Off-label use of Lumen-apposing metal stents for treatment of short benign biliary strictures

Massimiliano Mutignani; Mario Capasso; Giulia Bonato; Francesco Pugliese; Lorenzo Dioscoridi; Marcello Cintolo; Marianna Bravo; Andrea Palermo; Irene Cottone; Edoardo Forti

doi:10.1016/j.dld.2024.04.011

Off-label use of Lumen-apposing metal stents for treatment of short benign biliary strictures

Dig Liver Dis. 2024 May 11:S1590-8658(24)00712-6. doi: 10.1016/j.dld.2024.04.011. Online ahead of print.

Affiliations

¹ Digestive and Interventional Endoscopy Unit, Niguarda Hospital, Piazza dell'Ospedale Maggiore 3, 20161, Milan, Italy.
² Gastroenterology and Endoscopy Department, ASST Maggiore Hospital, Largo Ugo Dossena 2, 26013, Crema (CR), Italy; Department of Clinical Medicine and Surgery, Diseases of the Liver and Biliary System Unit, University "Federico II", Via Sergio Pansini 5, 80131, Naples, Italy. Electronic address: mario.capa05@gmail.com.
³ Digestive and Interventional Endoscopy Unit, Niguarda Hospital, Piazza dell'Ospedale Maggiore 3, 20161, Milan, Italy; Medical Science Department, University of Turin, Via Accademia Albertina, 13, 10123, Turin, Italy.

PMID: 38735795
DOI: 10.1016/j.dld.2024.04.011

Abstract

Background: Endoscopic stenting is the mainstay of treatment for benign biliary strictures. There is a not-negligible rate of recurrence and stent migration. Lumen-apposing metal stents (LAMS) have a unique design with short length, large diameter and wide flanges which make them less prone to migration.

Aims: To describe the intraluminal use of LAMS to treat short benign biliary strictures.

Methods: All consecutive patients who underwent bi-flanged LAMS placement for benign biliary strictures, in approximately 6 years, were retrospectively included. Primary outcomes were technical and clinical success; secondary outcomes were number of endoscopic procedures, adverse events evaluation and stricture recurrence during follow-up.

Results: Seventy patients (35 male, mean age 67) were enrolled; bilio-enteric anastomotic stricture was the most common etiology. Technical and clinical success were 100 % and 85.7 %, respectively. Patients with post-surgical stricture had a higher success rate than patients with non-surgical stricture or with bilio-enteric anastomotic stricture (90.4 %, 86.3 % and 81.4 %, respectively). Adverse events were 12/70 (17.1 %): stent migration was the most frequent (8/70, 11.4 %). Stricture recurrence was found in 10/54 patients (18.5 %).

Conclusion: LAMS placement could be safe and effective treatment for short benign biliary strictures in patients in which a significant caliber disproportion between stricture and the duct above was revealed.

Keywords: Biliary strictures; ERCP; LAMS; Metal stent.