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      Lumen-apposing covered self-expanding metal stent for management of benign gastrointestinal strictures

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          Abstract

          Background and aims: Self-expanding metal stents (SEMS) are safe and effective for endoscopic management of malignant gastrointestinal strictures, but there is limited experience with their use in refractory benign strictures. We assessed the use of a new lumen-apposing covered SEMS for the management of benign gastrointestinal strictures.

          Methods: A single-center case-series of five patients who underwent lumen-apposing covered SEMS placement for benign gastrointestinal strictures.

          Results: Three patients had a benign gastroduodenal stricture, one had a distal colonic anastomotic stricture, and one with complete gastrojejunal anastomotic stenosis underwent endoscopic creation of a new gastrojejunostomy. None of the patients developed any immediate or delayed stent-related adverse events. In two patients, the stents were left in place indefinitely. Stents were removed from the other three patients with successful resolution of their symptoms during follow-up.

          Conclusion: Lumen-apposing, fully covered SEMS appear to be safe and effective for management of selected benign gastrointestinal strictures.

          Most cited references13

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          Clinical evaluation of a novel lumen-apposing metal stent for endosonography-guided pancreatic pseudocyst and gallbladder drainage (with videos).

          Tubular plastic and metal stents have inherent shortcomings when used for transenteric drainage of fluid collections. To evaluate a novel lumen-apposing, self-expandable metal stent for EUS-guided drainage of pancreatic pseudocysts and the gallbladder. Retrospective case series. Tertiary-care academic medical center. This study involved 15 patients (median age 54 years) with symptomatic pancreatic pseudocysts who underwent 12 transgastric and 3 transduodenal pseudocyst drainage procedures. Five patients (median age 69.5 years) with acute cholecystitis underwent 4 cholecystoduodenostomies and 1 cholecystogastostomy. Stent deployment under EUS guidance, passage of an endoscope through the stent lumen for pseudocystoscopy or cholecystoscopy, transenteric endoscopy-guided interventions including biopsy, necrosectomy, and stone removal. Technical and clinical success. All stents were successfully deployed without complication, with a median time to removal of 35 days. All pseudocysts resolved after a single drainage procedure. One stent migrated into the stomach, and the remaining 14 were found to be patent at the time of removal. There was no pseudocyst recurrence during the 11.4-month median follow-up period. One gallbladder stent remains indwelling and fully patent at 12 months. Resolution of acute cholecystitis was observed immediately after stent implantation. No recurrence of symptoms was observed during a median follow-up period of 9 months. Retrospective study, small sample size, lack of control patients. Transenteric drainage of pancreatic pseudocysts and the gallbladder by using a novel, lumen-apposing, metal stent was accomplished with high technical and clinical success in this pilot observational study. Further studies are warranted. Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.
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            Safety and efficacy of endoscopic ultrasound-guided drainage of pancreatic fluid collections with lumen-apposing covered self-expanding metal stents.

            Plastic stents, placed via endoscopy to drain pancreatic fluid collections (PFCs), require repeat access. Covered metal stents are larger in diameter and can be inserted in a single step, but can migrate. We evaluated the safety and efficacy of a lumen-apposing, covered, self-expanding metal stent (LACSEMS) for PFC drainage.
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              Perforation in colorectal stenting: a meta-analysis and a search for risk factors.

              Recent studies suggest that there is a substantial risk of perforation after colorectal stent placement.
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                Author and article information

                Journal
                Endosc Int Open
                Endosc Int Open
                10.1055/s-0034-1377934
                Endoscopy International Open
                © Georg Thieme Verlag KG (Stuttgart · New York )
                2364-3722
                2196-9736
                January 2016
                15 December 2015
                : 4
                : 1
                : E96-E101
                Affiliations
                Mayo Clinic – Division of Gastroenterology and Hepatology, Rochester, Minnesota, USA
                Author notes
                Corresponding author Barham K. Abu Dayyeh, MD Mayo Clinic – Division of Gastroenterology and Hepatology 200 First Street SWRochesterMinnesota 55905USA+1-507-538-5820 abudayyeh.barham@ 123456mayo.edu
                Article
                10.1055/s-0041-108195
                4713186
                26793793
                45485f9f-95bf-4cd0-bdd2-3a6db43abc27
                © Thieme Medical Publishers
                History
                : 06 October 2015
                : 08 October 2015
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