The Use of Fully Covered Lumen-Apposing Self-expandable Metallic Stents for Treatment of Benign Strictures of the Upper Gastrointestinal Tract: A Retrospective Case-Controlled Study

Abstract

Introduction: The AXIOSTM stent (Boston Scientific, Massachusetts, USA) is a fully covered lumen apposing self-expandable metallic stent (fcLASEMS). The stent was developed for transenteric drainage of pancreatic pseudocysts. The dumbbell shaped stent is available in lengths of 10mm or 15mm and can be deployed with or without electrocautery. The aim of this study was to examine the efficacy of fcLASEMSs in the treatment of benign stricture disease of the foregut. Methods: A single center retrospective database of patients who underwent endoscopic treatment of benign strictures was analyzed for this study. A total of 998 endoscopic procedures were identified on these patients between January 2014 and May 2017. Of those, 15 patients underwent endoscopic fcLASEMS placement. The average number of endoscopic dilations prior to stent placement was 2.46. A control group of non-stented patients that underwent 3 or more endoscopic dilations with Savary dilators or controlled radial expansion balloon dilators (n=36) was created. The Mann-Whitney test and twotailed-t test were used to compare the total number of endoscopic interventions between the control and fcLASEMS groups. The patient and stricture characteristics were determined based on review of follow up documentation. Complications were defined as events leading to hospitalization or requiring early removal of the stent. Results: The mean number of endoscopic dilations in the control group was 5.02 (SD 3.873). Whereas the mean number of endoscopic interventions in the fcLASEMS group was 3.385 (SD 0.870). The difference between the 2 groups was statistically significant (t-test (P < 0.0001) and Mann-Whitney test (P=0.017)). The mean duration of fcLASEMS placement was approximately 105 days. fcLASEMS placement provided symptomatic relief in 73% of patients. Stent migration and post procedure complications occurred in 6.6% and 20% of patients respectively. The mean length of follow up for the fcLASEMS and control group was 282 and 225 days respectively. Conclusion: Clinicians should consider the use of fcLASEMSs in patients with recurrently symptomatic benign foregut strictures. Early intervention with an fcLASEMS appears to be a viable option for durable symptomatic relief in patients with persistent benign foregut strictures. The overall number of endoscopic interventions was lower with the use of fcLASEMSs than with standalone serial dilations in patients who required 3 or more endoscopic dilations which may be more cost effective.Table: Table. Results of Fully Covered Lumen-Apposing Self-Expandable Metallic Stents for the Treatment of Benign Strictures of the Upper Gastrointestinal Tract