Lumen-apposing-metal stent misdeployment in endoscopic ultrasound-guided drainages: A systematic review focusing on issues and rescue management

World Journal of Gastroenterology · 7 authors, 7 centres

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TL;DR

The review reports that endoscopic rescue strategies were successfully performed in the majority of misdeployment cases (80% to 96.8%).

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The overall technical success rates for the procedures were 93.7% for EUS-CDS, 96.1% for EUS-GBD, and 98.1% for EUS-PFC. The reported rates of LAMS misdeployment were 5.8% for EUS-CDS, 3.4% for EUS-GBD, and 2.0% for EUS-PFC. Endoscopic rescue treatment was feasible in 86.8%, 80%, and 96.8% of misdeployment cases for EUS-CDS, EUS-GBD, and EUS-PFC, respectively. The findings indicate that LAMS misdeployment is a recognized adverse event, but endoscopic rescue maneuvers are typically successful in completing the intended procedure.

STUDY TYPE

systematic_review

SPECIALTY

gastroenterology

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100% · A

ORIGINAL PAPER

PMC10292149

Lumen-apposing-metal stent misdeployment in endoscopic ultrasound-guided drainages: A systematic review focusing on issues and rescue management

World Journal of Gastroenterology

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ABSTRACT

BACKGROUND The introduction of lumen-apposing metal stents (LAMS) for endoscopic ultrasound (EUS)-guided drainages has marked a turning point in the field of interventional ultrasound and it is gathering worldwide diffusion in different clinical settings. Nevertheless, the procedure may conceal unexpected pitfalls. LAMS misdeployment is the most frequent cause of technical failure and it can be considered a procedure-related adverse event when it hampers the conclusion of the planned procedure or results in significant clinical consequences. Stent misdeployment can be managed successfully by endoscopic rescue maneuvers to allow the completion of the procedure. To date, no standardized indication is available to guide an appropriate rescue strategy depending on the type of procedure or of misdeployment. AIM To evaluate the incidence of LAMS misdeployment during EUS-guided choledochoduodenostomy (EUS-CDS), gallbladder drainage (EUS-GBD) and pancreatic fluid collections drainage (EUS-PFC) and to describe the endoscopic rescue strategies adopted under the circumstance. METHODS We conducted a systematic review of the literature on PubMed by searching for studies published up to October 2022. The search was carried out using the exploded medical subject heading terms “lumen apposing metal stent”, “LAMS”, “endoscopic ultrasound” and “choledochoduodenostomy” or “gallbladder” or “pancreatic fluid collections”. We included in the review on-label EUS-guided procedures namely EUS-CDS, EUS-GBD and EUS-PFC. Only those publications reporting EUS-guided LAMS positioning were considered. The studies reporting a technical success rate of 100% and other procedure-related adverse events were considered to calculate the overall rate of LAMS misdeployment, while studies not reporting the causes of technical failure were excluded. Case reports were considered only for the extraction of data regarding the issues of misdeployment and rescue techniques. The following data were collected from each study: Author, year of publication, study design, study population, clinical indication, technical success, reported number of misdeployment, stent type and size, flange misdeployed and type of rescue strategy. RESULTS The overall technical success rate of EUS-CDS, EUS-GBD and EUS-PFC was 93.7%, 96.1%, and 98.1% respectively. Significant rates of LAMS misdeployment have been reported for EUS-CDS, EUS-GBD and EUS-PFC drainage, respectively 5.8%, 3.4%, and 2.0%. Endoscopic rescue treatment was feasible in 86.8%, 80%, and 96.8% of cases. Non endoscopic rescue strategies were required only in 10.3%, 16% and 3.2% for EUS-CDS, EUS-GBD, and EUS-PFC. The endoscopic rescue techniques described were over-the-wire deployment of a new stent through the created fistula tract in 44.1%, 8% and 64.5% and stent-in-stent in 23.5%, 60%, and 12.9%, respectively for EUS-CDS, EUS-GBD, and EUS-PFC. Further therapeutic option were endoscopic rendezvous in 11.8% of EUS-CDS and repeated procedure of EUS-guided drainage in 16.1% of EUS-PFC. CONCLUSION LAMS misdeployment is a relatively common adverse event in EUS-guided drainages. There is no consensus on the best rescue approach in these cases and the choice is often made by the endoscopist relying upon the clinical scenario, anatomical characteristics, and local expertise. In this review, we investigated the misdeployment of LAMS for each of the on-label indications focusing on the rescue therapies used, with the aim of providing useful data for endoscopists and to improve patient outcomes.

CITATION EXPORT

Elia Armellini, Flavio Metelli, Andrea Anderloni et al.. Lumen-apposing-metal stent misdeployment in endoscopic ultrasound-guided drainages: A systematic review focusing on issues and rescue management. World Journal of Gastroenterology. (2023). https://doi.org/10.3748/wjg.v29.i21.3341

AUTHORS

7 · 7 CENTRES

Elia Armellini, Flavio Metelli, Andrea Anderloni, Anna Cominardi, Giovanni Aragona, Michele Marini, Fabio Pace

Department of Gastroenterology, ASST-Bergamoest, Seriate 24068, Bergamo, Italy. [email protected]
Department of Gastroenterology, ASST-Bergamoest, Seriate 24068, Bergamo, Italy
Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia 27100, Italy
Department of Gastroenterology, “Guglielmo da Saliceto” Hospital, Piacenza 29121, Italy
Department of Gastroenterology, “Guglielmo da Saliceto” Hospital, Piacenza 29121, Italy
Department of General Surgery, ASST-Bergamoest, Seriate 24068, Italy
Department of Gastroenterology, ASST-Bergamoest, Seriate 24068, Bergamo, Italy