Avoidance, Recognition, and Management of Complications Associated with Lumen-Apposing Metal Stents

摘要

For decades, most endoscopists feared full-thickness mucosal defects and therefore the field, save for a handful of pioneers, had long been limited to disease management within the gastrointestinal tract. The advent of the lumen-apposing metal stent (LAMS), however, has allowed a broad swath of endoscopists the ability to create controlled full-thickness defects with the intent of connecting the gastrointestinal lumen with other walled compartments or adjacent lumen. With this, advanced gastroenterology now includes the capability of limited extraluminal therapies, including more aggressive transluminal management of walled off necrosis, alternative means of biliary and gallbladder drainage, and creation of enteroenterostomies for alternative routes of per os nutrition or reversal of surgical anatomy. 1 2 3 4 5 6 7 8 9 As with any advanced intervention, there are risks for complications. These complications can be immediately during the deployment phase or delayed because of the subsequent effects of the intervention and/or stent itself. As with any complication, early recognition remains critical to avoid long-term sequelae and overall poor outcomes. Limited observational data exist evaluating the safety of LAMS for each of the indications; however, maldeployment, bleeding, and free perforation are 3 recognized immediate complications, and migration, bleeding, stent occlusion, and fistulas are delayed concerns. Careful planning, technique, and clinical surveillance will assist in avoiding complications; however, the endoscopist should be ready to manage complications, be it by medical, endoscopic, or surgical interventions.