OUTCOMES OF LUMEN APPOSING METAL STENT PLACEMENT IN PATIENTS WITH SURGICALLY ALTERED ANATOMY: A MULTICENTER INTERNATIONAL EXPERIENCE

Introduction: While outcomes of lumen-apposing metal stents (LAMS) placement in native anatomy have been reported, data on LAMS placement in surgically altered anatomy (SAA) is sparse. We aim to assess outcomes of LAMS placement in patients with SAA for different indications. Methods: This was an international multicenter retrospective observational study at 25 tertiary-care centers through November 2023. Consecutive patients with SAA who underwent LAMS placement were included. The primary outcome was technical success defined as correct placement of LAMS. Secondary outcomes were clinical success and safety. Results: Two hundred and seventy patients (125 males; average age 61 ± 15 years) underwent LAMS placement with SAA. Procedures included EUS-directed transgastric ERCP (EDGE) and EUS-directed transenteric ERCP (EDEE) (n=82), EUS-guided entero-enterostomy (n=81), EUS-guided biliary drainage (n=57), EUS-guided drainage of peri-pancreatic fluid collections (n=48), and EUS-guided pancreaticogastrostomy (n=2). Most cases utilized AXIOS stents (n=255) compared to SPAXUS stents (n=15). Overall, technical success was 98%, clinical success was 97%, and adverse event rate was 12%. Using AGREE classification, 5 events were rated as Grade II, 21 events as Grade IIIa, and 6 events as IIIb. No difference in adverse events were noted among stent types (P=0.52). Conclusion: This study shows that placement of LAMS is associated with high technical and clinical success rates in patients with SAA. However, the rate of adverse events is noteworthy and thus these procedures should be performed by expert endoscopists at tertiary centers.