Lumen‐apposing metal stents provide early and late clinical benefits for the management of benign gastrointestinal strictures: Is there a role for definitive therapy?
Ethan Pollack,
Dalton Norwood,
Hector Caceres,
Babusai Rapaka,
Isaac E. Perry,
Usman Barlass,
Rachel Mitchell,
Jessica McCreight,
Shajan Peter,
Ramzi Mulki,
Ali Ahmed,
Kondal Kyanam,
Sergio A. Sánchez‐Luna
Affiliations
Ethan Pollack
Department of Internal MedicineThe University of Alabama at Birmingham Heersink School of MedicineBirmingham Alabama USA
Dalton Norwood
Department of Internal MedicineUAB Minority Health and Health Equity Research CenterThe University of Alabama at Birmingham Heersink School of MedicineBirmingham Alabama USA
Hector Caceres
Department of Internal MedicineUAB Minority Health and Health Equity Research CenterThe University of Alabama at Birmingham Heersink School of MedicineBirmingham Alabama USA
Babusai Rapaka
Department of Internal MedicineDivision of Gastroenterology & HepatologyBasil I. Hirschowitz Endoscopic Center of ExcellenceThe University of Alabama at Birmingham Heersink School of MedicineBirmingham Alabama USA
Isaac E. Perry
Department of Internal MedicineDivision of Gastroenterology & HepatologyBasil I. Hirschowitz Endoscopic Center of ExcellenceThe University of Alabama at Birmingham Heersink School of MedicineBirmingham Alabama USA
Usman Barlass
Department of Internal MedicineDivision of Gastroenterology & HepatologyBasil I. Hirschowitz Endoscopic Center of ExcellenceThe University of Alabama at Birmingham Heersink School of MedicineBirmingham Alabama USA
Rachel Mitchell
Department of Internal MedicineDivision of Gastroenterology & HepatologyBasil I. Hirschowitz Endoscopic Center of ExcellenceThe University of Alabama at Birmingham Heersink School of MedicineBirmingham Alabama USA
Jessica McCreight
Department of Internal MedicineDivision of Gastroenterology & HepatologyBasil I. Hirschowitz Endoscopic Center of ExcellenceThe University of Alabama at Birmingham Heersink School of MedicineBirmingham Alabama USA
Shajan Peter
Department of Internal MedicineDivision of Gastroenterology & HepatologyBasil I. Hirschowitz Endoscopic Center of ExcellenceThe University of Alabama at Birmingham Heersink School of MedicineBirmingham Alabama USA
Ramzi Mulki
Department of Internal MedicineDivision of Gastroenterology & HepatologyBasil I. Hirschowitz Endoscopic Center of ExcellenceThe University of Alabama at Birmingham Heersink School of MedicineBirmingham Alabama USA
Ali Ahmed
Department of Internal MedicineDivision of Gastroenterology & HepatologyBasil I. Hirschowitz Endoscopic Center of ExcellenceThe University of Alabama at Birmingham Heersink School of MedicineBirmingham Alabama USA
Kondal Kyanam
Department of Internal MedicineDivision of Gastroenterology & HepatologyBasil I. Hirschowitz Endoscopic Center of ExcellenceThe University of Alabama at Birmingham Heersink School of MedicineBirmingham Alabama USA
Sergio A. Sánchez‐Luna
Department of Internal MedicineDivision of Gastroenterology & HepatologyBasil I. Hirschowitz Endoscopic Center of ExcellenceThe University of Alabama at Birmingham Heersink School of MedicineBirmingham Alabama USA
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.
