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Mizrahi M, Fahmawi Y, Merritt L, Kumar M, Tharian B, Khan SA, Inamdar S, Sharma N, Uppal D, Shami VM, Kashif MS, Gabr M, Pleskow D, Berzin TM, James TW, Croglio M, Baron TH, Adler DG. Luminal-apposing stents for benign intraluminal strictures: a large United States multicenter study of clinical outcomes. Ann Gastroenterol 2021; 34:33-38. [PMID: 33414619 PMCID: PMC7774669 DOI: 10.20524/aog.2020.0538] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 06/16/2020] [Indexed: 11/25/2022] Open
Abstract
Background The use of fully covered lumen-apposing metal stents (LAMS) for benign short gastrointestinal (GI) strictures has been reported. This study aimed to evaluate the safety and efficacy of LAMS for refractory GI strictures. Methods A retrospective analysis was performed of patients who underwent LAMS placement for benign GI strictures in 8 United States centers. The primary outcomes were technical success and initial clinical response. Secondary outcomes were reintervention rate and adverse events. Results A total of 51 patients underwent 61 LAMS placement procedures; 33 (64.7%) had failed previous treatments. The most common stricture location was the pylorus (n=17 patients). Various sizes of stents were used, with 15-mm LAMS placed in 45 procedures, 20-mm LAMS in 14 procedures, and 10-mm LAMS in 2 procedures. The overall technical success, short-term clinical response and reintervention rate after stent removal were 100%, 91.8% and 31.1%, respectively. Adverse events were reported in 17 (27.9%) procedures, with stent migration being the most common (13.1%). In subgroup analysis, both 15 mm and 20 mm stents had comparable short-term clinical response and adverse event rates. However, stent migration (15.6%) was the most common adverse event with 15-mm LAMS while pain (14.3%) was the most common with 20-mm LAMS. The reintervention rate was 80% at 200-day follow up after stent removal. Conclusions Using LAMS for treatment of short benign GI strictures is safe and effective. Larger LAMS, such as the new 20 mm in diameter, may have a lower stent migration rate compared to smaller diameter LAMS.
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Affiliation(s)
- Meir Mizrahi
- Department of Gastroenterology and Hepatology, Advanced Endoscopy Unit, University of South Alabama, Mobile, AL (Meir Mizrahi, Lindsey Merritt, Manoj Kumar)
| | - Yazan Fahmawi
- Department of Internal Medicine, University of South Alabama, Mobile, AL (Yazan Fahmawi)
| | - Lindsey Merritt
- Department of Gastroenterology and Hepatology, Advanced Endoscopy Unit, University of South Alabama, Mobile, AL (Meir Mizrahi, Lindsey Merritt, Manoj Kumar)
| | - Manoj Kumar
- Department of Gastroenterology and Hepatology, Advanced Endoscopy Unit, University of South Alabama, Mobile, AL (Meir Mizrahi, Lindsey Merritt, Manoj Kumar)
| | - Benjamin Tharian
- Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR (Benjamin Tharian, Salman Ali Khan, Sumant Inamdar)
| | - Salman Ali Khan
- Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR (Benjamin Tharian, Salman Ali Khan, Sumant Inamdar)
| | - Sumant Inamdar
- Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR (Benjamin Tharian, Salman Ali Khan, Sumant Inamdar)
| | - Neil Sharma
- Department of Gastroenterology and Hepatology, Parkview Health, Fort Wayne, IN (Neil Sharma)
| | - Dushant Uppal
- Department of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, VA (Dushant Uppal, Vanessa M. Shami)
| | - Vanessa M Shami
- Department of Gastroenterology and Hepatology, University of Virginia Health System, Charlottesville, VA (Dushant Uppal, Vanessa M. Shami)
| | - Mahmood Syed Kashif
- Department of Gastroenterology and Hepatology, Orange Regional Medical Center, Middletown, NY (Mahmood Syed Kashif)
| | - Moamen Gabr
- Department of Gastroenterology and Hepatology, University of Kentucky College of Medicine, Lexington, KY (Moamen Gabr)
| | - Douglas Pleskow
- Department of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (Douglas Pleskow, Tyler M. Berzin)
| | - Tyler M Berzin
- Department of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (Douglas Pleskow, Tyler M. Berzin)
| | - Ted W James
- Department of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Ted W. James, Michael Croglio, Todd H Baron)
| | - Michael Croglio
- Department of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Ted W. James, Michael Croglio, Todd H Baron)
| | - Todd H Baron
- Department of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Ted W. James, Michael Croglio, Todd H Baron)
| | - Douglas G Adler
- Department of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT (Douglas G. Adler), USA
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James TW, Krafft M, Croglio M, Nasr J, Baron T. EUS-guided gallbladder drainage in patients with cirrhosis: results of a multicenter retrospective study. Endosc Int Open 2019; 7:E1099-E1104. [PMID: 31475226 PMCID: PMC6715426 DOI: 10.1055/a-0965-6662] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 06/12/2019] [Indexed: 01/20/2023] Open
Abstract
Background and study aims Cirrhosis has historically been considered a relative, if not absolute, contraindication to cholecystectomy. Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has been developed for use in non-operative candidates with cholecystitis; however, little data exist for use of the procedure in patients with cirrhosis. Patients and methods This was a retrospective series involving two large tertiary referral centers performing EUS-GBD. Patients with cirrhosis who underwent EUS-GBD for cholecystitis between August 2014 and December 2018 were identified. The primary endpoint was the rate of technical success, defined as EUS-guided placement of a lumen-apposing metal stent (LAMS) from duodenum to gallbladder. Patient demographics, procedural details, adverse events (AEs), post-procedural symptoms, and clinical success were recorded. Results Fifteen patients (9 females, 6 males) with cirrhosis underwent EUS-GBD during the study period. Mean patient age was 61 ± 17.1yrs, mean MELD-Na 15 ± 7. Etiology of cirrhosis was HCV (n = 2), alcohol (n = 4), non-alcoholic fatty liver disease (n = 8), and autoimmune hepatitis (n = 1). The technical success rate was 93.3 % and mean procedure time was 64 ± 59 minutes. Initial puncture site was duodenum (n = 11), stomach (n = 3) and jejunum (n = 1) and portion of gallbladder used for drainage was neck (n = 4) and body (n = 11). Fourteen patients went on to clinical success and two AEs occurred in this cohort. One decompensation event occurred in a patient with Child-Pugh class C disease 3 weeks post-procedure. Mean length of follow-up was 373 ± 367.3 days; one death occurred due to underlying malignancy. Conclusion EUS-GBD is safe and efficacious in managing cholecystitis in patients with Child-Pugh A and B cirrhosis who are non-operative candidates. Further studies are needed to determine optimal patient selection and procedural technique.
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Affiliation(s)
- Theodore W. James
- University of North Carolina, Division of Gastroenterology & Hepatology, Chapel Hill, North Carolina, United States,Corresponding author Theodore W. James University of North CarolinaDivision of Gastroenterology & Hepatology101 Manning DriveChapel Hill, NC 27514
| | - Matthew Krafft
- West Virginia Ruby Memorial Hospital Digestive Diseases, Morgantown, West Virginia, United States
| | - Michael Croglio
- University of North Carolina, Department of Medicine, Chapel Hill, North Carolina, United States
| | - John Nasr
- West Virginia Ruby Memorial Hospital Digestive Diseases, Morgantown, West Virginia, United States
| | - Todd Baron
- University of North Carolina, Division of Gastroenterology & Hepatology, Chapel Hill, North Carolina, United States
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