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DOI: 10.1055/s-0038-1637141
TECHNICAL ISSUES (TIS) DURING EUS-GUIDED INSERTION OF LUMEN APPOSING METAL STENTS (LAMS): CLASSIFICATION, ANALYSIS OF THEIR EFFECT ON PROCEDURE OUTCOMES, RISK FACTORS AND SALVAGE TECHNIQUES
Publikationsverlauf
Publikationsdatum:
27. März 2018 (online)
Aims:
LAMS have been recently introduced, presenting promising results in intraabdominal drainages and endoscopic anastomoses. A variety of TIs might appear but we lack a common terminology to address them and their consequences on outcomes are unknown.
Methods:
All consecutive patients undergoing an endoscopic procedure which included in its planning the deployment of a LAMS between May 2011 and June 2017 at a single tertiary center were prospectively enrolled (table 1). We propose a novel classification of TIs, categorized in dislodgment, access failure, liberation failures and misplacements. We analyzed their incidence, risk factors, management and effect on outcomes
Results:
A total of 289 procedures (47.4% pancreatic fluid collections, 22.2% gallbladder drainages, 13.8% enteric anastomoses, 16.6% others) were analyzed. TI developed in 27% of them, significantly decreasing the technical (99.5% vs. 52.6%, p < 0.001), procedural (100% vs. 82.1%, p < 0.001) and clinical success rates (88% vs. 77.9%, p = 0.03). Distal (25.6%) and proximal flange misplacements (17.9%) and complete liberation failures (17.9%) were the most frequently encountered. Forceps repositioning, placement of coaxial stents and deploying a different type of stent were the most frequent salvage techniques (83.3% of all the TIs). A larger stent saddle (OR: 3.32 (1.05 – 10.56)) and malignant disease (OR: 1.98 (1.07 – 3.65)) were associated to the development of TI on multivariate analysis. Enteric anastomoses (OR 3.42 (1.22 – 9.62)) and malignant disease (OR: 2.8 (1.04 – 7.51)) were associated to the development of distal flange misplacement.
Age, median (IQR) |
71.6 (58.3 – 83.5) |
Male sex, n (%) |
184 (63.7%) |
Malignant disease, n (%) |
75 (26%) |
Access, n (%) Stomach Duodenum Jejunum Esophagus Missing |
215 (74.4%) 63 (21.8%) 6 (2.1%) 3 (1%) 2 (0.7%) |
LAMS type, n (%) Hot Cold Missing |
170 (58.8%) 116 (40.1%) 3 (1%) |
Conclusions:
The transmural insertion of PAL Axios EUS-guided is associated in one of every four cases to various Tis, typically distal flange misplacement in the mobile targets. 83.3% of these Tis can be rescued, mainly through the insertion of another stent.