P0841 - Early and Late Clinical Outcomes, Safety, and Efficacy of Non-Cautery-Enhanced Lumen-Apposing Metal Stents for the Management of Benign Gastrointestinal Strictures: A Single-Center Experience

Ethan D. Pollack, MS, MD¹, Dalton A. Norwood, MD², Caceres Hector, BS², Isaac E. Perry, DO³, Usman Barlass, MD³, Rachel H. Mitchell, NP³, Jessica McCreight, NP³, Shajan Peter, MD³, Ramzi Mulki, MD³, Ali Ahmed, MD³, Kondal Kyanam, MD³, Sergio A. Sánchez-Luna, MD^3
1University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL; ²UAB Minority Health and Health Equity Research Center, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL; ³Basil I. Hirschowitz Endoscopic Center of Excellence, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL

Introduction: The morbidity and treatment burden associated with benign gastrointestinal (GI) strictures remains a challenge. Endoscopic balloon dilation has suboptimal outcomes and frequently requires re-intervention. LAMS have been utilized as an off-label treatment for this indication. The study aimed to characterize the clinical outcomes, safety, and efficacy of non-cautery-enhanced LAMS in the treatment of benign GI strictures.

Methods: This is an IRB-approved retrospective review of a prospectively collected database of all patients who underwent LAMS placement for benign strictures from 06/2017 to 03/2023 at a single tertiary care center. The primary outcomes were technical success, early clinical success (ECS), and late clinical success (LCS). Secondary outcomes included a change in stenosis diameter ≥ 5 mm, stent dwell time, migration, adverse events (AEs), re-intervention rate, and symptoms evaluation via a standardized follow-up instrument.

Results: A total of 33 patients (Table 1, Figure 1) underwent placement of 37 LAMS (78% female). Anastomotic strictures accounted for 59% of cases with the most common stricture site being the gastro-jejunal anastomosis (43%). The mean age for non-anastomotic cases was 61.1 ± 11.1 versus 49.0 ± 9.3 years in the anastomotic group (p= 0.002). The average stent dwell time was 87.3 ± 53.1 days. Technical success was obtained in all cases. ECS was achieved in 69% of non-anastomotic strictures versus 84% of anastomotic strictures (p= 0.31), while LCS was achieved in 50% of non-anastomotic strictures and 47% of anastomotic strictures (p= 0.89). A change of stenosis diameter by ≥ 5 mm occurred in 70% of cases. Migration occurred in 27% of cases while AEs irrespective of migration occurred in 5% of cases. The re-intervention rate was 10.8% for both groups. ECS and LCS had a trend towards association in cases where post-LAMS stenosis diameter was > 10mm (p= 0.039 and p= 0.14, respectively). Improvement of symptoms with indwelling LAMS occurred in 74% of cases versus 62% at 30 days post-removal and 58% at 60 days post-removal.

Discussion: This study elucidates patient-driven clinical success rates and better characterizes symptomatic changes during and after LAMS placement. Migration rates and AEs were similar to previously published data. Although further randomized studies are required, LAMS placement for benign GI strictures is associated with technical success, high early and late clinical success rates, and positive quality-of-life metrics.




Disclosures:


Ethan D. Pollack, MS, MD¹, Dalton A. Norwood, MD², Caceres Hector, BS², Isaac E. Perry, DO³, Usman Barlass, MD³, Rachel H. Mitchell, NP³, Jessica McCreight, NP³, Shajan Peter, MD³, Ramzi Mulki, MD³, Ali Ahmed, MD³, Kondal Kyanam, MD³, Sergio A. Sánchez-Luna, MD³. P0841 - Early and Late Clinical Outcomes, Safety, and Efficacy of Non-Cautery-Enhanced Lumen-Apposing Metal Stents for the Management of Benign Gastrointestinal Strictures: A Single-Center Experience, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.