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Cumulative risks of stent migration and gastrointestinal bleeding in patients with lumen-apposing metal stents.
Garcia-Alonso, Francisco Javier; Sanchez-Ocana, Ramón; Peñas-Herrero, Irene; Law, Ryan; Sevilla-Ribota, Sergio; Torres-Yuste, Raúl; Gil-Simón, Paula; de la Serna Higuera, Carlos; Perez-Miranda, Manuel.
Afiliación
  • Garcia-Alonso FJ; Gastroenterology Department, Hospital Universitario Río Hortega, Valladolid, Spain.
  • Sanchez-Ocana R; Gastroenterology Department, Hospital Universitario Río Hortega, Valladolid, Spain.
  • Peñas-Herrero I; Gastroenterology Department, Hospital Universitario Río Hortega, Valladolid, Spain.
  • Law R; University of Michigan, Ann Arbor, Michigan, USA.
  • Sevilla-Ribota S; Gastroenterology Department, Hospital Universitario Río Hortega, Valladolid, Spain.
  • Torres-Yuste R; Gastroenterology Department, Hospital Universitario Río Hortega, Valladolid, Spain.
  • Gil-Simón P; Gastroenterology Department, Hospital Universitario Río Hortega, Valladolid, Spain.
  • de la Serna Higuera C; Gastroenterology Department, Hospital Universitario Río Hortega, Valladolid, Spain.
  • Perez-Miranda M; Gastroenterology Department, Hospital Universitario Río Hortega, Valladolid, Spain.
Endoscopy ; 50(4): 386-395, 2018 04.
Article en En | MEDLINE | ID: mdl-29514354
BACKGROUND: Delayed gastrointestinal (GI) bleeding and stent migration are known adverse events which may occur following placement of lumen-apposing metal stents (LAMSs). METHODS: All consecutive patients who underwent LAMS placement between May 2011 and June 2017 at a single tertiary medical center were included. Demographics and procedural details were prospectively collected. Post-procedure follow-up and outcome measures were retrospectively collected. The cumulative risks of migration and LAMS-related GI bleeding were estimated using the life-table method. Risk predictors were assessed using Cox proportional hazards models. RESULTS: We analyzed 250 patients (64.8 % men; median age 71.6 [interquartile range (IQR) 57.9 - 83.6]). Median follow-up was 78.5 days (IQR 31 - 246.5 days). Thirty-four stent migrations (13.6 %) occurred (5 symptomatic). On multivariable analysis, associations with migration included nasocystic drains (hazard ratio [HR] 6.5, 95 % confidence interval [CI] 2.2 - 19.3), pancreatic fluid collections (PFCs; HR 4.2, 95 %CI 1.8 - 10.1), and double-pigtail stents (HR 2.4, 95 %CI 1.2 - 4.9). Migration risk at 12 months was 25.5 % (95 %CI 17.9 % - 35.7 %) and was higher for PFCs 48.9 % (33.4 % - 66.9 %) than other indications 8.4 % (4.9 % - 17.5 %; P < 0.001). LAMSs placed for longer durations (i. e. enteral anastomoses, biliary and gallbladder drainage) presented an 8.4 % cumulative risk at 2 years. There were 13 LAMS-related GI hemorrhages (5.2 %), two of them fatal, presenting a median of 3 days (IQR 1 - 9 days) after deployment. The cumulative risk of bleeding at 12 months was 6.9 % (3.6 % - 12.7 %). CONCLUSIONS: LAMS migration occurs in 1 out of 7 cases and is most common when treating PFCs. Bleeding related to LAMS placement occurs much less commonly but can be life-threatening.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Falla de Prótesis / Stents / Hemorragia Gastrointestinal Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Endoscopy Año: 2018 Tipo del documento: Article País de afiliación: España Pais de publicación: Alemania
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Falla de Prótesis / Stents / Hemorragia Gastrointestinal Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Endoscopy Año: 2018 Tipo del documento: Article País de afiliación: España Pais de publicación: Alemania