S1137 Analysis of Off-Label Usage of Lumen Apposing Metal Stents in the GI Tract: A Single Center Experience

Abstract

Introduction: Lumen apposing metal stents (LAMS) have revolutionized our approach to pancreatic fluid collections (PFCs). In addition to tremendous success in safely and effectively managing PFCs, LAMS have been utilized in other interventions including EUS-guided gallbladder drainage (EUS-GBD), EUS-directed transgastric ERCP (EDGE), EUS-guided transgastric intervention (EDGI), EUS-guided gastrojejunostomy (EUS-GJ), EUS-guided choledochoduodenostomy (EUS-CD), EUS-guided drainage of post-operative collection (EUS-PO) and stricture dilation (SD). There is limited research on the use of LAMS for these off-label indications. We present our experience using LAMS in the management of conditions other than pancreatic fluid collections. Methods: All patients who underwent LAMS placement between March 2015-October 2021 were added to a prospectively maintained database. Collected data including patients’ demographics, procedure details, clinical outcomes, and adverse events was retrospectively reviewed. All patients who underwent LAMS placement for PFCs were excluded from the analysis. Descriptive statistics were used to summarize our findings. Results: A total of 191 patients underwent LAMS placement during the study period. Of these, 65 patients had indications outside of drainage of PFCs. This included EUS-GBD (25), EDGE (6), EDGI (2), EUS-GJ (11), EUS-CD (4), SD (6), EUS-PO (9), and miscellaneous (2) (Table). The average age was 65.7 years (SD 8.6) and 24 were female (36.9%). Technical success was achieved in 63 patients (96.9%). The diameter of LAMS used included 8mm (n=2), 10mm (n=23), 15mm (n=17), and 20mm (n=21). The average procedure time was 39.4 minutes (SD 5.3) and the average duration of LAMS placement was 36.2 days (SD 8.5). Clinical success was achieved in 57/63 patients (90.5%); however, this was much lower for patients who underwent LAMS placement for stricture dilatation (50%). LAMS was left indefinitely in 24 patients (38.1%). Adverse events occurred in six patients (9.2%). Conclusion: LAMS provide an effective and safe modality for securing endoscopic access and allowing interventions outside of PFCs. However, the efficacy of LAMS for managing gastrointestinal strictures remains in question. Table 1. - Summary of usage of LAMS in the GI Tract EUS-GBD (n=25) EDGE (n=6) EDGI (n=2) EUS-GJ (n=11) EUS-CD (n=4) SD (n=6) EUS-PO (n=9) Miscellaneous (n=2) Age, mean, SD 73.64, 12.0 65.8, 8.1 61.0, 9.9 64.5, 13.0 65.3, 17.0 55.2, 11.75 52.0, 18.5 71, 66 Female gender, n, % 6, 24% 5, 83.3% 1, 50% 2, 18% 3, 75% 5, 83% 2, 22.2% 0, 0% Indications, n % Calculous Cholecystitis, 15, 60% Choledocholithiasis (n=4, 66.7%) Pancreatic mass (n=1, 50%) Malignant GOO, 11, 100% Distal malignant biliary obstruction, 4 100% Anastomotic stricture, 4 (67%) Post-operative fluid collections, 9, 100% Liver abscess, 2, 100% Malignant cholecystitis, 5, 20% Acalculous cholecystitis, 2, 8% Benign papillary stenosis (n=2, 33.3%) Pancreatic cyst (n=1, 50%) Pyloric stricture, 2 (33%) Malignant biliary obstruction, 3, 12% Technical success, n, % 23, 92.0% 6, 100% 2, 100% 11, 100% 4, 100% 6, 100% 9, 100% 2, 100% Clinical success, n, % 21/23, 91.3% 6, 100% 2, 100% 11, 100% 4, 100% 3, 50% 8, 88.9% 2, 100% Procedure duration (min), mean, SD 39.5, 21.7 38.7, 20.0 52, 17.0 66, 31.6 24.5, 13.3 18.7, 3.8 27.3, 9.1 28, 7.1 Duration of LAMS placement, mean, SD 47.9, 27.0 30.3, 11.6 28, 0 N/A N/A 68.5, 26.7 47.3, 28.2 39, 5 Adverse events, n, % 4, 18% 0, 0% 1, 50% 0, 0% 0, 0% 1, 16.7% 0, 0% 0, 0% Length of follow-up (days), mean, SD 47.3, 27.9 208.2, 179.1 240, 144.2 46.50, (28.3, 82.8) 143, 119.9 292, 171.2 565.8, 465.1 43.5, 53.0