Project description:Background and aimsPlacing a lumen-apposing metal stent (LAMS) through ascites carries serious risks, including death from leakage around the LAMS and failure to create a mature fistula between the 2 lumens. However, sometimes no options exist or are equally dangerous. We present 5 patients who underwent LAMS placement despite ascites in 2 different locations.MethodsThis is a retrospective review of 5 patients who underwent LAMS placement despite ascites in 2 different locations from 2016 to 2018.ResultsThree patients with cholecystitis and 2 patients with afferent limb syndrome and severe ascites were treated with a combination of preprocedural and intraprocedural paracentesis. Serum ascites albumin gradient was measured. Weight was recorded daily. Patients were encouraged to sleep at an incline, and periodic paracentesis (every 3-7 days) was performed when ascites reaccumulated over 4 weeks. Median volume of ascites aspirated was 2 L preprocedurally and 300 mL intraprocedurally. Only 1 patient had ascites with a high serum ascites albumin gradient and was treated with diuretics. Technical and clinical success was achieved in all 5 patients without any adverse events over a median follow-up of 28 weeks.ConclusionsIn situations in which no better options remain, LAMS placement appears to be safe after adequate and aggressive treatment of the underlying ascites pre-, intra-, and postprocedurally. Larger studies are needed to establish the safety of this approach.

| S-EPMC7652702 | biostudies-literature

EUS-guided stent removal in buried lumen-apposing metal stent syndrome: a case series.

Project description:Background and Aims:Lumen-apposing metal stents (LAMSs) play an increasing role in transgastric and transduodenal drainage of pancreatic fluid collections and allow novel EUS-guided interventions. Alongside the main adverse events of bleeding and occlusion, LAMSs can be overgrown by mucosa, which leads to the inability to visualize the stent in endoscopy. Methods:We describe a series of 4 cases of buried LAMSs that were removed under EUS guidance for identification of the stent followed by removal with rat-tooth forceps. Results:The median in situ time of the LAMSs in the reported 4 cases was 53 days. All stents could no longer be visualized endoscopically when drainage of necrosis was complete. All 4 buried LAMSs could be identified by EUS and were removed successfully with forceps. In 1 case, balloon dilation of the stent tract was performed before stent removal. No adverse events were observed after the procedure. Conclusions:Buried stent syndrome is a rare adverse event of LAMSs. Here we describe a safe and effective approach for stent identification and removal without prior mucosal dissection.

| S-EPMC6945230 | biostudies-literature

EUS-guided drainage of a 20-cm biloma by use of a lumen-apposing metal stent.

Project description: Not available

| S-EPMC6945231 | biostudies-literature

EUS-guided choledochoduodenostomy with a lumen-apposing metal stent for biliary drainage.

Project description: Not available

| S-EPMC5992443 | biostudies-literature

Transpyloric lumen-apposing metal stent for management of persistent post-esophagogastrectomy leak.

Project description:VideoVideo case report highlighting the improvement of an anastomotic leak after improving transpyloric drainage.

| S-EPMC9479681 | biostudies-literature

The use of a lumen-apposing metal stent for a short malignant duodenal stricture in a patient with a coexisting metal biliary stent.

Project description: Not available

| S-EPMC6031239 | biostudies-literature

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

Project description: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.A single-center case-series of five patients who underwent lumen-apposing covered SEMS placement for benign gastrointestinal strictures.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.Lumen-apposing, fully covered SEMS appear to be safe and effective for management of selected benign gastrointestinal strictures.

| S-EPMC4713186 | biostudies-other

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