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Lumen apposing metal stent

Douglas G Adler, Janak Shah, Jose Nieto, Kenneth Binmoeller, Yasser Bhat, Linda Jo Taylor, Ali A Siddiqui
Backgrounds and Objectives: No study on the use of lumen-apposing fully covered self-expanding metal stent (LAMS) to drain pancreatic fluid collections (PFCs) has evaluated outcomes of patients in the outpatient setting. The objective of this multicenter study was to evaluate the clinical outcomes, success rate, and adverse events of the LAMS for endoscopic ultrasound (EUS)-guided transmural drainage of patients with symptomatic PFCs on an inpatient versus an outpatient basis. Methods: This was a multicenter, retrospective study conducted at 4 tertiary care centers...
May 17, 2018: Endoscopic Ultrasound
Monica Saumoy, Amy Tyberg, Elizabeth Brown, Soumitra R Eachempati, Michael Lieberman, Cheguevara Afaneh, Rastislav Kunda, Natalie Cosgrove, Ali Siddiqui, Monica Gaidhane, Michel Kahaleh
BACKGROUND: Endoscopic ultrasound-guided gallbladder drainage (EGBD) with a lumen apposing metal stent is becoming a widely accepted alternative to percutaneous gallbladder drainage (PTGD) for patients who are not candidates for cholecystectomy (CCY). In some patients, medical comorbidites can improve, allowing them to undergo CCY. We compare feasibility and outcomes of interval CCY after EGBD versus PTGD. METHODS: We conducted a multicentered international cohort study of patients who underwent EGBD or PTGD and then underwent interval CCY...
April 24, 2018: Journal of Clinical Gastroenterology
Andrea Anderloni, Alessandro Fugazza, Francesco Auriemma, Luís Maia, Roberta Maselli, Edoardo Troncone, Ferdinando D'Amico, Alessandro Repici
No abstract text is available yet for this article.
April 23, 2018: American Journal of Gastroenterology
Sebastian Zeissig, Stefan Sulk, Stefan Brueckner, Katja Matthes, Margarete Hohmann, Stephanie Reichel, Mark Ellrichmann, Alexander Arlt, Uwe Will, Jochen Hampe
No abstract text is available yet for this article.
April 20, 2018: Gut
Deepanshu Jain, Manan Shah, Upen Patel, Abhinav Sharma, Shashideep Singhal
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...
April 19, 2018: Digestion
A Poszler, P Klare, A Weber, M Abdelhafez, K Holzapfel, R M Schmid, S von Delius
BACKGROUND: Endosonographically guided transgastric drainage is the first-line interventional therapy of walled-off necrosis and symptomatic pancreatic pseudocysts in necrotizing pancreatitis. Plastic stents or lumen apposing metal stents are commonly used. A possible complication of endoscopic therapy is stent migration. CASE REPORT: We report upon a 51-year-old man who presented with acute necrotizing pancreatitis. Transgastric necrosectomy was performed and 5 transmural double-pigtail stents (DPS) were left in situ to drain the residual retroperitoneal cavity...
April 16, 2018: Der Internist
Yen-I Chen, Alan N Barkun, Viviane Adam, Ge Bai, Vikesh K Singh, Majidah Bukhari, Olaya Brewer Gutierrez, B Joseph Elmunzer, Robert Moran, Lea Fayad, Mohamad El Zein, Vivek Kumbhari, Alessandro Repici, Mouen A Khashab
BACKGROUND AND AIMS: EUS-guided transmural drainage is effective in the management of pancreatic walled-off necrosis (WON). A lumen-apposing metal stent (LAMS) has recently been developed specifically for the drainage of pancreatic fluid collections showing promising results. However, no cost-effectiveness data have been published in comparison to endoscopic drainage with traditional plastic stents (PSs). The aim is to compare the cost-effectiveness of LAMSs to PSs in the management of WON...
March 31, 2018: Gastrointestinal Endoscopy
Arvind J Trindade, Divyesh V Sejpal, Petros C Benias
No abstract text is available yet for this article.
March 30, 2018: Clinical Gastroenterology and Hepatology
Manuel Puga, Claudia F Consiglieri, Juli Busquets, Natàlia Pallarès, Lluis Secanella, Nuria Peláez, Joan Fabregat, José Castellote, Joan B Gornals
BACKGROUND:  The aim of this study was to evaluate whether the placement of a coaxial double-pigtail plastic stent (DPS) within a lumen-apposing metal stent (LAMS) may improve the safety of endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collections (PFCs). METHODS:  This was a retrospective cohort study including patients with PFCs and an indication for transmural drainage. Two strategies (LAMS alone or LAMS plus DPS) were used at the endoscopist's discretion...
March 28, 2018: Endoscopy
Raffaele Manta, Massimiliano Mutignani, Giuseppe Galloro, Rita Conigliaro, Angelo Zullo
Management of patients with acute cholecystitis unfit for surgery is challenging. Recently, endoscopic ultrasound (EUS)-guided gallbladder drainage with a lumen-apposing metal stent (LAMS) has been introduced for these patients. We performed a systematic review and pooled-data analysis in this field. A comprehensive review of case series on gallbladder drainage with EUS-guided LAMS placement was performed. Only case series with at least five patients were considered. The rates of technical success, clinical success, and adverse events were computed...
March 23, 2018: European Journal of Gastroenterology & Hepatology
Yen-I Chen, Theodore James, Amol Agarwal, Todd H Baron, Takao Itoi, Rastislav Kunda, Jose Nieto, Majidah Bukhari, Olaya Brewer Gutierrez, Omid Sanaei, Robert Moran, Lea Fayad, Mouen A Khashab
Background and study aims:  Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) in malignant gastric outlet obstruction (GOO) appears to be promising; however, its role in benign GOO is unclear. The aim of this study was to ascertain the clinical efficacy and safety of EUS-GE in benign GOO. Patients and methods : This was an international retrospective series involving 5 tertiary centers. Consecutive patients who underwent EUS-GE between 1/2013 - 10/2016 for benign GOO were included...
March 2018: Endoscopy International Open
Charles J Lightdale
No abstract text is available yet for this article.
April 2018: Gastrointestinal Endoscopy Clinics of North America
Ji Young Bang, Shyam Varadarajulu
Lumen-apposing metal stents are integrated in a single-step delivery system for draining intra-abdominal fluid collections. The theoretic advantage of lumen-apposing stents is the ability to approximate the wall of the drained cavity or organ to the gastrointestinal tract lumen. The use of lumen-apposing stents now includes drainage of organs adjacent to the stomach/duodenum and creation of anastomosis between the stomach and jejunum. The lumen-apposing stents may also serve as a conduit for accessing the remnant stomach for performing biliary tract interventions...
April 2018: Gastrointestinal Endoscopy Clinics of North America
Jaehoon Cho, Ara B Sahakian
The development of new endoscopic techniques, such as gastrointestinal (GI) stenting, full-thickness suturing, clip application, and use of tissue adhesives, has had a significant impact on management of GI fistulae. These techniques have shown promising results, but further study is needed to optimize the efficacy of long-term closure. The advancement of endoscopic techniques, including the use of the lumen apposing metal stent (LAMS), has allowed for the deliberate creation of fistula tracts to apply endoscopic therapy that previously could not be achieved...
April 2018: Gastrointestinal Endoscopy Clinics of North America
Stuart K Amateau, Martin L Freeman
The lumen-apposing metal stent has evolved endoscopic transluminal therapies, although it has potential complications, including maldeployment, bleeding, perforation, migration, and several risks specific to necrotizing pancreatitis. Careful planning and technique mitigate these inherent risks of lumen-apposing metal sent deployment; however, setbacks occur even in the most experienced of hands. Therefore, early recognition and management of these complications are critical to alleviating morbidity and avoiding mortality...
April 2018: Gastrointestinal Endoscopy Clinics of North America
Matthew W Stier, Irving Waxman
Numerous lumen-apposing metal stents (LAMS) have been designed for transluminal applications, including complex pancreatic fluid collections (PFCs) and difficult biliary access. Limited high-quality data exist directly comparing the various LAMS models, and their use remains largely dependent on availability and operator expertise. LAMS placement has been streamlined by the addition of electrocautery, allowing for single-step or modified "hot" approach, if desired. Therapeutic endoscopists continue to explore the application of this technology in a variety of clinical scenarios, and future innovations will be needed to meet these evolving clinical demands...
April 2018: Gastrointestinal Endoscopy Clinics of North America
Monica Saumoy, Clark Yarber, Michel Kahaleh
The lumen apposing metal stent (LAMS) has historically been used for drainage of pancreatic fluid collections. The unique design of this stent has allowed endoscopists to develop novel uses, including drainage of abscesses adjacent to gastrointestinal lumens, maintaining patency in gastrointestinal strictures, and creating a fistulous tract to bypass altered or compromised anatomy. These alternative uses for the LAMS take advantage of its ability to form a sealed, well-approximated anastomosis. Future applications of the LAMS are continuously being developed as clinicians provide minimally invasive approaches for management of these disease processes...
April 2018: Gastrointestinal Endoscopy Clinics of North America
Marc Giovannini
Ultrasound-guided drainage is the first-line modality for drainage of symptomatic of pancreatic fluid collections. In the context of pancreatic cancer, use of multiple double-pigtail plastic stents suffice, with high treatment efficacy. This approach provides similar success rates with low complications and better quality of life compared with surgery. Lumen apposing metallic stents (LAMSs) permit more effective drainage with larger diameter; because of their higher costs than plastic stents, their main role is probably in the context of walled-off necrosis, but the place and the use of LAMS should be studied to avoid and reduce the risks of complications...
April 2018: Gastrointestinal Endoscopy Clinics of North America
Kenneth F Binmoeller, Andrew Nett
The lumen-apposing metal stent is the first stent specifically designed for endoscopic ultrasound-guided transluminal drainage of extraintestinal fluid collections. With the "hot" electrocautery-enhanced delivery system, this platform marks the most recent evolutionary stage of endoscopic therapy of pancreatic fluid collections. The lumen-apposing metal stent platform has made endoscopic drainage of pancreatic fluid collections easier and safer, while serving as a port for safe entry into the cyst cavity to extend the reach of endoscopic diagnosis and therapy...
April 2018: Gastrointestinal Endoscopy Clinics of North America
Francisco Javier Garcia-Alonso, Ramón Sanchez-Ocana, Irene Peñas-Herrero, Ryan Law, Sergio Sevilla-Ribota, Raúl Torres-Yuste, Paula Gil-Simón, Carlos de la Serna Higuera, Manuel Perez-Miranda
BACKGROUND:  Delayed gastrointestinal (GI) bleeding and stent migration are known adverse events which may occur following placement of lumen-apposing metal stents (LAMSs). METHODS:  All consecutive patients who underwent LAMS placement between May 2011 and June 2017 at a single tertiary medical center were included. Demographics and procedural details were prospectively collected. Post-procedure follow-up and outcome measures were retrospectively collected...
April 2018: Endoscopy
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