Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Sep 1;39(5):348-355.
doi: 10.1097/MOG.0000000000000965. Epub 2023 Jul 20.

Use of lumen apposing metal stents in patients with altered gastrointestinal anatomy

Yervant Ichkhanian  1 , Manol Jovani  2   3
Affiliations
Review

Use of lumen apposing metal stents in patients with altered gastrointestinal anatomy

Yervant Ichkhanian et al. Curr Opin Gastroenterol. .

Abstract

Purpose of review: Lumen apposing metal stents (LAMS) have been increasingly used to manage patients with surgically altered anatomy (SAA), who would have otherwise required percutaneous or surgical interventions. Via the creation of de-novo anastomoses, LAMS provides a conduit to access distal parts of the gastrointestinal tract to perform various interventions.

Recent findings: Pancreatobiliary (PB) and non-PB interventions are challenging in patients with SAA. Endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography (ERCP) (EDGE) and endoscopic ultrasound (EUS)-directed transenteric ERCP (EDEE) are effective procedures that are being increasingly utilized to perform ERCP in patient with Roux-en-Y gastric bypass (RYGB) and non-RYGB SAA, respectively. Furthermore, EUS-directed trans-gastric intervention (EDGI) is a collective term for the non-PB procedures that could be performed in patients with SAA. EDGE/EDEE/EDGI are considered relatively safe procedures, however, intra-procedural stent misdeployement, and long-term ramifications of persistent fistula and stent migration could require endoscopic or, in rare instances, surgical management.

Summary: The advent of LAMS has revolutionized the therapeutic capabilities of EUS, by allowing the creation of new gastrointestinal anastomoses. With the growing body of literature, it is expected that such techniques will be more commonly performed in the community, providing less invasive and more effective treatment options for patients with SAA.

PubMed Disclaimer

References

    1. Bhenswala P, Lakhana M, Gress FG, Andalib I. Novel uses of lumen-apposing metal stents: a review of the literature. J Clin Gastroenterol 2021; 55:641–651.
    1. Law RJ, Chandrasekhara V, Bhatt A, et al. Lumen-apposing metal stents (with videos). Gastrointest Endosc 2021; 94:457–470.
    1. Muthusamy VR, Chandrasekhara V, Acosta RD, et al. The role of endoscopy in the diagnosis and treatment of inflammatory pancreatic fluid collections. Gastrointest Endosc 2016; 83:481–488.
    1. Mangiavillano B, Larghi A, Vargas-Madrigal J, et al. EUS-guided gastroenterostomy using a novel electrocautery lumen apposing metal stent for treatment of gastric outlet obstruction (with video). Dig Liver Dis 2023; 55:644–648.
    1. Jovani M, Ichkhanian Y, Parsa N, et al. Assessment of the learning curve for EUS-guided gastroenterostomy for a single operator. Gastrointest Endosc 2021; 93:1088–1093.