Meir Mizrahi, MD1, Manoj Kumar, MD2, Benjamin Tharian, MD3, Salman Ali Khan, MD3, Sumant Inamdar, MD, MPH3, Neil Sharma, MD4, Dushant Uppal, MD5, Vanessa M. Shami, MD, FACG6, Mahmood Syed Kashif, MD7, Moamen Gabr, MD, MSc8, Douglas Pleskow, MD9, Tyler M. Berzin, MD, MS9, Douglas G. Adler, MD, FACG10
1University of South Alabama College of Medicine, Spanish Fort, AL; 2University of South Alabama, Mobile, AL; 3University of Arkansas for Medical Sciences, Little Rock, AR; 4Parkview Health, Fort Wayne, IN; 5Mobile, AL; 6University of Virginia Digestive Health Center, Charlottesville, VA; 7New York, NY; 8University of Kentucky College of Medicine, Lexington, KY; 9Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; 10University of Utah School of Medicine, Salt Lake City, UT
Introduction: Benign gastrointestinal (GI) strictures may occur anywhere in the GI tract but are more common in the upper GI tract or post-surgery. Large amount of these strictures will be resistant for conventional treatments such as balloon or mechanical dilation, incisional therapy, steroid injection, and conventional stents. Recently few small studies reported the use of fully covered lumen-apposing metal stents (LAMS) for benign short strictures. The aim of this study was to evaluate the safety and efficacy of LAMS for refractory GI strictures.
Methods: Consecutive patients who underwent LAMS placement for various benign strictures seven tertiary care centers were reviewed retrospectively. The primary outcomes were technical success and initial clinical success of LAMS placement. Secondary outcomes were stent migration, rate of re-intervention, and adverse events.
Results: A total of 51 patients underwent 54 LAMS placement procedures. Median length of the stricture was 8 mm. Previous treatment had failed in 61% of patients. Location of the stricture was found to be at the level of esophagogastric or gastro-Jejunal anastomosis, Pylorus, Ileo-colonic and other in 25%, 21%, 41%, 8% and 5% respectively. A 15 mm × 10 mm LAMS was placed in 32 patients (63%) and a 20 mm × 10 mm LAMS was placed in 19 patients (37%). Median procedure time was 29 min (20-64min). Technical success was achieved in 100% of procedures and initial clinical success was achieved in 98.2% of all procedures. Patient initial clinical success was 49/51 (96%). Mean (range) stent indwell time was 56 (3-126) days. No stent migration occurred during the study period. Adverse events were noted in 10/51 of 25 patients (19%) including pain requiring removal, 1 pain not requiring removal 7; new stricture formation, 1; bleeding, 1). Median follow-up was 162 days after stent placement.
Discussion: LAMS are safe and effective in the treatment of short benign GI strictures. The use of larger diameter LAMS such as the new 20mm length my improve outcome and reduce the need of re-intervention. Large prospective studies to the determine the optimal stent size and length of treatment are required.
Citation: Meir Mizrahi, MD; Manoj Kumar, MD; Benjamin Tharian, MD; Salman Ali Khan, MD; Sumant Inamdar, MD, MPH; Neil Sharma, MD; Dushant Uppal, MD; Vanessa M. Shami, MD, FACG; Mahmood Syed Kashif, MD; Moamen Gabr, MD, MSc; Douglas Pleskow, MD; Tyler M. Berzin, MD, MS; Douglas G. Adler, MD, FACG. P1473 - LUMINAL-APPOSING STENTS FOR BENIGN INTRALUMINAL STRICTURES: ARE WE THERE? U.S. MULTICENTER STUDY. Program No. P1473. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.