Benign Gastrointestinal Strictures Research Articles

Lumen-apposing metal stents provide early and late clinical benefits for the management of benign gastrointestinal strictures: Is there a role for definitive therapy?

This study aimed to characterize the clinical outcomes, safety, and efficacy of lumen-apposing metal stents (LAMS) in treating benign gastrointestinal strictures. 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. 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 eventsoccurred 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. 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.

S1227 Early and Late Clinical Outcomes, Safety, and Efficacy of Non-Cautery-Enhanced Lumen-Apposing Metal Stents for the Management of Benign Gastrointestinal Strictures: A Single-Center Experience

S1227 Early and Late Clinical Outcomes, Safety, and Efficacy of Non-Cautery-Enhanced Lumen-Apposing Metal Stents for the Management of Benign Gastrointestinal Strictures: A Single-Center Experience

Efficacy of lumen-apposing metal stents for the management of benign gastrointestinal stricture: a systematic review and meta-analysis.

Lumen-apposing metal stents (LAMS) are an evolving option for the management of benign gastrointestinal (GI) strictures. Multiple studies have reported on the efficacy and safety of LAMS for benign GI strictures, but were limited by their small sample size. Hence, we conducted this meta-analysis to assess the critical role of LAMS for the management of benign GI strictures. A literature search of various databases from inception until October 2022 was conducted for studies evaluating the outcome of LAMS in patients with benign GI strictures. The outcomes assessed included technical and clinical success, adverse events including stent migration, and reintervention. Pooled event rates across studies were expressed with summative statistics. A total of 18 studies (527 patients) were included in the present analysis. The pooled event rates for technical, short-term and long-term clinical success were 99.9% (95% confidence interval [CI] 99.1-100.0), 93.9% (95%CI 90.7-100.0), and 72.8% (95%CI 55.7-90.0), respectively. The pooled incidence of adverse events and stent migration with LAMS for benign GI strictures was 13.5% (95%CI 8.6-18.5) and 10.6% (95%CI 6.0-15.2), respectively. The pooled event rate for reintervention with LAMS for GI strictures was 23.0% (95%CI 15.7-30.3). In a subgroup analysis focusing only on anastomotic strictures there was no significant difference in the pooled event rates for various outcomes. LAMS have a high technical and short-term clinical success rate, with an acceptable safety profile for the management of benign GI strictures. Further studies are needed to determine the appropriate duration of stent therapy and long-term outcomes.

Lumen-apposing metal stents for the treatment of benign gastrointestinal tract strictures: a single-center experience and proposed treatment algorithm.

Lumen-apposing metal stents (LAMS) are an alternative therapeutic option for benign gastrointestinal (GI) tract strictures. Our study aimed to evaluate the safety and efficacy of LAMS for the management of benign GI strictures. Consecutive patients who underwent a LAMS placement for benign luminal GI strictures at a tertiary care center between January 2014 and July 2021 were reviewed. Primary outcomes included technical success, early clinical success, and adverse events (AEs). Other outcomes included rates of stent migration and re-intervention after LAMS removal. One hundred and nine patients who underwent 128 LAMS placements (67.9% female, mean age of 54.3 ± 14.2years) were included, and 70.6% of the patients had failed prior endoscopic treatments. The majority of strictures (83.5%) were anastomotic, and the most common stricture site was the gastrojejunal anastomosis (65.9%). Technical success was achieved in 100% of procedures, while early clinical success was achieved in 98.4%. The overall stent-related AE rate was 25%. The migration rate was 27.3% (35/128). Of these, five stents were successfully repositioned endoscopically. The median stent dwell time was 119days [interquartile range (IQR) 68-189days], and the median follow-up duration was 668.5days [IQR: 285.5-1441.5days]. The re-intervention rate after LAMS removal was 58.3%. LAMS is an effective therapeutic option for benign GI strictures, offering high technical and early clinical success. However, the re-intervention rate after LAMS removal was high. In select cases, using LAMS placement as destination therapy with close surveillance is a reasonable option.

Novel modified side-by-side balloon dilatation method for esophagogastric junction strictures: Single-/double-barrel techniques.

Endoscopic balloon dilatation is an established treatment for benign gastrointestinal strictures. In order to dilatate safely, it is necessary to dilatate gradually and preferably under direct endoscopic visualization. However, it is currently difficult to achieve dilatation widths of 20-30 mm with commercial products and of over 30-mm with endoscopic visualization. Therefore, a safe and innovative application technique is needed for patients who need these 20-mm or greater dilatation widths. We have developed two methods that enable more than 20-mm dilatation under direct visualization. (i) Single-barrel method: an endoscopic balloon dilatation catheter was fixed with grasping forceps at the tip of the endoscope and carried into the stomach. The balloon catheter was released from the endoscope to create a retroflexed view. The endoscope and balloon were positioned adjacent to each other at the gastric cardia. The balloon was inflated gradually and the esophagogastric junction was dilatated under direct visualization. (ii) Double-barrel method: the same procedure was repeated with two balloons. Theoretically, we achieved a dilatation of >30-mm in diameter. These modified methods may be helpful for esophagogastric junction strictures, such as esophageal achalasia (serving as an initial endoscopic balloon dilatation prior to using a 30-mm achalasia balloon), or for functional strictures after Nissen fundoplication. In conclusion, our simple, modified method enables safe and gradual dilatation under direct endoscopic visualization. Additionally, combination of the sizes of one or two balloons can achieve various widths of dilatation.

ID: 3522814 LUMEN-APPOSING METAL STENTS FOR BENIGN GASTROINTESTINAL TRACT STRICTURES: A SINGLE-CENTER EXPERIENCE

Lumen-apposing metal stent (LAMS) is an alternative therapeutic option for benign gastrointestinal (GI) tract strictures. Our study aimed to evaluate the safety and efficacy of LAMS for the management of benign GI strictures.

Feasibility and safety of self-expandable metal stent in nonmalignant disease of the lower gastrointestinal tract.

In recent years, self-expandable metal stents (SEMSs) have been employed to treat benign gastrointestinal strictures secondary to several conditions: Acute diverticulitis, radiation colitis, inflammatory bowel disease (IBD), and postanastomotic leakages and stenosis. Other applications include endometriosis and fistulas of the lower gastrointestinal tract. Although it may be technically feasible to proceed to stenting in the aforementioned benign diseases of the lower gastrointestinal tract, the outcome has been reported to be poor. In fact, in some settings (such as complicated diverticulitis and postsurgical anastomotic strictures), stenting seems to have a limited evidence-based benefit as a bridge to surgery, while in other settings (such as endometriosis, IBD, radiation colitis, etc.), even society guidelines are not able to guide the endoscopist through decisional algorithms for SEMS placement. The aim of this narrative paper is to review the scientific evidence regarding the use of SEMSs in nonmalignant diseases of the lower gastrointestinal tract, both in adult and pediatric settings.

Luminal-apposing stents for benign intraluminal strictures: a large United States multicenter study of clinical outcomes.

BackgroundThe use of fully covered lumen-apposing metal stents (LAMS) for benign short gastrointestinal (GI) strictures has been reported. This study aimed to evaluate the safety and efficacy of LAMS for refractory GI strictures.MethodsA retrospective analysis was performed of patients who underwent LAMS placement for benign GI strictures in 8 United States centers. The primary outcomes were technical success and initial clinical response. Secondary outcomes were reintervention rate and adverse events.ResultsA total of 51 patients underwent 61 LAMS placement procedures; 33 (64.7%) had failed previous treatments. The most common stricture location was the pylorus (n=17 patients). Various sizes of stents were used, with 15-mm LAMS placed in 45 procedures, 20-mm LAMS in 14 procedures, and 10-mm LAMS in 2 procedures. The overall technical success, short-term clinical response and reintervention rate after stent removal were 100%, 91.8% and 31.1%, respectively. Adverse events were reported in 17 (27.9%) procedures, with stent migration being the most common (13.1%). In subgroup analysis, both 15 mm and 20 mm stents had comparable short-term clinical response and adverse event rates. However, stent migration (15.6%) was the most common adverse event with 15-mm LAMS while pain (14.3%) was the most common with 20-mm LAMS. The reintervention rate was 80% at 200-day follow up after stent removal.ConclusionsUsing LAMS for treatment of short benign GI strictures is safe and effective. Larger LAMS, such as the new 20 mm in diameter, may have a lower stent migration rate compared to smaller diameter LAMS.

901 Luminal-Apposing Stents for Benign Intraluminal Strictures: Are We There? U.S. Multicenter Study

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: Patients and 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: 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. CONCLUSION: 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.

1691 Lumen-Apposing Metal Stent Assisted ERCP in Stenosis Associated With Silastic Ring in Vertical Banded Gastroplasty

INTRODUCTION: Lumen-apposing metal stent is being increasingly used for transmural drainage of pancreatic fluid collections (PFC). More recently, certain off label uses for LAMS are being explored1 such as benign gastrointestinal strictures, gastrojejunostomy, and gastro-gastrostomy. Here we present a case of LAMS-assisted ERCP for stenosis in a patient with silastic ring vertical banded gastroplasty. CASE DESCRIPTION/METHODS: An 82yo F with h/o breast cancer and diabetes mellitus type 2 was referred for EUS guided biopsy of a pancreatic head mass identified on CT scan of the abdomen, performed during evaluation of abdominal pain. The patient had normal liver enzymes. An EUS was planned for biopsy of pancreatic mass. At the time of the procedure, a benign-appearing, severe, intrinsic stenosis was found in the gastric body. An echoendoscope could not be advanced across this mid-gastric body stenosis, despite balloon dilation to 15mm. No significant mucosal disruption was seen. It was suspected that the stenosis was due to adhesions related to the silastic ring. A 15 mm × 10 mm LAMS was deployed across the stenosis to facilitate EUS. LAMS was dilated to 15 mm with balloon dilation under fluoroscopic guidance. An EUS scope could not be advanced despite dilation of LAMS to 15 mm. A duodenoscope could not be advanced, either. The plan was made to repeat EUS in 48 hrs. However, the patient developed obstructive jaundice, and an ERCP was planned instead. LAMS was removed prior to ERCP due to mild resistance to passage of the scope. This was done to prevent stent dislodgement. Following LAMS removal, a duodenoscope could be advanced across the stenosis with minimal resistance. An ERCP was successfully performed, which revealed a tight distal biliary stricture. Brush cytology was performed using a large caliber brush. A biliary stent was placed. Her immediate post-ERCP course was uncomplicated. She had normalization of her liver function tests. Final cytology results revealed pancreatic adenocarcinoma. DISCUSSION: ERCP is a challenging procedure in patients with previous bariatric surgery due to anatomical variations. LAMS have a high success rate for the drainage of PFCs. Many new off-label indications are being identified for LAMS, and the early results are promising1. We present an off-label use for LAMS placement, for facilitating ERCP in patients with stenosis related to silastic ring vertical banded gastroplasty. Watch the video: http://bit.ly/2LuZ2Mo.

Lumen-apposing Metal Stents, Fully Covered Self-expanding Metal Stents, and Biodegradable Stents in the Management of Benign of GI Strictures: A Systematic Review and Meta-Analysis.

Refractory benign gastrointestinal (GI) strictures are difficult to treat and placement of a stent is a commonly sought resort. Stents used for this purpose are fully covered self-expanding metal stent (FCSEMS), a biodegradable stent (BDS) and recently, a lumen-apposing metal stent (LAMS). There is no data comparing these stents to this end. We conducted a comprehensive search of multiple electronic databases and conference proceedings (from inception through October 2018) to identify studies that reported on the performance of FCSEMS, BDS, and LAMS in the treatment of refractory benign GI strictures. Our goals were to evaluate the pooled rate of technical success, clinical success, and adverse events with these stents and compare the outcomes between them. A total of 31 studies were analyzed. In total, 14 (342 patients), 11 (226 patients), and 8 studies (192 patients) reported the use of FCSEMS, BDS, and LAMS, respectively. The pooled rate of technical success was 96.5% [95% confidence interval (CI): 93.5-98.1], 91.9% (95% CI: 85.6-95.6), and 97.6% (95% CI: 94.0-99.0) with FCSEMS, BDS, and LAMS respectively. No statistical significance to the difference was noted. The pooled rate of clinical success was 48.4% (95% CI: 37.1-59.8), 34.9% (95% CI: 23.6-48.1), and 78.8% (95% CI: 65.8-87.8) with FCSEMS, BDS, and LAMS, respectively. Statistical significance was noted in LAMS versus FCSEMS (P=0.001) and LAMS versus BDS (P=0.001). LAMS demonstrated statistically better outcomes in regards to stent migration and postprocedure pain when compared with FCSEMS and BDS. Our study demonstrates that LAMS gives better clinical outcomes in the treatment of refractory benign GI strictures when compared with FCSEMS and BDS. Variability in the site, as well as the length of stricture, indirect comparison, and heterogeneity, were the limitations of our study.

Use of Axios Stent to Relieve Short Malignancy Stricture

Pancreatic cancer is a leading cause of malignant strictures in the upper gastrointestinal tract, caused by a head of the pancreas mass abutting the duodenum. Often, these tumors are not responsive to chemotherapy or radiation leading to supportive care with gastric decompression via endoscopic stenting or operative bypass to relieve obstruction. The lumen-apposing self-expandable metal stent (LASEMS), which is often used to drain pancreatic fluid collections, may serve as a safe and effective option to stent short strictures from pancreatic malignancy. Axios stents, with their short and flared ends, create an anastomotic conduit between two lumens, allowing short strictures to be bypassed. These stents have lumen-apposing and dual anchoring capabilities. The unique design allows for robust pseudocyst drainage and for the passage of an endoscope with a lower risk of stent migration due to anchoring. The ease of deployment and retrieval serves as an advantage over uncovered and partially-covered stents. We present a patient with history of duodenal cancer and recurrent bleeds in which an Axios stent was used to relieve a malignant duodenal stricture. A 57 year old male presented with 4-5 months of decreased oral intake, weight loss, and coffee ground emesis. Endoscopy revealed a near complete, circumferential stricture between the first and second portion of the duodenum, consistent with malignancy (Figure 1). An Axios LASEMS was advanced over a guidewire, across the duodenal stricture (Figure 2). Ampullary exclusion was confirmed endoscopically and patency was confirmed fluoroscopically. An argon plasma coagulation catheter was used to fenestrate the proximal plastic covering of the stent to allow improved mucosal adhesion and was further secured using an over the scope clip (Figure 3).1426_A.tif Figure 1: Near complete, circumferential stricture between the first and second portion of the duodenum1426_B.tif Figure 2: Advancement of a guidewire over the stricture1426_C.tif Figure 3: Axios stent with an over scope clip; argon plasma coagulation catheter was used to fenestrate the proximal plastic covering of the stentSeveral studies have described the use of LASEMS for the management of benign gastrointestinal strictures. The majority of patients who underwent stenting for benign strictures failed prior therapy. Stricture recurrence was seen in those with prior endoscopic balloon dilation or stricturoplasty, and prior placement of covered SEMS had led to migration. In our literature review we were unable to find a case in which Axios stents were used to relieve malignant duodenal strictures. We demonstrated the feasibility and potential safety and efficacy of LASEMS for management of various types of gastrointestinal strictures.

Efficacy and safety of lumen-apposing metal stent for benign gastrointestinal stricture.

Management of benign gastrointestinal (GI) strictures refractory to primary (balloon and savary dilation) and secondary (steroid injection, fully covered self-expanding metal stent, incision therapy) treatment modalities remains a challenge. Lumen-apposing metal stents (LAMSs), originally designed for the management of pancreatic fluid collections, are an attractive option for GI stricture because of their anti-migratory property, attributable to their saddle-shaped design. In this article, we reviewed 70 patients from 12 original studies who received LAMS for refractory (68/70) or treatment-naïve (2/70) benign GI stricture. The technical and clinical success rates were 98.6% (69/70) and 79.7% (55/69), respectively. Endoscopic placement, with or without fluoroscopic guidance, was generally successful, with only a minority requiring endoscopic ultrasound (EUS) guidance where the lumen was completely obscured. The majority of the strictures were short (≤1 cm), but comparable technical and clinical success was noted in isolated cases with long strictures, where 2 overlapping LAMSs were placed. For the overall population, a failure rate of 21.5% (14/69) was noted and was attributed to either lack of follow up, or to persistent or de novo symptoms requiring stent removal/exchange or surgical referral. One perforation (1.4%), five stent migration events (7.1%), two bleeding events (2.9%) and two de novo strictures proximal to the LAMS (2.9%) were reported for the entire study cohort. No mortality was attributable to LAMS placement. Although experience is still evolving, LAMS placement guided by esophagogastroduodenoscopy or EUS is a technically feasible and safe procedure with good clinical outcomes for benign refractory GI strictures.

Lumen-apposing metal stents for benign gastrointestinal tract strictures: An international multicenter experience.

AIMTo investigate technical feasibility, outcomes and adverse events of the lumen-apposing metal stent (LAMS) for benign gastrointestinal (GI) tract strictures.METHODSBetween July 2015 and January 2017, patients undergoing treatment by LAMS for benign GI strictures at three tertiary referral centers were included in this study. Primary outcomes included technical success, short-term clinical success, long-term clinical success, and adverse events. Short-term clinical success was defined as symptom resolution at 30 d after stent placement. Long-term clinical success was defined by symptom resolution at 60 d in patients who continued to have indwelling stent, or continued symptom resolution at 30 d after elective stent removal.RESULTSA total of 21 patients (mean age 62.6 years, 47.6% males) underwent placement of LAMS for benign GI strictures. A 15 mm × 10 mm LAMS was placed in 16 patients, a 10 mm × 10 mm LAMS was placed in 2 patients, and a 16 mm × 30 mm LAMS was placed in 3 patients. Technical success was obtained in all cases. Short-term clinical success was achieved in 19 out of 21 cases (90.5%), and long-term clinical success was achieved in 12 out of 18 (66.7%). Mean (range) stent indwell time was 107.2 (28-370) d. After a mean (range) dwell time of 104.3 (28-306) d, 9 LAMSs were removed due to the following complications: ulceration at stent site (n = 1), angulation (n = 2), migration (n = 4) and stricture overgrowth (n = 2). Migration occurred in 4 cases (19.0%), and it was associated with stricture resolution in one case. Median (range) follow-up period was 119 (31-422) d.CONCLUSIONUtilization of LAMS for benign strictures has shown to be technically feasible and safe, but adverse events highlight the need for further study of its indications.

Lumen-apposing covered self-expandable metal stents for short benign gastrointestinal strictures: a multicenter study.

Background and study aim Use of the fully covered self-expandable metal stent (SEMS) for benign luminal gastrointestinal (GI) stricture (BLGS) has been limited by the migration rate. The role of the lumen-apposing metal stent (LAMS) for BLGS is not well defined. We assessed the safety, feasibility, and efficacy of LAMS for the treatment of BLGS. Patients and methods This was an observational, open-label, retrospective, single-arm, multicenter consecutive case series of patients undergoing LAMS placement for BLGS. Technical success was defined as successful placement of the LAMS. Short- and long-term clinical success rates were defined as symptom improvement/resolution with indwelling stent and after stent removal, respectively. All adverse events and additional interventions were recorded. Results A total of 30 patients (mean age 51.6 years; 63.3 % women) underwent LAMS placement for GI strictures (83.9 % anastomotic). Median stricture diameter and length were 4.5 mm (range 2 - 10 mm) and 8 mm (range 5 - 10 mm), respectively. Technical success was achieved in 29 patients (96.7 %), with an adverse event rate of 13.3 %. The stent migration rate was 8.0 % (2/25) on follow-up endoscopy. Short-term clinical success was achieved in 90.0 % (27/30) at a median of 60 days (interquartile range [IQR] 40 - 90 days). Most patients (19/23; 82.6 %) experienced sustained symptom improvement/resolution without the need for additional interventions at a median follow-up of 100 days (IQR 60 - 139 days) after LAMS removal. Conclusion This multicenter study demonstrated that LAMS placement represents a safe, feasible, and effective therapeutic option for patients with BLGS and is associated with a low stent migration rate. Our initial findings suggest that future prospective comparative studies are needed on the use of LAMS, endoscopic dilation, and conventional SEMS. .

EUS-guided recanalization of complete gastrointestinal strictures.

Complete gastrointestinal strictures are a technically demanding problem. In this setting, an anterograde technique is associated with a high risk of complications and a combined anterograde-retrograde technique requires a prior ostomy. Our aim was to assess the outcome of a first case series for the management of complete gastrointestinal strictures using endoscopic ultrasound (EUS)-guided puncture as a novel endoscopic approach. This retrospective case-series describes four cases that were referred for treatment of complete benign gastrointestinal strictures, three upper and one lower. Recanalization was attempted with EUS-guided puncture using a 22G or 19G needle and contrast filling was visualized by fluoroscopy. Afterwards, a cystotome and/or a dilator balloon were used under endoscopic and fluoroscopic guidance. A fully covered metal stent was placed in two cases, keeping the strictures open in order to prevent another stricture. Feasibility, adverse events, efficacy and the number of dilations required after recanalization were evaluated. Technical and clinical success was achieved in three of the four cases (75%). A first dilation was performed using a dilator balloon in all successful cases and fully covered metal stents were used in two cases. These patients underwent a consecutive number of balloon dilatations (range 1-4) and all three were able to eat a soft diet. No adverse events were related to the EUS-guided approach. In the failed case with a long stricture (> 3 cm), an endoscopic rendezvous technique was attempted which caused a pneumothorax requiring a chest tube placement. EUS-guided recanalization, as a first approach in the treatment of complete digestive stricture, is a feasible and promising procedure that can help to avoid major surgery.

Lumen-apposing covered self-expanding metal stent for management of benign gastrointestinal strictures.

Background and aims: Self-expanding metal stents (SEMS) are safe and effective for endoscopic management of malignant gastrointestinal strictures, but there is limited experience with their use in refractory benign strictures. We assessed the use of a new lumen-apposing covered SEMS for the management of benign gastrointestinal strictures. Methods: A single-center case-series of five patients who underwent lumen-apposing covered SEMS placement for benign gastrointestinal strictures. Results: Three patients had a benign gastroduodenal stricture, one had a distal colonic anastomotic stricture, and one with complete gastrojejunal anastomotic stenosis underwent endoscopic creation of a new gastrojejunostomy. None of the patients developed any immediate or delayed stent-related adverse events. In two patients, the stents were left in place indefinitely. Stents were removed from the other three patients with successful resolution of their symptoms during follow-up. Conclusion: Lumen-apposing, fully covered SEMS appear to be safe and effective for management of selected benign gastrointestinal strictures.

Techniques and principles of endoscopic treatment of benign gastrointestinal strictures.

The fundamental goal of treating any stenosis is luminal enlargement to ameliorate the underlying obstructive symptoms. Symptoms depend on the etiology and the site of the stricture and may include dysphagia, nausea and vomiting, abdominal pain, obstipation, or frank bowel obstruction. This article compares the various current technologies available for the treatment of gastrointestinal stenoses with regard to ease and site of application, patient tolerance, safety and efficacy data, and cost-benefit ratio. Recent studies indicate that gastrointestinal dilation and stenting have evolved to a point at which in many if not most situations they can be the first line therapy and potentially the final therapy needed to treat the underlying condition. Following techniques and principles in the management of gastrointestinal strictures would allow for the well tolerated and effective treatment of most patients with the tools currently available today.

Risk of biodegradable stent-induced hypergranulation causing re-stenosis of a gastric conduit after esophageal resection

Biodegradable stents are increasingly used to treat benign gastrointestinal strictures [1] [2]. Here, we report on two patients who developed persistent vomiting after thoraco-abdominal esophageal resection for cancer and perforation. Assessments by endoscopy and imaging studies demonstrated a severe stricture of the distal gastric conduit in both patients ([Fig. 1]), which were thought likely to be due to low-flow ischemia of the gastric conduit.

Initial Experience With Biodegradable Stents in the Treatment of Refractary Benign Gastrointestinal Strictures

Initial Experience With Biodegradable Stents in the Treatment of Refractary Benign Gastrointestinal Strictures