S, Dhindsa BS, Khan SR, Deliwala S, Kassab LL, Mohan BP, Chandan OC, Loras C, Shen B, Kochhar GS. Endoscopic Stenting in Crohn's Disease-related Strictures: A Systematic Review and Meta-analysis of Outcomes. Inflamm Bowel Dis 2022:6650011. [PMID: 35880681 DOI: 10.1093/ibd/izac153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Crohn's disease (CD) is a chronic progressive condition that is complicated by intestinal or colonic stricture in nearly 30% of cases within 10 years of the initial diagnosis. Endoscopic balloon dilation (EBD) is associated with a risk of perforations and recurrence rates of up to 60% at 5 years. Endoscopic stenting has been used as an alternative to EBD, but data on its safety and efficacy are limited. We conducted a systematic review and meta-analysis to assess the outcomes of endoscopic stenting in CD-related strictures. METHODS A systematic and detailed search was run in January 2022 with the assistance of a medical librarian for studies reporting on outcomes of endoscopic stenting in CD-related strictures. Meta-analysis was performed using random-effects model, and results were expressed in terms of pooled proportions along with relevant 95% confidence intervals (CIs). RESULTS Nine studies with 163 patients were included in the final analysis. Self-expanding metal stents (SEMS) including both partial and fully covered were used in 7 studies, whereas biodegradable stents were used in 2 studies. Pooled rate of clinical success and technical success was 60.9% (95% CI, 51.6-69.5; I2 = 13%) and 93% (95% CI, 87.3-96.3; I2 = 0%), respectively. Repeat stenting was needed in 9.6% of patients (95% CI, 5.3-16.7; I2 = 0%), whereas pooled rate of spontaneous stent migration was 43.9% (95% CI, 11.4-82.7; I2 = 88%). Pooled incidence of overall adverse events, proximal stent migration, perforation, and abdominal pain were 15.7%, 6.4%, 2.7%, and 17.9%, respectively. Mean follow-up period ranged from 3 months to 69 months. DISCUSSION Endoscopic stenting in CD-related strictures is a safe technique that can be performed with technical ease, albeit with a limited clinical success. Postprocedure abdominal pain and proximal stent migration are some of the common adverse events reported.
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Affiliation(s)
- Saurabh Chandan
- Department of Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, NE, USA
| | - Banreet S Dhindsa
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Shahab R Khan
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Smit Deliwala
- Department of Internal Medicine, Michigan State University at Hurley Medical Center, Flint, MI, USA
| | | | - Babu P Mohan
- Division of Gastroenterology and Hepatology, University of Utah, Salt Lake City, UT, USA
| | - Ojasvini C Chandan
- Division of Pediatric Gastroenterology, Hepatology & Nutrition, Childrens Hospital of Omaha, Omaha, NE, USA
| | - Carme Loras
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain.,Department of Gastroenterology, Hospital Universitari Mútua Terrassa, Fundació per la Recerca Mútua Terrassa, Terrrassa, Catalonia, Spain
| | - Bo Shen
- Center for Ileal Pouch Disorders, Columbia University Irving Medical Center-New York Presbyterian Hospital, NY, USA
| | - Gursimran S Kochhar
- Division of Gastroenterology, Hepatology & Nutrition, Allegheny Health Network, Pittsburgh, PA, USA
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Moreira M, Pita I, Fernandes J, Azevedo R, Canena J, Lopes L. Lumen-Apposing Metal Stents (Lams) in the Management of Refractory Gi Stenosis: A Series of 3 Cases. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2022; 29:64-67. [PMID: 35111967 PMCID: PMC8787497 DOI: 10.1159/000514782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/11/2021] [Indexed: 08/09/2023]
Affiliation(s)
- Marta Moreira
- Department of Gastroenterology, Santa Luzia Hospital − Unidade Local de Saúde Alto Minho, Viana do Castelo, Portugal
| | - Inês Pita
- Department of Gastroenterology, Instituto Português de Oncologia, Porto, Portugal
| | - João Fernandes
- Department of Gastroenterology, Santa Luzia Hospital − Unidade Local de Saúde Alto Minho, Viana do Castelo, Portugal
| | - Richard Azevedo
- Department of Gastroenterology, Santa Luzia Hospital − Unidade Local de Saúde Alto Minho, Viana do Castelo, Portugal
| | - Jorge Canena
- Department of Gastroenterology, Professor Doutor Fernando Fonseca Hospital, Amadora, Portugal
- Department of Gastroenterology − Nova Medical School/Faculty of Medical Sciences, Lisbon, Portugal
| | - Luís Lopes
- Department of Gastroenterology, Santa Luzia Hospital − Unidade Local de Saúde Alto Minho, Viana do Castelo, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's − PT Government Associate Laboratory, Braga/Guimarães, Portugal
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8
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Endoscopic Gastrointestinal Anastomosis Using Lumen-apposing Metal Stent (LAMS) for Benign or Malignant Etiologies: A Systematic Review and Meta-Analysis. J Clin Gastroenterol 2021; 55:e56-e65. [PMID: 33060441 DOI: 10.1097/mcg.0000000000001453] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/14/2020] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND AIM Endoscopic gastrointestinal anastomosis using lumen-apposing metal stents (EGAL) is a new technique that is used as an alternative method to bypass benign or malignant strictures. Endoscopists take advantage of 2 bowel loops that are close to each other and place a stent between the lumen of these 2 bowel loops. The authors performed this systematic review and meta-analysis to evaluate the efficacy and safety of this rising procedure. METHODS Electronic database searches were conducted for full eligible articles that were published from the inception to July 2019 using the EGAL procedure to bypass malignant or benign obstruction or to restore bowel integrity after a gastrointestinal altering surgery. The primary outcome of this meta-analysis was to assess efficacy through technical and clinical success. Secondary outcomes were to assess safety through adverse events and to assess the rate of stent maldeployment and the rate of reintervention during the study period. RESULTS Eight studies were eligible, providing data on 269 patients who underwent 271 EGAL procedures. The median age was 65 years (interquartile range: 63 to 66) with 46% male individuals. Out of 269 patients, 203 underwent EGALs because of malignant etiology and 66 underwent EGAL for benign etiology. The median duration of follow-up was 114 days (interquartile range: 78 to 121). Technical success rate was 94.1% [95% confidence interval (CI), 91.4%-96.9%]. Clinical success rate was 91.4% (95% CI, 88.1%-94.7%). Adverse events rate was 8.5% (95% CI, 4.7%-12.3%). Stent maldeployment rate was 9.5% (95% CI, 3.5%-15.4%) of the total performed EGALs and the reintervention rate was 6.0% (95% CI, 2.3%-9.8%). CONCLUSION EGAL procedure has high efficacy and a relatively safe profile and it can be performed in selected patients. Comparison between EGAL and other conventional therapies is difficult because of the lack of randomized trials.
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D'Souza LS. Lumen-Apposing Metal Stents in Benign Gastrointestinal Luminal Strictures. Clin Gastroenterol Hepatol 2021; 19:1337-1340. [PMID: 33636151 DOI: 10.1016/j.cgh.2021.01.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/24/2021] [Accepted: 01/25/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Lionel S D'Souza
- Director of Endoscopic Surgery, Stony Brook University Hospital, Stony Brook, New York
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10
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Singh A, Aggarwal M, Siddiki H. Treatment of refractory benign gastroenteral strictures with fully covered metal stents. VideoGIE 2021; 6:308-310. [PMID: 34278093 PMCID: PMC8267956 DOI: 10.1016/j.vgie.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Video 1Treatment of refractory benign gastroenteral strictures with fully covered metal stents.
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Affiliation(s)
- Amandeep Singh
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Manik Aggarwal
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Hassan Siddiki
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
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11
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The Off-Label Use of a Lumen-Apposing Metal Stent (LAMS) for a Benign Colon Anastomotic Stricture Causing Recurrent Bowel Obstruction in a Patient with Keloids. Case Rep Gastrointest Med 2021; 2021:5595518. [PMID: 33884206 PMCID: PMC8041523 DOI: 10.1155/2021/5595518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 11/23/2022] Open
Abstract
Anastomotic strictures are a known complication of colorectal surgery. Despite a wide range of medical devices that have been deployed for this complication, outcomes remain challenging. Lumen-apposing metal stents (LAMSs) have recently emerged as a potentially superior therapeutic option. We herein report a patient with a past medical history of pT3, N0 adenocarcinoma of the colon with anastomotic stricture recurrence who underwent successful placement of an LAMS. We suggest that patients with a predisposition for keloid formation or fibrosis-prone anastomotic wound healing should be considered for LAMS deployment early in the treatment course.
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12
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Endoscopic Management of Refractory Benign Esophageal Strictures. Dysphagia 2021; 36:504-516. [PMID: 33710389 DOI: 10.1007/s00455-021-10270-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 02/13/2021] [Indexed: 12/13/2022]
Abstract
Benign esophageal strictures are commonly encountered in clinical practice. The principal etiologies of benign esophageal strictures include long term acid reflux, caustic injuries, eosinophilic esophagitis, anastomotic strictures or endoscopic therapy. Dysphagia is most prominently present in esophageal strictures along with a variety of other symptoms which depend on the stricture etiology. Benign esophageal strictures can be categorized into two groups: simple or complex depending on their structure. Most strictures can be treated successfully with endoscopic dilation by bougies or balloons dilators. In some cases, treatment is more challenging, involving a higher risk of the patient developing recurrent or refractory strictures. To improve symptoms in these patients, other endoscopic treatments such as steroid injection, incisional therapy and stent placement should be considered. In this manuscript, we provide a comprehensive review of the main treatment options currently available to manage recurrent benign esophageal strictures.
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Li J, Basseri H, Donnellan F, Harris A. Lumen-apposing metals stents in advanced endoscopic ultrasound-guided interventions: novel applications, potential complications and radiologic assessment. Abdom Radiol (NY) 2021; 46:776-791. [PMID: 32761403 DOI: 10.1007/s00261-020-02696-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/20/2020] [Accepted: 07/25/2020] [Indexed: 11/25/2022]
Abstract
Endoscopic ultrasound (EUS)-guided drainage procedures are an increasingly utilized minimally invasive alternative to percutaneous or surgical management strategies, having been shown to decrease recovery time, cost, and duration of hospital stay. The current mainstay of EUS-guided drainage procedures is in pancreatic and peripancreatic collections in pancreatitis. Recent technological advancements and the development of specialized stents have allowed for novel applications in a growing variety of clinical scenarios, including biliary obstruction, cholecystitis and gastrointestinal obstruction. An overview is provided of standard EUS-guided lumen-apposing metal stent (LAMS) management in pancreatic collections, including the expected radiologic findings and appropriate post-treatment sequelae. Relevant parameters to report include presence of a walled-off collection, collection contents, proximity of the target collection to the gastrointestinal lumen, intervening vascular structures or vascular malformations, and presence of regional cystic structures. Novel stent applications in biliary and gastrointestinal drainage are summarized and examples are provided, including choledochoduodenostomy in biliary obstruction, cholecystogastrostomy in cholecystitis, and jejunogastrostomy in focal gastrointestinal obstruction. Finally, a pictorial review of imaging findings of complications including perforation, hemorrhage, displacement, occlusion, migration and mistargeting is provided. Minimally invasive EUS-guided endoluminal stenting is utilized in a growing variety of clinical applications. Radiologist familiarity with common and novel applications of EUS-guided stenting is invaluable in determining suitability for endoscopic management, evaluating treatment response and identifying potential complications.
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Affiliation(s)
- Jessica Li
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
| | - Hamed Basseri
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Fergal Donnellan
- Division of Gastroenterology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Alison Harris
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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14
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Mizrahi M, Fahmawi Y, Merritt L, Kumar M, Tharian B, Khan SA, Inamdar S, Sharma N, Uppal D, Shami VM, Kashif MS, Gabr M, Pleskow D, Berzin TM, James TW, Croglio M, Baron TH, Adler DG. Luminal-apposing stents for benign intraluminal strictures: a large United States multicenter study of clinical outcomes. Ann Gastroenterol 2021; 34:33-38. [PMID: 33414619 PMCID: PMC7774669 DOI: 10.20524/aog.2020.0538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 06/16/2020] [Indexed: 11/25/2022] Open
Abstract
Background The use of fully covered lumen-apposing metal stents (LAMS) for benign short gastrointestinal (GI) strictures has been reported. This study aimed to evaluate the safety and efficacy of LAMS for refractory GI strictures. Methods A retrospective analysis was performed of patients who underwent LAMS placement for benign GI strictures in 8 United States centers. The primary outcomes were technical success and initial clinical response. Secondary outcomes were reintervention rate and adverse events. Results A total of 51 patients underwent 61 LAMS placement procedures; 33 (64.7%) had failed previous treatments. The most common stricture location was the pylorus (n=17 patients). Various sizes of stents were used, with 15-mm LAMS placed in 45 procedures, 20-mm LAMS in 14 procedures, and 10-mm LAMS in 2 procedures. The overall technical success, short-term clinical response and reintervention rate after stent removal were 100%, 91.8% and 31.1%, respectively. Adverse events were reported in 17 (27.9%) procedures, with stent migration being the most common (13.1%). In subgroup analysis, both 15 mm and 20 mm stents had comparable short-term clinical response and adverse event rates. However, stent migration (15.6%) was the most common adverse event with 15-mm LAMS while pain (14.3%) was the most common with 20-mm LAMS. The reintervention rate was 80% at 200-day follow up after stent removal. Conclusions Using LAMS for treatment of short benign GI strictures is safe and effective. Larger LAMS, such as the new 20 mm in diameter, may have a lower stent migration rate compared to smaller diameter LAMS.
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Affiliation(s)
- Meir Mizrahi
- Department of Gastroenterology and Hepatology, Advanced Endoscopy Unit, University of South Alabama, Mobile, AL (Meir Mizrahi, Lindsey Merritt, Manoj Kumar)
| | - Yazan Fahmawi
- Department of Internal Medicine, University of South Alabama, Mobile, AL (Yazan Fahmawi)
| | - Lindsey Merritt
- Department of Gastroenterology and Hepatology, Advanced Endoscopy Unit, University of South Alabama, Mobile, AL (Meir Mizrahi, Lindsey Merritt, Manoj Kumar)
| | - Manoj Kumar
- Department of Gastroenterology and Hepatology, Advanced Endoscopy Unit, University of South Alabama, Mobile, AL (Meir Mizrahi, Lindsey Merritt, Manoj Kumar)
| | - Benjamin Tharian
- Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR (Benjamin Tharian, Salman Ali Khan, Sumant Inamdar)
| | - Salman Ali Khan
- Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR (Benjamin Tharian, Salman Ali Khan, Sumant Inamdar)
| | - Sumant Inamdar
- Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR (Benjamin Tharian, Salman Ali Khan, Sumant Inamdar)
| | - Neil Sharma
- Department of Gastroenterology and Hepatology, Parkview Health, Fort Wayne, IN (Neil Sharma)
| | - Dushant Uppal
- Department of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, VA (Dushant Uppal, Vanessa M. Shami)
| | - Vanessa M Shami
- Department of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, VA (Dushant Uppal, Vanessa M. Shami)
| | - Mahmood Syed Kashif
- Department of Gastroenterology and Hepatology, Orange Regional Medical Center, Middletown, NY (Mahmood Syed Kashif)
| | - Moamen Gabr
- Department of Gastroenterology and Hepatology, University of Kentucky College of Medicine, Lexington, KY (Moamen Gabr)
| | - Douglas Pleskow
- Department of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (Douglas Pleskow, Tyler M. Berzin)
| | - Tyler M Berzin
- Department of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (Douglas Pleskow, Tyler M. Berzin)
| | - Ted W James
- Department of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Ted W. James, Michael Croglio, Todd H Baron)
| | - Michael Croglio
- Department of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Ted W. James, Michael Croglio, Todd H Baron)
| | - Todd H Baron
- Department of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Ted W. James, Michael Croglio, Todd H Baron)
| | - Douglas G Adler
- Department of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT (Douglas G. Adler), USA
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Liang C, Tan Y, Lu J, Le M, Liu D. Endoscopic incision for treatment of benign gastrointestinal strictures. Expert Rev Gastroenterol Hepatol 2020; 14:445-452. [PMID: 32380885 DOI: 10.1080/17474124.2020.1766966] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Benign gastrointestinal strictures are common, and can be congenital or acquired (anastomotic, corrosive, induced by Crohn's disease or endoscopic treatments, etc.). Patients usually present with stricture-related symptoms such as vomiting, dysphagia, dyschezia, abdominal pain, which impair their quality of life. Endoscopic balloon dilation (EBD) is the first-line treatment for most of the benign strictures; however, long-term efficacy is suboptimal, and the recurrence rate can be up to 38%. Endoscopic incision (EI) was firstly reported for treatment of congenital membranous stricture, and then applied to other benign gastrointestinal strictures. AREA COVERED In the present review, we provided a comprehensive review of EI for the treatment of benign gastrointestinal strictures, mainly focus on the technical details, indication, safety, and efficacy of EI. The present review is expected to provide tips for operators who are going to perform EI. EXPERT OPINION EI can serve as an alternative method for treatment of gastrointestinal strictures, the best indications are congenital membranous stricture and short-segmental (<1 cm) anastomotic strictures refractory to EBD. EI may also be attempted for strictures induced by other reasons. Combination with other endoscopic methods such as EBD, local steroid injection, stent placement, may improve the efficacy of EI.
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Affiliation(s)
- Chengbai Liang
- Department of Gastroenterology, The Second Xiangya Hospital , Changsha, Hunan, China.,Research Center of Digestive Disease, Central South University , Changsha, Hunan, China
| | - Yuyong Tan
- Department of Gastroenterology, The Second Xiangya Hospital , Changsha, Hunan, China.,Research Center of Digestive Disease, Central South University , Changsha, Hunan, China
| | - Jiaxi Lu
- Department of Gastroenterology, The Second Xiangya Hospital , Changsha, Hunan, China.,Research Center of Digestive Disease, Central South University , Changsha, Hunan, China
| | - Meixian Le
- Department of Gastroenterology, The Second Xiangya Hospital , Changsha, Hunan, China.,Research Center of Digestive Disease, Central South University , Changsha, Hunan, China
| | - Deliang Liu
- Department of Gastroenterology, The Second Xiangya Hospital , Changsha, Hunan, China.,Research Center of Digestive Disease, Central South University , Changsha, Hunan, China
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Mohan BP, Asokkumar R, Khan SR, Kotagiri R, Sridharan GK, Chandan S, Ravikumar NPG, Ponnada S, Jayaraj M, Adler DG. Outcomes of endoscopic sleeve gastroplasty; how does it compare to laparoscopic sleeve gastrectomy? A systematic review and meta-analysis. Endosc Int Open 2020; 8:E558-E565. [PMID: 32258380 PMCID: PMC7089787 DOI: 10.1055/a-1120-8350] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/23/2020] [Indexed: 02/06/2023] Open
Abstract
Abstract
Background and study aims Endoscopic sleeve gastroplasty (ESG) is a novel moderately invasive technique in endo-bariatrics as compared to laparoscopic sleeve gastrectomy (LSG). Data is limited as to its efficacy and safety.
Methods We searched multiple databases from inception through August 2019 to identify studies that reported on ESG in the treatment of obesity. Our goals were to calculate the pooled rates of total weight loss (%TWL), excess weight loss (%EWL), and body mass index (BMI) at 1 month, 6 months, and 12 months with ESG. We included studies that reported on LSG, in a similar time frame as ESG, and compared the 12-month outcomes.
Results From eight studies on ESG (1815 patients), the pooled rates of %TWL at 1 month, 6 months, and 12 months were 8.7 (7.2–10.2), 15.3 (14.1–16.6) and 17.1 (15.1–19.1), respectively. The pooled rates of %EWL at 1 month, 6 months, and 12 months were 31.7 (29.3–34.1), 59.4 (57–61.8) and 63 (51.3–74.6), respectively. The pooled rates of BMI at 1 m, 6 m, and 12 m were 32.6 (31–34.3), 30.4 (29–31.8) and 30 (27.7–32.3, I2 = 97), respectively. At 12 months, the pooled %TWL, %EWL and BMI with LSG (7 studies, 2179 patients) were 30.5 (27.4–33.5), 69.3 (60.1–78.4) and 29.3 (27.1–31.4) respectively. On comparison analysis, %TWL with LSG was superior to ESG (P = 0.001). %EWL and BMI were comparable. All adverse events, bleeding and gastro-esophageal reflux disease were significantly lower with ESG when compared to LSG.
Conclusion ESG demonstrates acceptable weight loss parameters and seems to have a better safety profile when compared to LSG.
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Affiliation(s)
- Babu P. Mohan
- Internal Medicine, University of Arizona, Banner University Medical Center, Tucson, Arizona, United States
| | - Ravishankar Asokkumar
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Shahab R. Khan
- Section of Gastroenterology, Rush University Medical Center, Chicago, Illinois, United States
| | - Rajesh Kotagiri
- Internal Medicine, University of Arizona, Banner University Medical Center, Tucson, Arizona, United States
| | | | - Saurabh Chandan
- Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Naveen PG. Ravikumar
- Internal Medicine, University at Buffalo, Buffalo General Hospital, Buffalo, New York, United States
| | - Suresh Ponnada
- Internal Medicine, Carilion Roanoke Memorial Hospital, Roanoke, Virginia, United States
| | - Mahendran Jayaraj
- Department of Gastroenterology and Hepatology, University of Nevada, Las Vegas, Nevada, United States
| | - Douglas G. Adler
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States
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Garg R, Chaar A, Szpunar S, Mohan BP, Barawi M. Efficacy and Safety of Lumen-Apposing Stents for Management of Pancreatic Fluid Collections in a Community Hospital Setting. Clin Endosc 2019; 53:480-486. [PMID: 31615198 PMCID: PMC7403019 DOI: 10.5946/ce.2019.116] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 08/21/2019] [Indexed: 12/26/2022] Open
Abstract
Background/Aims Endoscopic ultrasound-guided transmural drainage and necrosectomy employing lumen-apposing metal stent (LAMS) are used for treating pancreatic fluid collections (PFCs) with excellent results from academic centers. Herein, we report the efficacy and safety of LAMS in the treatment of PFCs at a community hospital.
Methods We retrospectively reviewed the etiology of pancreatitis, type and size of PFCs, length of procedure, technical success, clinical success, adverse events, and stent removal. The primary outcome was the rate of clinical success, and secondary outcomes were technical success and adverse events.
Results Twenty-seven patients with a mean age of 54.1±6.5 years were included, 44% of which were men. The mean size of the PFCs was 9.7±5.0 cm (range, 3–21). The most common etiology of pancreatitis was alcohol (44%) followed by idiopathic causes (30%) and presence of gallstones (22%). The diagnosis was pseudocyst in 44.4% (12/27) and walled off necrosis in 55.6% (15/27) of patients. There was 100% technical success without any complications. Clinical success was achieved in 22 of 27 patients (81.5%) who underwent stent removal.
Conclusions Our study is the first to report that endoscopic therapy of PFCs using LAMS is safe and effective even in a community hospital setting with limited resources and support compared to large academic centers.
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Affiliation(s)
- Rajat Garg
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Abdelkader Chaar
- Department of Internal Medicine, Ascension St. John Hospital, Detroit, MI, USA
| | - Susan Szpunar
- Department of Biomedical Investigations and Research, Ascension St. John Hospital, Detroit, MI, USA
| | - Babu P Mohan
- Department of Internal Medicine, University of Alabama, Tuscaloosa, AL, USA
| | - Mohammed Barawi
- Division of Gastroenterology and Hepatology, Ascension St. John Hospital, Detroit, MI, USA
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Zimmer V. Upfront lumen-apposing metal stenting for a high-grade colorectal anastomotic stricture. Tech Coloproctol 2019; 23:943-944. [PMID: 31538297 DOI: 10.1007/s10151-019-02088-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 09/08/2019] [Indexed: 10/26/2022]
Affiliation(s)
- V Zimmer
- Department of Medicine, Marienhausklinik St. Josef Kohlhof, Klinikweg 1-5, 66539, Neunkirchen, Germany. .,Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany.
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