A retrospective, multicenter analysis of incidents associated with Axios™ lumen-apposing stents

Indirect comparison of various lumen-apposing metal stents for EUS-guided biliary and gallbladder drainage: a systematic review and meta-analysis

BACKGROUND AND AIMS

Studies assessing EUS-guided biliary drainage (EUS-BD) or gallbladder drainage (EUS-GB) using lumen-apposing metal stents (LAMSs) have shown variable results based on the type of LAMS. We performed a meta-analysis of the available data.

METHODS

Multiple online databases were searched for studies using LAMSs (Axios [Boston Scientific, Marlborough, Mass, USA] or Spaxus [Taewoong Medical Co, Gimpo, Korea]) for EUS-BD and EUS-GB. The outcomes of interest were technical success, clinical success, and adverse events. Pooled proportions along with 95% confidence intervals were calculated.

RESULTS

A total of 18 observational studies were included: 11 for the Axios stent (433 patients; mean age, 72 years; 54% male) and 7 for the Spaxus stent (242 patients; mean age, 74 years; 50% male). The respective pooled outcomes for the Axios stent (EUS-BD and EUS-GB, respectively) were technical success, 96.2% and 96.2%; clinical success, 92.8% and 92.7%; total adverse events, 10.1% and 23.6%; and bleeding, 3.7% and 4.8%. The respective pooled outcomes for the Spaxus stent (EUS-BD and EUS-GB, respectively) were technical success, 93.8% and 95.9%; clinical success, 90.1% and 94.2%; total adverse events, 12.6% and 9.5%; and bleeding, 3.1% and 1.8%.

CONCLUSIONS

Axios and Spaxus stents demonstrate similar pooled technical and clinical success rates. Adverse events occurred in 23.6% of patients (Axios stent) and 9.5% of patients (Spaxus stent) during EUS-GB.

Comprehensive analysis of adverse events associated with transmural use of LAMS in patients with liver cirrhosis: International multicenter study

Background and study aims Endoscopic ultrasound (EUS)-guided transmural (TM) deployment of lumen-apposing metal stents (LAMS) is considered relatively safe in non-cirrhotic patients and is cautiously offered to cirrhotic patients. Patients and methods This was a retrospective, multicenter, international matched case-control study to study the safety of EUS-guided TM deployment of LAMS in cirrhotic patients. Results Forty-three cirrhotic patients with model for end-stage liver disease score 12.5 ± 5, with 23 having ascites and 16 with varices underwent EUS-guided TM LAMS deployment, including 19 for pancreatic fluid collection (PFC) drainage, 13 gallbladder drainage, six for endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography (ERCP), three for EDGI, one for endoscopic ultrasound-directed transenteric ERCP, and one postsurgical collection drainage. Technical failure occurred in one LAMS for PFC drainage. Clinical failure was encountered in another PFC. Nine adverse events (AEs) occurred. The most common AE was LAMS migration (3), followed by non-bleeding mucosal erosion (2), delayed bleeding (2), sepsis (1), and anesthesia-related complication (pulseless electrical activity) (1). Most AEs were graded as mild (6), followed by severe (2), and moderate (1); the majority were managed conservatively. On univariable comparison, risk of AE was higher when using a 20 × 10 mm LAMS and the absence of through-the-LAMS plastic stent(s). Conditional logistic regression of matched case-control patients did not show any association between potential predicting factors and occurrence of AEs. Conclusions Our study demonstrated that mainly in patients with Child-Pugh scores A and B cirrhosis and despite the presence of mild-to-moderate ascites in over half of cases, the majority of AEs were mild and could be managed conservatively. Further studies are warranted to verify the safety of LAMS in cirrhotic patients.

Guessing the future of endoscopic drainage of walled-off necrosis

The endoscopic treatment of walled-off necrosis is rapidly evolving concurrently with an increasing number of endoscopic techniques, devices, and combined procedures. Thus, there is a growing armamentarium of alternatives for those patients in whom the conventional direct endoscopic necrosectomy is not enough. However, when the patient reaches this point he enters in an unexplored field and choosing the correct option can be challenging. Furthermore, there is no consensus on the number of endoscopic procedures to perform before considering that direct endoscopic necrosectomy has failed and therefore another strategy should be considered.

Endoscopic ultrasound-guided drainage with lumen-apposing metal stents: a good safety profile also in the long term?

Lumen-apposing metal stents (LAMSs) have been specifically designed for the endoscopic drainage of pancreatic fluid collections and walled-off necrosis. Lately, LAMS indications have expandedto other anastomoses, and these stents have proven to be effective in multiple situations. Safety data for this device are still limited, most studies to date being focused on intraoperative complications and not long-term issues. There are little data regarding the best timing for removal and the risks associated in leaving them in place for long duration. In addition, not all the procedure-related complications have the same clinical impact, and the settings in which LAMS have been used are heterogeneous, leading to different safety profiles and outcomes. A wide consensus on the definition of complications and a list of key performance measures for LAMS placement seems mandatory to allow for a robust assessment of their long-term outcomes.