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Lumen apposing metal stent

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...
March 7, 2018: Endoscopy
Hugh D Mai, Ethan Dubin, Arun A Mavanur, Marvin Feldman, Sudhir Dutta
We submit the first case report of a successful EUS-guided transmural LAMS placement to drain the small bowel directly into the transverse colon in a high surgical risk patient with obstruction due to severe anastomotic stricture. We describe our technique for endoscopic colo-enterostomy and are hopeful that this will become a viable option to manage non-operable high-grade distal small bowel obstruction.
March 5, 2018: Clinical Journal of Gastroenterology
Stuart K Amateau, Chin Hong Lim, Nicholas M McDonald, Mustafa Arain, Sayeed Ikramuddin, Daniel B Leslie
Traditionally, restoration of normal bowel continuity after resection and bypass of a diseased or obstructed gastrointestinal tract can only be achieved through surgery, which can be technically challenging and comes with a risk of adverse events. Here, we describe our institutions' experience with endoscopic-guided gastroenterostomy or enteroenterostomy with lumen-apposing metal stent (LAMS) from March 2015 to August 2016. Ten patients had gastrogastrostomy (gastric pouch to gastric remnant) and three patients had jejunogastrostomy (Roux limb to gastric remnant) for the reversal of Roux-en-Y bariatric surgery...
March 2, 2018: Obesity Surgery
Suresh Vasan Venkatachalapathy, Noor Bekkali, Stephen Pereira, Gavin Johnson, Kofi Oppong, Manu Nayar, John Leeds, Bharat Paranandi, Ian Penman, Nicholas Carroll, Edmund Godfrey, Martin James, Guruprasad Aithal, Colin McKay, John Devlin, Terry Wong, Alistair Makin, Barbara Ryan, Matthew Huggett
Background and study aims:  Pancreatic fluid collection (PFC) is a common complication of pancreatitis for which endoscopic ultrasound-guided drainage is first-line treatment. A new single-device, lumen-apposing, covered self-expanding metal stent (LAMS) has been licensed for PFC drainage. We therefore present our multicenter experience with the LAMS for PFC drainage in a multicenter prospective case series to assess success and complication rates. Patients and methods:  All adult patients from 11 tertiary centers who had LAMS placement for PFC from July 2015 to July 2016 were included...
March 2018: Endoscopy International Open
Syed Kashif Mahmood, Pavlos Kaimakliotis
The introduction of lumen-apposing metal stents (LAMS) has been an important development in the management of pancreatic fluid collections. Stent migration out of pancreatic fluid collections into the stomach has been reported, despite the special anti-migratory design of the bi-flanged stent. Data on stent migration rates remain sparse, with some studies suggesting a migration rate of 3.3-5%. There have been no reported cases of LAMS migration outside of the stomach. We describe the first reported case of a transgastric LAMS migrating from the stomach and passing into the colon...
2018: ACG Case Reports Journal
Bryan Brimhall, Samuel Han, Philip D Tatman, Toshimasa J Clark, Sachin Wani, Brian Brauer, Steven Edmundowicz, Mihir S Wagh, Augustin Attwell, Hazem Hammad, Raj J Shah
BACKGROUND & AIMS: There have been few studies that compared the effects of lumen-apposing metal stents (LAMS) and double pigtail plastic stents (DPS) in patients with peri-pancreatic fluid collections from pancreatitis. We aimed to compare technical and clinical success and adverse events in patients who received LAMS vs DPS for pancreatic pseudocysts and walled-off necrosis. METHODS: We performed a retrospective study of endoscopic ultrasound-mediated drainage in 149 patients (65% male; mean age, 47 years) with pancreatic pseudocysts or walled-off necrosis (97 received LAMS and 152 received DPS), from January 2011 through September 2016 at a single center...
February 20, 2018: Clinical Gastroenterology and Hepatology
Yan Chen, Huiyun Zhu, Zhendong Jin, Zhaoshen Li, Yiqi Du
No abstract text is available yet for this article.
January 2018: Endoscopic Ultrasound
Tajana Pavic, Davor Hrabar, Dominik Kralj, Ivan Lerotic, Doris Ogresta
Necrotizing pancreatitis remains a challenging and unpredictable condition accompanied by various complications. Endoscopic ultrasound-guided transmural drainage and necrosectomy have become the standard treatment for patients with walled-off necrosis (WON). Endoscopic therapy via lumen-apposing metal stents (LAMS) with large diameters has shown success in the management of pancreatic fluid collections, but there are few data on specific complications of that therapy. We report a case of infected WON and concomitant fungemia following LAMS placement and necrosectomy...
January 30, 2018: Clinical Journal of Gastroenterology
Nan Ge, Jinlong Hu, Siyu Sun, Enqiang Linghu, Zhendong Jin, Zhaoshen Li
Objective: To compare the efficiency of plastic and metal stents for symptomatic pancreatic pseudocyst (PP) drainage and analyze other main associated factors that affect the outcome of drainage therapy. Method: Rates of technical and clinical success, procedure-related side effects (hemorrhage, stent migration, and cyst rupture), reinterventions, and duration of hospital stay. Results: There were 52 patients, 40 patients underwent plastic stent placement and 12 patients underwent lumen-apposing metal stent (LAMS) placement...
December 2017: Journal of Translational Internal Medicine
Nabeel Azeem, Martin L Freeman, Stuart K Amateau
No abstract text is available yet for this article.
January 12, 2018: Endoscopy
Javier Santos-Fernandez, Christopher Paiji, Mohammad Shakhatreh, Irene Becerro-Gonzalez, Ramon Sanchez-Ocana, Paul Yeaton, Jason Samarasena, Manuel Perez-Miranda
AIM: To investigate technical feasibility, outcomes and adverse events of the lumen-apposing metal stent (LAMS) for benign gastrointestinal (GI) tract strictures. METHODS: Between July 2015 and January 2017, patients undergoing treatment by LAMS for benign GI strictures at three tertiary referral centers were included in this study. Primary outcomes included technical success, short-term clinical success, long-term clinical success, and adverse events. Short-term clinical success was defined as symptom resolution at 30 d after stent placement...
December 16, 2017: World Journal of Gastrointestinal Endoscopy
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