Department of Gastroenterology, Virginia Mason Medical Center, Seattle, Washington, USA.
Division of Gastroenterology & Hepatology, University of North Carolina, Charlotte, North Carolina, USA.
Gastrointest Endosc. 2017 Jun;85(6):1285-1289. doi: 10.1016/j.gie.2016.08.028. Epub 2016 Sep 12.
Benign GI strictures occur typically in the esophagus and pyloric channel but can occur anywhere in the GI tract and at anastomotic sites. Such strictures can be treated with dilation, incisional therapy, steroid injection, and stents. Our aim was to describe the use of a lumen-apposing metal stent (LAMS) to treat short, benign GI strictures.
Consecutive patients who underwent LAMS placement for various benign strictures at 2 tertiary care centers from August 2014 to November 2015 were reviewed retrospectively. The main outcome measures were technical success, clinical success, stent migration, and adverse events.
Twenty-five patients (7 males, 18 females) with a median age of 54 years (33-85 years) underwent 28 LAMS placements to treat various benign strictures. The location of the strictures included esophagogastric anastomoses (n=4), gastrojejunal anastomoses (n=13), pylorus (n=6), vertical banded gastroplasty (n=1), and ileocolonic anastomosis (n=1). Twenty patients had been previously treated with dilation alone (9 patients with ≥3 dilations), 11 patients with dilation and steroid injection, 2 patients with additional needle-knife therapy, and 1 patient with placement of a traditional fully covered self-expandable metal stent. A 15-mm internal diameter LAMS was placed in all patients; 3 patients had been treated previously with a 10-mm LAMS. Technical success was achieved in all patients, whereas clinical success was achieved in 15 of 25 patients (60%) who completed a minimum of 6 months of follow-up after placement. Median stent dwell time was 92 days (range, 3-273 days). Stent migration was seen in 2 of 28 stent placements (7%). Four of 25 patients (16%) developed 5 moderate adverse events (pain requiring removal, 2; new stricture formation, 2; bleeding, 1). Median follow-up was 301 days after stent placement. Study limitations include the small, select group of patients, the retrospective study design, and short follow-up.
LAMS placement for benign GI strictures is technically easy and safe with low migration rates and may be an option to treat selected patients with short-length strictures.
良性胃肠道狭窄通常发生在食管和幽门通道，但也可能发生在胃肠道的任何部位和吻合部位。这些狭窄可以通过扩张、切开治疗、类固醇注射和支架来治疗。我们的目的是描述使用腔对腔吻合金属支架（LAMS）来治疗短段良性胃肠道狭窄。
回顾性分析 2014 年 8 月至 2015 年 11 月在 2 家三级护理中心因各种良性狭窄而行 LAMS 放置术的连续患者。主要观察指标为技术成功率、临床成功率、支架迁移和不良事件。
25 例患者（7 例男性，18 例女性），中位年龄 54 岁（33-85 岁），共行 28 例 LAMS 放置术治疗各种良性狭窄。狭窄部位包括食管胃吻合口（n=4）、胃空肠吻合口（n=13）、幽门（n=6）、垂直带型胃成形术（n=1）和回肠结肠吻合口（n=1）。20 例患者曾单独接受过扩张治疗（9 例患者接受了≥3 次扩张），11 例患者接受了扩张和类固醇注射治疗，2 例患者接受了额外的针刀治疗，1 例患者接受了传统的全覆膜自扩张金属支架治疗。所有患者均放置了 15mm 内径的 LAMS，3 例患者曾接受过 10mm LAMS 治疗。所有患者均达到技术成功，25 例患者中有 15 例（60%）在放置后至少 6 个月的随访中达到临床成功。中位支架留置时间为 92 天（范围 3-273 天）。28 例支架放置中有 2 例（7%）发生支架迁移。25 例患者中有 4 例（16%）发生 5 例中度不良事件（需要取出的疼痛 2 例，新发狭窄 2 例，出血 1 例）。支架放置后中位随访时间为 301 天。研究局限性包括患者数量少、选择的患者组、回顾性研究设计和随访时间短。
LAMS 放置治疗良性胃肠道狭窄技术简单、安全，迁移率低，可能是治疗短段狭窄的一种选择。
