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Yuksel I, Atay A, Cagir Y, Kenarli K, Tenlik I, Coskun O. Combined Endoscopic Stricturotomy and Lumen Apposing Metal Stent in the Treatment of Crohn's Disease with Primary Ileocecal Valve Stricture. Gastrointest Endosc 2024:S0016-5107(24)00144-5. [PMID: 38432491 DOI: 10.1016/j.gie.2024.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 12/29/2023] [Accepted: 02/28/2024] [Indexed: 03/05/2024]
Affiliation(s)
- Ilhami Yuksel
- Department of Gastroenterology, Ankara Bilkent City Hospital, Ankara, Turkey; Department of Gastroenterology, Ankara Yildirim Beyazit University School of Medicine, Ankara, Turkey.
| | - Ali Atay
- Department of Gastroenterology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Yavuz Cagir
- Department of Gastroenterology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Kerem Kenarli
- Department of Gastroenterology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Ilyas Tenlik
- Department of Gastroenterology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Orhan Coskun
- Department of Gastroenterology, Ankara Bilkent City Hospital, Ankara, Turkey
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Seagle M, Li W, Perumpillichira J, Pawa R. Enteroscopy-Assisted EUS-Guided Trans-gastric Intervention After Roux-en-Y Gastric Bypass Surgery. Obes Surg 2024; 34:291-292. [PMID: 37957460 DOI: 10.1007/s11695-023-06931-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 10/26/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023]
Abstract
Endoscopic ultrasound-directed trans-gastric interventions (EDGI) using lumen apposing metal stent (LAMS) have been increasingly utilized in patients with Roux-en-Y gastric bypass surgery. We present a case of a 71-year-old woman with Roux-en-Y anatomy presenting with choledocholithiasis and enlarged retroperitoneal lymph nodes. Given inability to identify the excluded stomach on routine EUS, enteroscopy was performed with retrograde filling of the excluded stomach to allow for its localization on EUS. The patient underwent LAMS placement to create a jejuno-gastric anastomosis. Subsequently, she had an ERCP (via the LAMS) for removal of bile duct stone and an EUS with fine needle aspiration of the para-aortic lymph node (via the LAMS) confirming malignancy. The LAMS was removed after 2 weeks and the defect closed with APC and clips. An upper GI series obtained at 4 weeks did not show any residual leak. Patient continues to follow up with oncology for workup of primary malignancy.
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Affiliation(s)
- Madeline Seagle
- Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA
| | - Wencheng Li
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA
| | - James Perumpillichira
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA
| | - Rishi Pawa
- Division of Gastroenterology, Department of Medicine, Medical Center Boulevard, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA.
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Campbell C, Koutlas N, Fernandez A, Pawa R. Endoscopic Ultrasound-Guided Gastro-gastrostomy Using Lumen Apposing Metal Stent for Management of High-Grade Gastric Outlet Obstruction Secondary to Vertical Banded Gastroplasty. Obes Surg 2023; 33:3330-3331. [PMID: 37555896 DOI: 10.1007/s11695-023-06763-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/15/2023] [Accepted: 07/25/2023] [Indexed: 08/10/2023]
Abstract
Vertical banded gastroplasty (VBG) is associated with an increased risk of pouch stricture secondary to narrowing of the banded gastroplasty outlet. We describe a case of a 60-year-old male with stage 4 small cell lung cancer presenting with recurrent gastric outlet obstruction secondary to stenosis at the site of VBG. Given a prior history of failed standard endoscopic maneuvers including balloon dilation and steroid injection, the decision was made to create an endoscopic ultrasound-guided gastro-gastrostomy using lumen opposing metal stent. The patient did well post procedure and was able to tolerate a soft mechanical diet within 24 h. He was subsequently discharged to hospice for his advanced metastatic disease.
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Affiliation(s)
- Charlotte Campbell
- Department of Medicine, Division of Gastroenterology, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA
| | - Nicholas Koutlas
- Department of Medicine, Division of Gastroenterology, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA
| | - Adolfo Fernandez
- Department of General Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA
| | - Rishi Pawa
- Department of Medicine, Division of Gastroenterology, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA.
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Chálim Rebelo C, Nunes N, Moura DB, Corte-Real F, Pereira JR, Duarte MA. The Cutting-EDGE: Biliary Intervention in Altered Anatomy. GE Port J Gastroenterol 2023; 30:57-60. [PMID: 37818400 PMCID: PMC10561313 DOI: 10.1159/000526127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/03/2022] [Indexed: 10/12/2023]
Affiliation(s)
- Carolina Chálim Rebelo
- Gastroenterology Department, Hospital do Divino Espírito Santo de Ponta Delgada, Ponta Delgada, Portugal
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Rana SS, Sharma R, Sharma G, Gupta R. Safety and Efficacy of Long-Term Transmural Plastic Stent Placement After Removal of Lumen Apposing Metal Stent in Resolved Pancreatic Fluid Collections with Duct Disconnection at Head/Neck of Pancreas. Dig Dis Sci 2023:10.1007/s10620-023-07973-7. [PMID: 37269369 DOI: 10.1007/s10620-023-07973-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/11/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND AND AIMS Replacing lumen apposing metal stents (LAMS) with permanent indwelling plastic stents after the resolution of pancreatic fluid collections (PFC) in patients with disconnected pancreatic duct (DPD) is a debatable issue. We retrospectively evaluated the safety and efficacy of replacing LAMS with long-term indwelling transmural plastic stents in patients with DPD at head/neck of pancreas. METHODS The database of patients with PFC who underwent endoscopic transmural drainage with LAMS over the last three years was retrospectively analyzed to identify patients with DPD at the level of the head/neck of the pancreas. The patients were divided into two groups: Group A where LAMS could be replaced with plastic stents and Group B, where LAMS could not be replaced with plastic stents. The two groups were compared for recurrence of symptoms/PFC and complications. RESULTS Out of 53 patients studied, 39 patients (34 males; mean age: 35.7 ± 6.6 years) were included in Group A and 14 patients in Group B (11 males; mean age: 33.4 ± 5.9 years). The demographic profile as well as indwelling time of LAMS was comparable between two groups. PFC recurrence was observed in 2/39 (5.1%) patients in group A and 6/14 (42.8%) patients in group B (p = 0.0001) with one patient in group A and 5 patients in group B requiring repeat intervention for recurrent PFC. CONCLUSIONS Long-term transmural plastic stent placement after removal of LAMS in pancreatic duct disconnection at head/neck of the pancreas is safe and effective strategy to prevent the recurrence of PFC.
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Affiliation(s)
- Surinder S Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Ravi Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Gaurav Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Rajesh Gupta
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
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Vedantam S, Shah R, Bhalla S, Kumar S, Amin S. No difference in outcomes with 15 mm vs. 20 mm lumen-apposing metal stents for endoscopic ultrasound-guided gastroenterostomy for gastric outlet obstruction: a meta-analysis. Clin Endosc 2023; 56:298-307. [PMID: 37259242 DOI: 10.5946/ce.2022.299] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 03/10/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND/AIMS We compared outcomes between use of 15 vs. 20 mm lumen-apposing metal stents (LAMSs) in endoscopic ultrasound-guided gastroenterostomy (EUS-GE) for gastric outlet obstruction. METHODS Databases were queried for studies that used LAMS for EUS-GE to relieve gastric outlet obstruction, and a proportional meta-analysis was performed. RESULTS Thirteen studies were included. The 15 mm and 20 mm LAMS had pooled technical success rates of 93.2% (95% confidence interval [CI], 90.5%-95.2%) and 92.1% (95% CI, 68.4%-98.4%), clinical success rates of 88.6% (95% CI, 85.4%-91.1%) and 89.6% (95% CI, 79.0%-95.1%), adverse event rates of 11.4% (95% CI, 8.1%-15.9%) and 14.7% (95% CI, 4.4%-39.1%), and reintervention rates of 10.3% (95% CI, 6.7%-15.4%) and 3.5% (95% CI, 1.6%-7.6%), respectively. Subgroup analysis revealed no significant differences in technical success, clinical success, or adverse event rates. An increased need for reintervention was noted in the 15 mm stent group (pooled odds ratio, 3.59; 95% CI, 1.40-9.18; p=0.008). CONCLUSION No differences were observed in the technical, clinical, or adverse event rates between 15 and 20 mm LAMS use in EUS-GE. An increased need for reintervention is possible when using a 15 mm stent compared to when using a 20 mm stent.
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Affiliation(s)
- Shyam Vedantam
- Department of Medicine, University of Miami, Miami, FL, USA
| | - Rahil Shah
- Department of Medicine, University of Miami, Miami, FL, USA
| | - Sean Bhalla
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami, Miami, FL, USA
| | - Shria Kumar
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami, Miami, FL, USA
| | - Sunil Amin
- Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami, Miami, FL, USA
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Koutlas NJ, Pawa R. Cholecystocolonic fistula following endoscopic ultrasound-guided gallbladder drainage for stump cholecystitis. Clin J Gastroenterol 2023; 16:116-120. [PMID: 36287350 DOI: 10.1007/s12328-022-01726-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/19/2022] [Indexed: 02/03/2023]
Abstract
Cholecystocolonic fistulas are a rare sequela of gallstone disease. Presenting symptoms are variable but a triad of chronic diarrhea, vitamin K malabsorption, and pneumobilia has been proposed. If untreated, recurrent biliary sepsis can occur with substantial morbidity and mortality. Definitive management is surgical although endoscopic treatment has been described in nonsurgical patients. We present a case of a cholecystocolonic fistula following transgastric endoscopic ultrasound-guided gallbladder drainage with a lumen-apposing metal stent for stump cholecystitis. The patient's presenting symptom was diarrhea. Upper endoscopy and cholecystoscopy 4 weeks following gallbladder drainage revealed a cholecystocolonic fistula. The cholecystogastric tract was closed through the scope clips. The patient had no episodes of cholangitis and had a patent biliary tree with a prior biliary sphincterotomy so clinical observation was chosen. Colonoscopy 1 month later confirmed the closure of the fistula and the patient had a resolution of diarrhea. Our case highlights a novel adverse event of endoscopic ultrasound-guided gallbladder drainage caused by direct pressure of the lumen apposing metal and double pigtail stents on an already inflamed gallbladder wall. Endoscopic therapies that aid in transcapillary biliary drainage are viable alternatives to surgery and can result in fistula closure.
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Affiliation(s)
- Nicholas J Koutlas
- Department of Medicine Section On Gastroenterology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Rishi Pawa
- Department of Medicine Section On Gastroenterology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
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Doyon T, Maniere T, Désilets É. Endoscopic ultrasonography drainage and debridement of an infected subcapsular hepatic hematoma: A case report. World J Gastrointest Endosc 2022; 14:335-341. [PMID: 35719904 PMCID: PMC9157698 DOI: 10.4253/wjge.v14.i5.335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/25/2022] [Accepted: 04/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endoscopic ultrasonography (EUS) has evolved in the last years making it not only a diagnostic modality but a therapeutic procedure. EUS is now used as an alternative technique to percutaneous and surgical drainage. Even though EUS is a challenging procedure and not always suitable compared to percutaneous drainage, there is a need for developing new therapeutic approaches to the liver for when percutaneous drainage is not feasible.
CASE SUMMARY We present the case of a 82 years old male who developed an infected subcapsular hepatic hematoma (SHH) of the left lobe following percutaneous biliary drainage. After 2 failed attempts of percutaneous drainage of the SHH and because the patients couldn’t withstand surgery, we conducted a EUS drainage and debridement of the SHH. Using a lumen apposing metal stent (LAMS) by a transgastric approach, we were able to gain endoscopic access to the SHH. With our experience in the debridement of walled off pancreatic necrosis using this technique, we were confident it was the right approach. After four debridement sessions, the computed tomography scan showed a clear regression of the SHH.
CONCLUSION To our knowledge, this is the first case of successful endoscopic debridement of a SHH using a LAMS which appear to be feasible and safe in this specific case.
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Affiliation(s)
- Theo Doyon
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke J1H 7N4, Québec, Canada
| | - Thibault Maniere
- Department of Gastroenterology, Hopital Charles-Lemoyne, Greenfield Park J4V 2H1, Québec, Canada
| | - Étienne Désilets
- Department of Gastroenterology, Hopital Charles-Lemoyne, Greenfield Park J4V 2H1, Québec, Canada
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Kouanda A, Binmoeller K, Hamerski C, Nett A, Bernabe J, Watson R. Endoscopic ultrasound-guided gastroenterostomy versus open surgical gastrojejunostomy: clinical outcomes and cost effectiveness analysis. Surg Endosc 2021; 35:7058-7067. [PMID: 33479837 DOI: 10.1007/s00464-020-08221-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 12/03/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Early data suggests that endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a safe and efficacious option for gastric outlet obstruction (GOO). However, there is a scarcity of data comparing outcomes with open gastrojejunostomy (OGJ). METHODS Single-center retrospective cohort study of adult patients hospitalized with GOO who underwent EUS-GE or OGJ between January 1, 2014 and February 28, 2020. Primary outcomes were technical and clinical success. RESULTS Sixty-six patients were included of which 40 (60.0%) underwent EUS-GE and 26 (40.0%) underwent OGJ. Baseline characteristics were similar with respect to age (70.5 vs 69.7, p = 0.81), sex (42.5% vs 42.3% female, p = 0.99), median length of follow-up (98.0 vs 166.5 days, p = 0.8), prior failed intervention for GOO (22.5% vs 26.9%, p = 0.68), and the presence of altered anatomy (12.5% vs 30.8%, p = 0.07) between EUS-GE and OGJ, respectively. Technical success was achieved in 37 (92.5%) of EUS-GE and 26 (100%) of OGJ patients (p = 0.15). EUS-GE was associated with faster resumption of oral intake (1.3 vs 4.7 days, p < 0.001) and shorter length of stay (5 vs 14.5 days, p < 0.001). There were no significant differences in symptom recurrence (17.5% vs 19.2%, HR 1.85, CI 0.52-6.65, p = 0.34), reintervention (20% vs 11.5%, HR 0.82, CI 0.22-3.15, p = 0.78), death within 30 days (12.5% vs 3.8%, HR 0.80, CI 0.09-6.85, p = 0.84), or 30-day readmission (17.5% vs 24.1%, HR 1.69, CI 0.53-5.41, p = 0.37) between EUS-GE and OGJ, respectively. EUS-GE patients initiated chemotherapy sooner (17.7 vs 31.3 days, p = 0.033) and had lower overall costs as compared to OGJ ($49,387 vs $124,192, p < 0.001). CONCLUSION There were no significant differences in technical or clinical success, symptom recurrence, reintervention, 30-day readmission, or 30-day mortality between EUS-GE and OGJ. EUS-GE patients experienced shorter delays to resumption of oral intake and chemotherapy, had shorter lengths of stay, and reduced hospital costs. Further prospective comparative studies are warranted to verify our results.
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Affiliation(s)
- Abdul Kouanda
- Department of Medicine, Division of Gastroenterology, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Kenneth Binmoeller
- Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, CA, 94109, USA
| | - Christopher Hamerski
- Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, CA, 94109, USA
| | - Andrew Nett
- Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, CA, 94109, USA
| | - Jona Bernabe
- Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, CA, 94109, USA
| | - Rabindra Watson
- Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, CA, 94109, USA.
- Interventional Endoscopy Services, California Medical Center, 1101 Van Ness Ave, Rm 3158, San Francisco, CA, 94109, USA.
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Antonelli G, Kovacevic B, Karstensen JG, Kalaitzakis E, Vanella G, Hassan C, Vilmann P. Endoscopic ultrasound-guided gastro-enteric anastomosis: A systematic review and meta-analysis. Dig Liver Dis 2020; 52:1294-301. [PMID: 32505567 DOI: 10.1016/j.dld.2020.04.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 03/04/2020] [Accepted: 04/17/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Endoscopic ultrasound-guided gastro-enteric anastomosis (EUS-GEA) using lumen-apposing metal stents (LAMS) is emerging as a minimally invasive alternative to surgery across several indications. Literature on this subject is heterogeneous, with variable reporting of techniques and outcomes. Our aim was to perform a meta-analysis of published data on EUS-GEA, providing a pooled estimate of technical and clinical outcomes. METHODS The protocol was registered in PROSPERO (Reg. no. CRD42018111110). PubMed, Embase, Scopus, and Web of Science databases were searched until February 2019 for studies describing patients undergoing EUS guided enteric anastomosis. PRISMA methodology was used. Pooled technical and clinical success rates as well as pooled adverse events rates were calculated. Study quality, publication bias, and heterogeneity were explored. RESULTS Twelve studies including 290 patients were included, published between 2016 and 2019. All studies but one were retrospective. Main procedure indication was gastric outlet obstruction (62.4%), followed by ERCP access (27.9%) in patients with gastric bypass surgery. Direct puncture technique was the most frequently adopted (68.2%). Pooled technical success rate (12 studies, 290 patients) was 93.5% [95% confidence interval (CI) 89.7-6.0%; I2:0%], while clinical success rate (11 studies, 260 patients) was 90.1% [95%CI 85.5-93.4%; I2:0%]. Pooled total adverse events rate (11 cohorts, 261 patients) was 11.7% [95%CI 8.2-16.6%; I2:0%], mainly mild/moderate: 10.6% [95%CI 7 - 15.6%]. No publication bias or significant heterogeneity was found. CONCLUSIONS EUS-GEA has a high rate of technical and clinical success when performed in expert centers. The procedure appears to be relatively safe, and might represent a non-inferior minimally invasive alternative to surgery. The paucity of long-term clinical outcomes suggests prudency and need for further research, especially regarding non-malignant indications.
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Anderloni A, Fabbri C, Nieto J, Uwe W, Dollhopf M, Aparicio JR, Perez-Miranda M, Tarantino I, Arlt A, Vleggaar F, Vanbiervliet G, Hampe J, Kahaleh M, Vila JJ, Dayyeh BKA, Storm AC, Fugazza A, Binda C, Charachon A, Sevilla-Ribota S, Tyberg A, Robert M, Wani S, Repici A, Sethi A, Khashab MA, Kunda R. The safety and efficacy of a new 20-mm lumen apposing metal stent (lams) for the endoscopic treatment of pancreatic and peripancreatic fluid collections: a large international, multicenter study. Surg Endosc 2020; 35:1741-1748. [PMID: 32323015 DOI: 10.1007/s00464-020-07567-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 04/10/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Lumen apposing metal stent (LAMS) allows an easy access to peripancreatic fluid collections (PPFCs) and the possibility of performing direct endoscopic necrosectomy (DEN). The aim of our study was to evaluate the safety and efficacy of a new 20-mm LAMS in the management of PPFCs. This novel stent represents the largest diameter LAMS available on the market to date. METHODS This is an international, multicenter retrospective study involving 20 centers. Consecutive patients who underwent EUS-guided PPFC drainage using a 20-mm LAMS were included. Primary outcomes were technical and clinical success. Secondary outcomes were rate and the severity of adverse events. RESULTS A total 105 patients underwent PPFC drainage using the new 20-mm LAMS and 106 LAMS were placed. Technical success was 100% (106/106). 7/105 patients died due to causes not related to the stent. Clinical success was achieved in 92/98 patients (93.9%). Significant adverse events occurred in 8/98 patients (8.16%): 4 cases (4.08%) of bleeding, 3 cases (3.06%) of suprainfection, 1 case of gastric outlet obstruction. CONCLUSIONS This multicenter study demonstrated acceptable rates of technical and clinical success using a new 20-mm LAMS for PPFC, including walled-off pancreatic necrosis (WOPN). The results of our study suggest that a new 20-mm LAMS is non-inferior in terms of safety, efficacy, and adverse events as compared to smaller diameter LAMS in the management of PPFCs, including pancreatic psuedocysts (PP) and WOPN. Randomized controlled studies will be needed to determine the ideal size of LAMS need to achieve the greatest clinical benefit with the minimized risk exposure for this high-risk patient population.
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Affiliation(s)
- Andrea Anderloni
- Digestive Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, Milano, Italy.
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy
| | - Jose Nieto
- Advanced Therapeutic Endoscopy Center Borland Groover Clinic, Jacksonville, FL, USA
| | - Will Uwe
- Department of Gastroenterology, Municipal Hospital, Gera, Germany
| | - Markus Dollhopf
- Department of Gastroenterology, Klinikum Neuperlach, Munich, Germany
| | - José Ramón Aparicio
- Endoscopy Unit, Digestive Service, Alicante University General Hospital, Alicante, Spain
| | - Manuel Perez-Miranda
- Gastroenterology & Hepatology Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Ilaria Tarantino
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT, Palermo, Italy
| | - Alexander Arlt
- Department of Medicine I, University Hospital Schleswig-Holstein, Christian-Albrechts-University Kiel, Kiel Campus, Kiel, Germany
| | - Frank Vleggaar
- Department of Gastroenterology and Hepatology, University Medical Center, Utrecht, Netherlands
| | | | - Jochen Hampe
- Medical Department 1, University Hospital Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | | | - Juan J Vila
- Endoscopy Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Barham K Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic Alix School of Medicine, 200 First Street SW, Rochester, MN, 55905, USA
| | - Andrew C Storm
- Division of Gastroenterology and Hepatology, Mayo Clinic Alix School of Medicine, 200 First Street SW, Rochester, MN, 55905, USA
| | - Alessandro Fugazza
- Digestive Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, Milano, Italy
| | - Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy
| | - Antoine Charachon
- Service d'Hépato-gastro-entérologie, CH Princesse Grace, Monaco, Monaco
| | | | - Amy Tyberg
- Weill Cornell Medical, New York, NY, USA
| | - Moran Robert
- Therapeutic Endoscopy, Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, USA
| | - Sachin Wani
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Alessandro Repici
- Digestive Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, Milano, Italy.,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | - Amrita Sethi
- Pancreaticobiliary Endoscopy Services Division of Digestive and Liver Disease, Columbia University Medical Center-NYPH, New York, NY, USA
| | - Mouen A Khashab
- Therapeutic Endoscopy, Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, USA
| | - Rastislav Kunda
- Department of Surgical Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.,Department of Surgery, Department of Gastroenterology-Hepatology, Department of Advanced Interventional Endoscopy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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Jain D, Shah M, Patel U, Sharma A, Singhal S. Endoscopic Ultrasound Guided Choledocho-Enterostomy by Using Lumen Apposing Metal Stent in Patients with Failed Endoscopic Retrograde Cholangiopancreatography: A Literature Review. Digestion 2018; 98:1-10. [PMID: 29672294 DOI: 10.1159/000487185] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 01/25/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Endoscopic retrograde cholangiopancreatography (ERCP) has been the cornerstone in the management of malignant jaundice to provide symptomatic relief and/or to allow chemotherapy. Difficult biliary cannulation or the presence of concomitant duodenal obstruction may lead to its failure. METHOD An extensive English literature search was done via PubMed and Google Scholar to identify 13 peer-reviewed original articles. RESULTS Of 92 patients, 98.9% (91/92) successfully underwent EUS-guided biliary drainage by placement of a lumen-apposing metal stent (LAMS) across extrahepatic biliary tree and small bowel. Although technically challenging, a similar technical success was noted for patients with limited dilation of extrahepatic biliary tree (less than 1 cm) and altered gastrointestinal anatomy (Roux-en-Y, Whipple, or Billroth II). Of 91 patients, 98.9% (90/91) had clinical success. Procedure complications included perforation (2/92; 2.2%) and bleeding (1/92; 1.1%). Stent complications included obstruction (7/91; 7.7%), and migration (1/91; 1.1%) with all responding to endoscopic debridement of food or tumor, placement of plastic pigtail stent through the LAMS, or replacement with a new stent. No procedure-related mortality was noted. CONCLUSION In the hands of an expert, EUS-guided biliary drainage with the use of LAMS is an efficacious and safe option for patients with distal malignant biliary stricture, not amenable to ERCP.
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Affiliation(s)
- Deepanshu Jain
- Division of Gastroenterology and Hepatology, Department of Digestive Diseases and Transplantation, Einstein Healthcare Network, Philadelphia, Pennsylvania, USA
| | - Manan Shah
- Division of Gastroenterology, Hepatology and Nutrition, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Upen Patel
- Division of Gastroenterology, Hepatology and Nutrition, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Abhinav Sharma
- Division of Gastroenterology, Hepatology and Nutrition, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Shashideep Singhal
- Division of Gastroenterology, Hepatology and Nutrition, University of Texas Health Science Center at Houston, Houston, Texas, USA
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Mansoor MS, Tejada J, Parsa NA, Yoon E, Hida S. Off label use of lumen-apposing metal stent for persistent gastro-jejunal anastomotic stricture. World J Gastrointest Endosc 2018; 10:117-120. [PMID: 29988884 PMCID: PMC6033719 DOI: 10.4253/wjge.v10.i6.117] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/30/2018] [Accepted: 04/19/2018] [Indexed: 02/06/2023] Open
Abstract
We are reporting a novel “off-label” use of lumen apposing metal stent (LAMS) for management of refractory gastro-jejunal (GJ) anastomotic stricture after Roux-en-y gastric bypass (RYGB). With increasing prevalence of obesity, bariatric surgery is performed more frequently than ever. RYGB is one of the most commonly performed bariatric procedures. GJ anastomotic stricture is a late complication of this procedure. Our patient, seven years after RYGB developed GJ anastomotic ulcer and subsequently a stricture not amendable to repeated pneumatic dilations. Instead of using the conventional fully covered self-expanding metal stent (fcSEMS) we deployed the relatively new LAMS keeping in mind its novel dumbbell shaped design. Our patient’s symptoms were controlled successfully and she remained asymptomatic on follow-up. Despite initial approval for pancreatic pseudocyst drainage, LAMS has been used with increased frequency at various locations within gastrointestinal tract including GJ anastomotic strictures. Future randomized control trials are warranted to compare the efficacy of fcSEMS to LAMS.
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Affiliation(s)
| | - Juan Tejada
- Department of Gastroenterology, Albany Medical Center, Albany, NY 12047, United States
| | - Nour A Parsa
- Department of Gastroenterology, Albany Medical Center, Albany, NY 12047, United States
| | - Eric Yoon
- Department of Gastroenterology, Albany Medical Center, Albany, NY 12047, United States
| | - Sven Hida
- Department of Gastroenterology, Albany Medical Center, Albany, NY 12047, United States
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DeSimone ML, Asombang AW, Berzin TM. Lumen apposing metal stents for pancreatic fluid collections: Recognition and management of complications. World J Gastrointest Endosc 2017; 9:456-463. [PMID: 28979710 PMCID: PMC5605345 DOI: 10.4253/wjge.v9.i9.456] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 06/02/2017] [Accepted: 07/24/2017] [Indexed: 02/06/2023] Open
Abstract
For patients recovering from acute pancreatitis, the development of a pancreatic fluid collection (PFC) predicts a more complex course of recovery, and introduces difficult management decisions with regard to when, whether, and how the collection should be drained. Most PFCs resolve spontaneously and drainage is indicated only in pseudocysts and walled-off pancreatic necrosis when the collections are causing symptoms and/or local complications such as biliary obstruction. Historical approaches to PFC drainage have included surgical (open or laparoscopic cystgastrostomy or pancreatic debridement), and the placement of percutaneous drains. Endoscopic drainage techniques have emerged in the last several years as the preferred approach for most patients, when local expertise is available. Lumen-apposing metal stents (LAMS) have recently been developed as a tool to facilitate potentially safer and easier endoscopic drainage of pancreatic fluid collections, and less commonly, for other indications, such as gallbladder drainage. Physicians considering LAMS placement must be aware of the complications most commonly associated with LAMS including bleeding, migration, buried stent, stent occlusion, and perforation. Because of the patient complexity associated with severe pancreatitis, management of pancreatic fluid collections can be a complex and multidisciplinary endeavor. Successful and safe use of LAMS for patients with pancreatic fluid collections requires that the endoscopist have a full understanding of the potential complications of LAMS techniques, including how to recognize and manage expected complications.
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Affiliation(s)
- Michael L DeSimone
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - Akwi W Asombang
- Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - Tyler M Berzin
- Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
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Abstract
INTRODUCTION Endoscopic ultrasound guided translumenal drainage of pancreatic fluid collections (PFCs) has been widely practiced for over a decade, using conventional plastic and self-expandable metal stents. The use of such stents for transmural drainage is off-label and limited by the lack of lumen-to-lumen anchorage, which can lead to leakage, migration and tissue trauma. AREAS COVERED Novel stent designs dedicated to applications of translumenal drainage have recently emerged and promise to make transmural drainage quicker, safer, and more effective. Achieving faster resolution of the fluid collection, decreasing adverse events, decreasing recurrence rates, and lowering costs are critical to advancing the endoscopic management of PFCs. Expert commentary: Our paper suggests that the AXIOS stent is an innovative therapeutic approach for PFC drainage with excellent efficacy, safety, and relatively few adverse outcomes. Preliminary reports appear promising and large multicenter prospective studies are needed in the future to further determine its safety and efficacy.
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Affiliation(s)
| | - Todd H Baron
- b Division of Gastroenterology and Hepatology , University of North Carolina , Chapel Hill , North Carolina , USA
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