Larson Brian, Adler Douglas G
Department of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA.
Ann Gastroenterol. 2019 Mar-Apr;32(2):141-146. doi: 10.20524/aog.2018.0337. Epub 2018 Dec 14.
The management of short-segment benign gastrointestinal (GI) strictures refractory to currently available endoscopic treatments (endoscopic balloon dilation, intralesional steroid injection, incisional therapy and fully covered self-expanding metal stents) proves to be challenging. Lumen-apposing metal stents (LAMS), originally developed for access to and drainage of pancreatic fluid collections, are being used in an off-label manner for the treatment of short GI luminal strictures. The short length and wide flanges make LAMS potentially suitable for this indication and may reduce complications and improve patient tolerance. In this article we review the published literature, including 138 patients from 4 retrospective studies and 13 case reports who received a LAMS for the treatment of a short GI luminal stricture. In the reviewed literature only 2 of the 138 cases had immediate adverse events warranting hospitalization: perforation and postoperative GI bleed. A total adverse event rate of 32.5% (45 of 138 cases) was reported. Migration was the most common adverse event, accounting for 40% of the total. Nearly 58% of reported patients had symptom and stricture resolution after stent removal in the reviewed studies. Follow up varied from 28-352 days after stent removal. Although more data are needed to determine their long-term safety and efficacy, LAMS represent an important alternative to traditional endoscopic options when approaching patients with short GI luminal strictures.
目前可用的内镜治疗方法（内镜球囊扩张、病灶内注射类固醇、切开治疗和全覆膜自膨式金属支架）对短节段良性胃肠道（GI）狭窄治疗效果不佳，其管理颇具挑战性。管腔贴附金属支架（LAMS）最初是为了穿刺和引流胰液而研发，目前正被用于非标签适应证，即治疗短节段GI管腔狭窄。LAMS长度较短且凸缘较宽，可能适用于这一适应证，并且可能减少并发症，提高患者耐受性。在本文中，我们回顾了已发表的文献，包括来自4项回顾性研究的138例患者和13例接受LAMS治疗短节段GI管腔狭窄的病例报告。在回顾的文献中，138例病例中只有2例出现需要住院治疗的即刻不良事件：穿孔和术后GI出血。报告的总不良事件发生率为32.5%（138例中的45例）。移位是最常见的不良事件，占总数的40%。在回顾的研究中，近58%的报告患者在支架取出后症状和狭窄得到缓解。支架取出后的随访时间为28 - 352天。尽管需要更多数据来确定其长期安全性和有效性，但对于短节段GI管腔狭窄患者，LAMS是传统内镜治疗方法的重要替代方案。
