Stefanovic Sebastian, Degroote Helena, Hindryckx Pieter
Department of Gastroenterology, University Hospital of Ghent, Corneel Heymanslaan 10, 1K12-IE, 9000 Ghent, Belgium.
Diagnostic Center Bled, Pod Skalo 4, 4260 Bled, Slovenia.
J Clin Med. 2023 Jan 29;12(3):1037. doi: 10.3390/jcm12031037.
Lumen-apposing metal stents (LAMSs) are increasingly used both for on- and off-label indications. We continuously adapt our step-by-step protocol to optimize the safe deployment of LAMSs for the different indications. The aim of this study was to evaluate the impact of this approach over time.
We conducted a single-center study on consecutive patients who underwent LAMS placement for on- and off-label indications between June 2020 and June 2022. Endpoints included technical success, clinical success and adverse event rates. We compared the results with our previously published early experience with LAMSs (N = 61), between March 2018 and May 2020.
This cohort consisted of 168 LAMSs in 153 patients. Almost half of them (47.6%) were placed for off-label indications (gastro-enterostomy, temporary access to the excluded stomach in patients with previous gastric bypass, drainage of postsurgical collections, stenting of short refractory gastrointestinal strictures). While the technical and clinical success rates were similar to those in our previously published cohort (97% and 93.5% versus 93.4% and 88.5%, respectively), the adverse event rate dropped from 21.3% to 8.9%.
Our results demonstrate the impact of a learning curve in LAMS placement, with a clinically relevant drop in LAMS-related adverse events over time.
管腔贴壁金属支架（LAMS）越来越多地用于适应证内和适应证外的情况。我们不断调整逐步操作方案，以优化LAMS在不同适应证中的安全置入。本研究的目的是评估这种方法随时间的影响。
我们对2020年6月至2022年6月期间因适应证内和适应证外情况接受LAMS置入的连续患者进行了一项单中心研究。终点包括技术成功率、临床成功率和不良事件发生率。我们将结果与我们之前发表的2018年3月至2020年5月期间LAMS的早期经验（N = 61）进行了比较。
该队列包括153例患者中的168个LAMS。其中近一半（47.6%）是用于适应证外情况（胃肠吻合术、既往胃旁路手术后暂时进入旷置胃、术后积液引流、短难治性胃肠道狭窄的支架置入）。虽然技术成功率和临床成功率与我们之前发表的队列相似（分别为97%和93.5%，而之前为93.4%和88.5%），但不良事件发生率从21.3%降至8.9%。
我们的结果证明了LAMS置入学习曲线的影响，随着时间的推移，与LAMS相关的不良事件在临床上有显著下降。
