1
|
Hedjoudje A, Jais B, Stefanescu C, Lorenzo D, Aubert A, Badurdeen D, Bouhnik Y, Prat F. Clinical Efficacy of Lumen-Apposing Metallic Stents for Lower Gastrointestinal Anastomotic Strictures. J Gastrointest Surg 2023:10.1007/s11605-023-05642-8. [PMID: 36849608 DOI: 10.1007/s11605-023-05642-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 01/28/2023] [Indexed: 03/01/2023]
Affiliation(s)
- Abdellah Hedjoudje
- Service d'endoscopie Digestive, Hôpital Beaujon, DMU DIGEST, Hôpital Beaujon, Assistance Publique Des Hôpitaux de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Bénédicte Jais
- Service d'endoscopie Digestive, Hôpital Beaujon, DMU DIGEST, Hôpital Beaujon, Assistance Publique Des Hôpitaux de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Carmen Stefanescu
- Service de Gastro-Entérologie, MICI Et Assistance Nutritive, DMU DIGEST, Hôpital Beaujon, Assistance Publique Des Hôpitaux de Paris, Clichy, France
| | - Diane Lorenzo
- Service d'endoscopie Digestive, Hôpital Beaujon, DMU DIGEST, Hôpital Beaujon, Assistance Publique Des Hôpitaux de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Alain Aubert
- Service d'endoscopie Digestive, Hôpital Beaujon, DMU DIGEST, Hôpital Beaujon, Assistance Publique Des Hôpitaux de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Dilhana Badurdeen
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Yorham Bouhnik
- Service de Gastro-Entérologie, MICI Et Assistance Nutritive, DMU DIGEST, Hôpital Beaujon, Assistance Publique Des Hôpitaux de Paris, Clichy, France
| | - Frédéric Prat
- Service d'endoscopie Digestive, Hôpital Beaujon, DMU DIGEST, Hôpital Beaujon, Assistance Publique Des Hôpitaux de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France.
| |
Collapse
|
2
|
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.
Collapse
|
3
|
Secured Lumen-Apposing Fully Covered Metallic Stents for Stenoses in Post-Bariatric Surgery Patients. Obes Surg 2020; 29:2695-2699. [PMID: 31055739 DOI: 10.1007/s11695-019-03906-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
New approaches for refractory stenosis in post-bariatric surgical patients include fully covered lumen-apposing metallic stents (LAMS); however, stent migration continues to be a problem. Endoscopic suture placement to LAMS can reduce the migration. Aiming to assess the feasibility and safety of the procedure, we evaluated nine consecutive patients with inability to tolerate a solid diet due to a benign gastrointestinal stricture recalcitrant to previous attempts at endoscopic therapy. All patients were symptom-free starting from 1-week follow-up. Median stent dwell time was nearly 3 months. During the removal procedures, three incidental foreign bodies were found and removed. No stent migration was observed in any patients. Suturing LAMS is a feasible technique allowing for prolonged stent dwell times; however, it requires a high level of expertise plus additional procedure time.
Collapse
|
4
|
Endoscopic Management of Duodenal Obstruction. Am J Gastroenterol 2019; 114:1566-1568. [PMID: 31589178 DOI: 10.14309/ajg.0000000000000385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
5
|
Tan S, Zhong C, Huang S, Luo X, Xu J, Fu X, Peng Y, Tang X. Clinical outcomes of lumen-apposing metal stent in the management of benign gastrointestinal strictures: a systematic review and meta-analysis. Scand J Gastroenterol 2019; 54:811-821. [PMID: 31290352 DOI: 10.1080/00365521.2019.1638447] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background and aims: Lumen-apposing metal stent (LAMS) have been considered as a viable alternative to treat benign gastrointestinal (GI) strictures. We aimed to determine the efficacy and safety of LAMS for benign GI strictures. Methods: Medline, Embase, Cochrane, and PubMed databases were searched using the keywords 'benign stricture', 'gastrointestinal stricture', 'lumen-apposing metal stent' and related terms on December 2018. Articles were selected for review by two authors independently according to predefined inclusion criteria and exclusion criteria. A meta-analysis using a random effects model was performed. Results: Six studies with a total of 144 patients were included in the final analysis (60 males, 41.7%). Overall, the pooled technical success rate was 98.3% [95% confidence interval (CI): 0.962-1.004], clinical success rate was 73.8% (95% CI: 0.563-0.912) and adverse events rate was 30.6% (95% CI: 0.187-0.425). The most common complication associated with LAMS for benign GI strictures was migration, and the pooled events rate was 10.9% (95% CI: 0.058-0.160). According to locations of stricture, subgroup analysis was performed in terms of clinical success [Esophagogastric: 63.9% (95% CI: 0.365-0.914); Gastroduodenal: 67.4% (95% CI: 0.421-0.927); Gastrojejunal: 78% (95% CI: 0.638-0.922); Pylorus: 77.6% (95% CI: 0.551-1.002); Colonic: 85.3% (95% CI: 0.515-1.191)]. Conclusions: Although the safety of LAMS placement in benign GI strictures is not very satisfactory, it is associated with a low migration rate. LAMS can achieve clinical symptom improvement or resolution in most patients with benign GI strictures, and it might be an alluring prospect for treating patients with this difficult condition.
Collapse
Affiliation(s)
- Shali Tan
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University , Luzhou , China
| | - Chunyu Zhong
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University , Luzhou , China
| | - Shu Huang
- Department of Gastroenterology, The People's Hospital of Lianshui , Huaian , China
| | - Xujuan Luo
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University , Luzhou , China
| | - Jin Xu
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University , Luzhou , China
| | - Xiangsheng Fu
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College , Nanchong , China
| | - Yan Peng
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University , Luzhou , China
| | - Xiaowei Tang
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University , Luzhou , China
| |
Collapse
|
6
|
Kerdsirichairat T, Irani S, Yang J, Brewer Gutierrez OI, Moran R, Sanaei O, Dbouk M, Kumbhari V, Singh VK, Kalloo AN, Khashab MA. Durability and long-term outcomes of direct EUS-guided gastroenterostomy using lumen-apposing metal stents for gastric outlet obstruction. Endosc Int Open 2019; 7:E144-E150. [PMID: 30705945 PMCID: PMC6353651 DOI: 10.1055/a-0799-9939] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 11/09/2018] [Indexed: 12/14/2022] Open
Abstract
Background and study aims EUS-guided gastroenterostomy (GE) is a novel, minimally invasive endoscopic procedure for the treatment of gastric outlet obstruction (GOO). The direct-EUS-GE (D-GE) approach has recently gained traction. We aimed to report on a large cohort of patients who underwent DGE with focus on long-term outcomes. Patients and methods This two-center, retrospective study involved consecutive patients who underwent D-GE between October 2014 and May 2018. The primary outcomes were technical and clinical success. Secondary outcomes were adverse events (AEs), rate of reintervention, procedure time, time to resume oral diet, and post-procedure length of stay (LOS). Results A total of 57 patients (50.9 % female; median age 65 years) underwent D-GE for GOO. The etiology was malignant in 84.2 % and benign in 15.8 %. Technical success and clinical success were achieved in 93 % and 89.5 % of patients, respectively, with a median follow-up of 196 days in malignant GOO and 319.5 days in benign GOO. There were 2 (3.5 %) AEs, one severe and one moderate. Median procedure time was 39 minutes (IQR, 26 - 51.5 minutes). Median time to resume oral diet after D-GE was 1 day (IQR 1 - 2 days). Median post D-GE LOS was 3 days (IQR 2 - 7 days). Rate of reintervention was 15.1 %. Conclusions D-GE is safe and effective in management of both malignant and benign causes of GOO. Clinical success with D-GE is durable with a low rate of reintervention based on a long-term cohort.
Collapse
Affiliation(s)
- Tossapol Kerdsirichairat
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Shayan Irani
- Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, United States
| | - Juliana Yang
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Olaya I. Brewer Gutierrez
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Robert Moran
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Omid Sanaei
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Mohamad Dbouk
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Vikesh K. Singh
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Anthony N. Kalloo
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Mouen A. Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States,Corresponding author Mouen A. Khashab, M.D. Associate Professor of MedicineDirector of Therapeutic EndoscopyJohns Hopkins HospitalShiekh Zayed BuildingDivision of Gastroenterology and Hepatology1800 Orleans Street, Suite 7125GBaltimore, MD 21287+1- 410-502-7010
| |
Collapse
|