Nimri Faisal, Ichkhanian Yervant, Shinn Brianna, Kowalski Thomas E, Loren David E, Kumar Anand, Schlachterman Alexander, Tantau Alina, Arevalo Martha, Taha Ashraf, Shamaa Omar, Viales Maria Chavarria, Khashab Mouen A, Simmer Stephen, Singla Sumit, Piraka Cyrus, Zuchelli Tobias E
Division of Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, United States.
Department of Internal Medicine, Henry Ford Hospital, Detroit, United States.
Endosc Int Open. 2024 Jun 6;12(6):E740-E749. doi: 10.1055/a-2312-1528. eCollection 2024 Jun.
Endoscopic ultrasound (EUS)-guided transmural (TM) deployment of lumen-apposing metal stents (LAMS) is considered relatively safe in non-cirrhotic patients and is cautiously offered to cirrhotic patients. This was a retrospective, multicenter, international matched case-control study to study the safety of EUS-guided TM deployment of LAMS in cirrhotic patients. Forty-three cirrhotic patients with model for end-stage liver disease score 12.5 ± 5, with 23 having ascites and 16 with varices underwent EUS-guided TM LAMS deployment, including 19 for pancreatic fluid collection (PFC) drainage, 13 gallbladder drainage, six for endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography (ERCP), three for EDGI, one for endoscopic ultrasound-directed transenteric ERCP, and one postsurgical collection drainage. Technical failure occurred in one LAMS for PFC drainage. Clinical failure was encountered in another PFC. Nine adverse events (AEs) occurred. The most common AE was LAMS migration (3), followed by non-bleeding mucosal erosion (2), delayed bleeding (2), sepsis (1), and anesthesia-related complication (pulseless electrical activity) (1). Most AEs were graded as mild (6), followed by severe (2), and moderate (1); the majority were managed conservatively. On univariable comparison, risk of AE was higher when using a 20 × 10 mm LAMS and the absence of through-the-LAMS plastic stent(s). Conditional logistic regression of matched case-control patients did not show any association between potential predicting factors and occurrence of AEs. Our study demonstrated that mainly in patients with Child-Pugh scores A and B cirrhosis and despite the presence of mild-to-moderate ascites in over half of cases, the majority of AEs were mild and could be managed conservatively. Further studies are warranted to verify the safety of LAMS in cirrhotic patients.
内镜超声（EUS）引导下经壁（TM）置入管腔贴附金属支架（LAMS）在非肝硬化患者中被认为相对安全，而在肝硬化患者中则谨慎应用。这是一项回顾性、多中心、国际匹配病例对照研究，旨在探讨EUS引导下TM置入LAMS在肝硬化患者中的安全性。43例终末期肝病模型评分12.5±5的肝硬化患者，其中23例有腹水，16例有静脉曲张，接受了EUS引导下TM LAMS置入，包括19例用于胰液积聚（PFC）引流、13例用于胆囊引流、6例用于内镜超声引导下经胃内镜逆行胰胆管造影（ERCP）、3例用于内镜下十二指肠镜引导下胰胆管造影（EDGI）、1例用于内镜超声引导下经肠ERCP以及1例用于术后积液引流。1例用于PFC引流的LAMS出现技术失败。另1例PFC出现临床失败。发生了9例不良事件（AE）。最常见的AE是LAMS移位（3例），其次是非出血性黏膜糜烂（2例）、延迟出血（2例）、脓毒症（1例）和麻醉相关并发症（无脉电活动）（1例）。大多数AE分级为轻度（6例），其次是重度（2例）和中度（1例）；大多数通过保守治疗处理。单变量比较时，使用20×10 mm LAMS且未置入通过LAMS的塑料支架时AE风险更高。匹配病例对照患者的条件逻辑回归未显示潜在预测因素与AE发生之间存在任何关联。我们的研究表明，主要是在Child-Pugh评分A和B级肝硬化患者中，尽管超过半数病例存在轻至中度腹水，但大多数AE为轻度，可通过保守治疗处理。有必要进一步研究以验证LAMS在肝硬化患者中的安全性。
