Lumen-apposing metal stents provide early and late clinical benefits for the management of benign gastrointestinal strictures: Is there a role for definitive therapy?

Abstract

Objectives: This study aimed to characterize the clinical outcomes, safety, and efficacy of lumen-apposing metal stents (LAMS) in treating benign gastrointestinal strictures.

Methods: A single-center retrospective review of all patients who underwent LAMS placement for benign strictures from June 2017 to July 2023. Primary outcomes were technical success, early clinical success, late clinical success (LCS), and sustained post-LAMS clinical success (SPLCS). Secondary outcomes included stent dwell time, stenosis changes, adverse events, reintervention rates, and symptomatology evaluation.

Results: Thirty-five patients underwent placement of 42 LAMS (74% female, mean age: 54.2 ± 11.7 years). Anastomotic strictures accounted for 64% of cases (N = 27, 45% at the gastrojejunal anastomosis). The median STD was 91.0 days (interquartile range [IQR]: 55.0-132.0). Technical success was obtained in all cases. Early clinical successand LCS were achieved in 80% of cases overall. SPLCS was achieved in 45% (n = 15) of cases. The overall reintervention rate was 63%, with a median time to reintervention being 50.5 days (IQR: 24-105). adverse events occurred in 28% (n = 12) overall, with a 24% migration rate (n = 10). Follow-up was completed in 83% of cases with a median duration of 629 days (range: 192.0-1297.0). Overall symptom improvement occurred in 79% (n = 27) during indwelling LAMS versus 58% and 56% at 30- and 60-days post-removal, respectively.

Conclusions: LAMS for benign gastrointestinal strictures are associated with high technical and early clinical success/LCS rates, positive quality-of-life metrics, and a tolerable adverse event rate. Overall, recurrence of symptoms and high reintervention rates post-LAMS removal reinforce the difficulty in managing benign gastrointestinal strictures but also argue for LAMS as a definitive therapy in select cases.

Keywords: gastrointestinal disorders; gastrointestinal endoscopes; gastrointestinal tract; stents; strictures.

FIGURE 1

Displays the structure of the AXIOS lumen‐apposing metal stent system (Boston Scientific Inc.), which is a biflanged dumbbell‐shaped fully‐covered stent made of Nitinol wire and covered with silicone. This lumen‐apposing metal stent and introducer system were used in all cases.

FIGURE 2

(a) High‐grade gastrojejunal anastomotic stricture. (b) Placement of a 20 × 10 mm non‐cautery enhanced lumen‐apposing metal stent over a 0.035‐inch guide wire with (c) subsequent through the scope balloon dilation up to 18 mm of the saddle of the lumen‐apposing metal stent and visualization of downstream jejunum. (d) Status post removal of lumen‐apposing metal stent 3 months after index episode showing a resolved gastrojejunal anastomotic stricture.

FIGURE 3

Depicts symptom behaviors during lumen‐apposing metal stent (LAMS) as well as 30‐ and 60‐days post‐LAMS removal. Depicts patient‐driven symptom improvement during LAMS as well as 30‐ and 60‐days post‐LAMS removal

FIGURE 4

Proposed treatment algorithm for managing refractory, benign gastrointestinal (GI) strictures with lumen‐apposing metal stent (LAMS). Proposed treatment algorithm for the management of refractory, benign GI strictures with the utilization of LAMS.