ADVERSE EVENTS RELATED TO DILATION OF LUMEN APPOSING METAL STENTS DURING ENDOSCOPIC ULTRASOUND GUIDED INTERVENTIONS

Document Type

Conference Proceeding

Publication Date

6-1-2024

Publication Title

Gastrointest Endosc

Abstract

Introduction: Endoscopic ultrasound (EUS) guided interventions with lumen apposing metal stents (LAMS) have been increasingly performed for a variety of indications. LAMS dilation is often performed to help achieve clinical outcomes including: access and debridement of pancreatic necrosis or maximizing LAMS aperture for optimal nutrition in the setting of gastric outlet obstruction. Given the frequent need for LAMS dilation, this study aims to identify whether LAMS dilation is associated with an increased risk of adverse events (AE). Methods: Cases of attempted EUS-guided LAMS interventions from 2015 to 2023 were identified from a single-center endoscopy database. Retrospective demographic and clinical data (including data using the American Society for Gastrointestinal Endoscopy lexicon for endoscopic AE) was collected from medical records. We compared AE for patients who did and did not undergo LAMS dilation during the same procedure as initial LAMS placement. Results: A total of 241 patients underwent EUS-guided LAMS interventions from 2015-2023. Of these patients, 145 patients underwent LAMS dilation (60.2%) and 96 patients (39.8%) did not undergo LAMS dilation. Rate of early AE (defined as AE occurring <48 hours after the initial procedure) did not differ between the dilation and non-dilation groups (16.6% vs 22.9%, p-value 0.22). The most common early AE included bleeding and abdominal pain. Although not statistically significant due to a small sample size (P-value 0.075), a greater rate of delayed AE (defined as AE occurring >48 hours and <30 days after the initial procedure) was noted in the dilation group (32.4%) compared to the non-dilation group (21.9%). Overall, rates of stent-related delayed AE in the dilation group compared to the non-dilation group were not significantly different. Delayed AE included (dilation vs non-dilation respectively): bleeding (4.8% vs 3.1%, p-value: 0.501), infection (6.2% vs 2.1%, p-value: 0.213), stent migration (4.1% vs 1.0%, p-value: 0.254), and stent occlusion (6.2% vs 1.0%, p-value: 0.046). Stent occlusion was only seen with pancreatic necrosis interventions and AE difference in the dilation and non-dilation groups was not statistically significant for this subset of interventions (p-value 0.08). Technical and clinical success rates were >92% in both groups. Conclusion: Although this study did not show statistically significant differences in overall AE rates, there was a higher rate of stent occlusion noted in patients who underwent LAMS dilation compared to those who did not. This may relate to potential change in mucosal lining and friability after LAMS dilation resulting in higher rates of occlusion from trapped food or necrosis. Risks of LAMS dilation should be weighed against the potential benefit of waiting until a subsequent procedure for dilation to allow time for stent security and mucosal healing.

Volume

99

Issue

6

First Page

AB915

Last Page

AB915-AB916

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