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

Authors Meir Mizrahi, Yazan Fahmawi, Lindsey Merritt, Manoj Kumar, Benjamin Tharian, Salman Ali Khan, Sumant Inamdar, Neil Sharma, Dushant Uppal, Vanessa M. Shami, Mahmood Syed Kashif, Moamen Gabr, Douglas Pleskow, Tyler M. Berzin, Ted W. James, Michael Croglio, Todd H. Baron, Douglas G. Adler, Cody Kern.


Background The 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.

Methods A 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.

Results A 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.

Conclusions Using 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.

Keywords Lumen-apposing metal stent, gastrointestinal stricture, stent migration

Ann Gastroenterol 2021; 34 (1): 33-38

Original Articles