Adverse Events Associated With LAMS With and Without Plastic Stents Placement During Different EUS-Guided Interventions

Document Type

Conference Proceeding

Publication Date

10-1-2024

Publication Title

Am J Gastroenterol

Abstract

Introduction: Endoscopic ultrasound (EUS) guided lumen apposing metal stent (LAMS) has been used increasingly in lieu of surgery for multiple conditions, due to the novelty of the intervention, data on adverse events (AE) is scarce. We conducted this study to better understand and quantify the AE rates associated with LAMS placement, and plastic stent placement along with LAMS. Methods: Patients who underwent attempted EUS-guided LAMS interventions from 2015 to 2023 were identified from a single quaternary care hospital (Henry Ford Hospital) endoscopic procedure database. Retrospective demographic, clinical, and procedure-related data (including AE data using a modified version of the American Society for Gastrointestinal Endoscopy lexicon for endoscopic AE) was collected from the medical record. Results: Out of 243 patients, 133 (54.7%) were male and 159 (65.4%) were white, with a mean age of 53.7 ± 15.9 years. The primary indication for lumen-apposing metal stents (LAMS) was pancreatic fluid collections in 170 (70%) patients, with cyst-gastrostomy being the most common intervention in 159 (65.4%) patients. The technical success rate of LAMS placement was 97.5%, while the clinical success rate, defined as an improvement in clinical outcomes, was 93%. A total of 96 (39.5%) patients experienced adverse events (AEs), with 48 (19.7%) having early AEs (occurring < 48 hours post-procedure) and 70 (28.8%) having late AEs (occurring >48 hours and < 30 days post-procedure). Abdominal pain was the most common early and late AE, affecting 28 and 25 patients, respectively. Plastic stents were placed alongside LAMS in 176 patients, of whom 85 (48.3%) experienced complications. The combination of plastic stent placement and LAMS was associated with a significantly higher overall risk of AEs (48.3% vs. 29.9%, P=0.009) and a higher risk of delayed AEs (33% vs. 17.9%, P=0.021). Multivariate analysis revealed that LAMS dilation without plastic stent placement resulted in a significantly higher rate of stent occlusion compared to LAMS dilation with plastic stent placement (7.3% vs. 0.8%, P=0.021). Additionally, LAMS dilation alone was associated with a higher rate of abdominal pain than when combined with stent placement (14.5% vs. 5.5%, P=0.027). Conclusion: LAMS has been demonstrated to have high technical and clinical success rates. Pairing of LAMS dilation and plastic stent placement may have beneficial effects on stent occlusion. More studies are needed to investigate the safety profile of LAMS. (Table Presented).

Volume

119

Issue

10

First Page

S1139

Last Page

S1141

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