P2753 - Adverse Events in the Creation of Lumen-to-Lumen Tracts Using Lumen Apposing Metal Stents and Plastic Stents

Pedro Cortes, MD, Paul T. Kroner, MD, MSc, Bhaumik Brahmbhatt, MBBS, Vivek Kumbhari, MBChB, PhD, Victoria Gomez, MD
Mayo Clinic, Jacksonville, FL

Introduction: Lumen-apposing metal stents (LAMS) and plastic stents allow for the minimally invasive management of pancreatic fluid collections, biliary or gallbladder drainage, gastric outlet obstruction (GOO), and biliary access in altered foregut anatomy.

Methods: Retrospective chart review of all patients undergoing endoscopic procedures where a LAMS or plastic stent deployment was attempted for the creation of a lumen-to-lumen tract.

Results: A total of 29 procedures were performed with 31 attempts at stent deployment. The procedures consisted of cystogastrostomies (62.1%), Endoscopic-Ultrasound [EUS] Directed Transgastric Endoscopic Retrograde Cholangiopancreatography [ERCP] (EDGE) (17.2%), EUS gastroenterostomy (GE) (10.3%) and EUS-biliary/gallbladder drainage (EUS-BD/GB) (10.3%), Table 1. Baseline characteristics of patients were mean age 61.2 years (±12.7), BMI 27.5 kg/m² (±8.0), ASA class 2.8 (±0.5) and female 62.1%. A HOT AXIOS stent was deployed in most attempts (93.5%). A technical success of 90.3% was achieved for all attempts. Two attempts at HOT AXIOS deployment failed leading to the conversion to a plastic stent. The overall rate for any adverse event was 41.4%, per ASGE lexicon, with the highest occurring in cystogastrostomies (55.6%). Half of all adverse events were mild. Three of the adverse events were classified as severe, all of which occurred in cystogastrostomies. Only one procedure failed from an intraprocedural complication. Cystogastrostomy led to the complete resolution of fluid collections in 76.5% of cases at a median time to resolution of 23.0 days (95% CI:16-35). One patient required conversion to surgical drainage. All EUS-GE were performed for malignant causes of GOO and were clinically successful with an average survival time of 49 days (± 39.0). All EUS-BD/GB led to successful drainage. All EDGE procedures, except one, were completed in a single step with average time to LAMS retrieval of 26 days (±5.8).



Discussion: The technical success of LAMS or plastic stent deployment is high despite having a moderate risk of adverse events. The ASGE lexicon defines adverse events based on timing (intraprocedural, post-procedural, and late), type (cardiovascular, infection, pain, bleeding, etc.) and severity (mild, moderate, severe, or fatal). Given its broad definitions, the ASGE lexicon may capture more adverse events than previously reported. Our experience using stents to create lumen-to-lumen tracts adds to the literature and shows that most adverse events are mild.

Table: Table 1: Adverse Events in All Patients Undergoing Creation of Lumen-to-Lumen Tract


Disclosures:
Pedro Cortes indicated no relevant financial relationships.
Paul Kroner indicated no relevant financial relationships.
Bhaumik Brahmbhatt indicated no relevant financial relationships.
Vivek Kumbhari: ERBE USA and Apollo Endosurgery – Grant/Research Support. Medtronic, Pentax Medical, Boston Scientific, FujiFilm, and Apollo Endosurgery – Consultant.
Victoria Gomez: Olympus Corporation of the Americas – Consultant.


Pedro Cortes, MD, Paul T. Kroner, MD, MSc, Bhaumik Brahmbhatt, MBBS, Vivek Kumbhari, MBChB, PhD, Victoria Gomez, MD. P2753 - Adverse Events in the Creation of Lumen-to-Lumen Tracts Using Lumen Apposing Metal Stents and Plastic Stents, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.