Gastrointestinal Anastomosis with Lumen Apposing Metal Stent
Gastric outlet obstruction, afferent or efferent limb obstruction, and biliary obstruction among patients with altered anatomy often require surgical intervention which is associated with significant morbidity and mortality. Endoscopic dilation for benign etiologies requires multiple sessions, where...
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Hoon Jai Chun
2018-09-01
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doaj-de9c3840cd5842cbb6cac3c8e96dd2b22020-11-24T23:02:36ZengHoon Jai ChunClinical Endoscopy2234-24002234-24432018-09-0151543944910.5946/ce.2018.0777141Gastrointestinal Anastomosis with Lumen Apposing Metal StentDeepanshu Jain0Ankit Chhoda1Abhinav Sharma2Shashideep Singhal3 Division of Gastroenterology and Hepatology, Department of Digestive Diseases and Transplantation, Einstein Healthcare Network, Philadelphia, PA, USA Department of Internal Medicine, Yale-Waterbury Internal Medicine Program, Yale school of medicine, Waterbury, CT, USA Department of Internal Medicine, Maulana Azad Medical College, New Delhi, India Gastrointestinal Care Consultants PA, Houston, TX, USAGastric outlet obstruction, afferent or efferent limb obstruction, and biliary obstruction among patients with altered anatomy often require surgical intervention which is associated with significant morbidity and mortality. Endoscopic dilation for benign etiologies requires multiple sessions, whereas self-expandable metal stents used for malignant etiologies often fail due to tumor in-growth. Lumen apposing metal stents, placed endoscopically with the intent of creating a de-novo gastrointestinal anastomosis bypassing the site of obstruction, can potentially achieve similar efficacy, with a much lower complication rate. In our study cohort (n=79), the composite technical success rate and clinical success rate was 91.1% (72/79) and 97.2% (70/72), respectively. Five different techniques were used: 43% (34/79) underwent the balloon-assisted method, 27.9% (22/79) underwent endoscopic ultrasound-guided balloon occluded gastro-jejunostomy bypass, 20.3% (16/79) underwent the direct technique, 6.3% (5/79) underwent the hybrid rendezvous technique, and 2.5% (2/79) underwent natural orifice transluminal endoscopic surgery (NOTES)-assisted procedure. All techniques required an echoendoscope except NOTES. In all, 53.2% (42/79) had non-cautery enhanced Axios stent, 44.3% (35/79) had hot Axios stent, and 2.5% (2/79) had Niti-S spaxus stent. Symptom-recurrence was seen in 2.8%, and 6.3% had a complication (bleeding, abdominal pain or peritonitis). All procedures were performed by experts at centers of excellence with adequate surgical back up.http://www.e-ce.org/upload/pdf/ce-2018-077.pdf entero-enteric anastomosisLumen apposing metal stentsEndosonography |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Deepanshu Jain Ankit Chhoda Abhinav Sharma Shashideep Singhal |
spellingShingle |
Deepanshu Jain Ankit Chhoda Abhinav Sharma Shashideep Singhal Gastrointestinal Anastomosis with Lumen Apposing Metal Stent Clinical Endoscopy entero-enteric anastomosis Lumen apposing metal stents Endosonography |
author_facet |
Deepanshu Jain Ankit Chhoda Abhinav Sharma Shashideep Singhal |
author_sort |
Deepanshu Jain |
title |
Gastrointestinal Anastomosis with Lumen Apposing Metal Stent |
title_short |
Gastrointestinal Anastomosis with Lumen Apposing Metal Stent |
title_full |
Gastrointestinal Anastomosis with Lumen Apposing Metal Stent |
title_fullStr |
Gastrointestinal Anastomosis with Lumen Apposing Metal Stent |
title_full_unstemmed |
Gastrointestinal Anastomosis with Lumen Apposing Metal Stent |
title_sort |
gastrointestinal anastomosis with lumen apposing metal stent |
publisher |
Hoon Jai Chun |
series |
Clinical Endoscopy |
issn |
2234-2400 2234-2443 |
publishDate |
2018-09-01 |
description |
Gastric outlet obstruction, afferent or efferent limb obstruction, and biliary obstruction among patients with altered anatomy often require surgical intervention which is associated with significant morbidity and mortality. Endoscopic dilation for benign etiologies requires multiple sessions, whereas self-expandable metal stents used for malignant etiologies often fail due to tumor in-growth. Lumen apposing metal stents, placed endoscopically with the intent of creating a de-novo gastrointestinal anastomosis bypassing the site of obstruction, can potentially achieve similar efficacy, with a much lower complication rate. In our study cohort (n=79), the composite technical success rate and clinical success rate was 91.1% (72/79) and 97.2% (70/72), respectively. Five different techniques were used: 43% (34/79) underwent the balloon-assisted method, 27.9% (22/79) underwent endoscopic ultrasound-guided balloon occluded gastro-jejunostomy bypass, 20.3% (16/79) underwent the direct technique, 6.3% (5/79) underwent the hybrid rendezvous technique, and 2.5% (2/79) underwent natural orifice transluminal endoscopic surgery (NOTES)-assisted procedure. All techniques required an echoendoscope except NOTES. In all, 53.2% (42/79) had non-cautery enhanced Axios stent, 44.3% (35/79) had hot Axios stent, and 2.5% (2/79) had Niti-S spaxus stent. Symptom-recurrence was seen in 2.8%, and 6.3% had a complication (bleeding, abdominal pain or peritonitis). All procedures were performed by experts at centers of excellence with adequate surgical back up. |
topic |
entero-enteric anastomosis Lumen apposing metal stents Endosonography |
url |
http://www.e-ce.org/upload/pdf/ce-2018-077.pdf |
work_keys_str_mv |
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