Percutaneous Placement of Lumen Apposing Metallic Stents for Patients with Afferent Loop Syndrome

Tuesday, March 7, 2023

4:12 PM – 4:21 PM

Location: Phoenix Convention Center, 222AB

Presenting Author(s)

Erez Klein, MD

VIR Clinical Fellow
University Health Network

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

LS

Lee Swanstrom, MD FACS

Scientific Director and Chief Innovations Office
University of Strasbourg
CB

Camilo Barragan, MD MSc

VIR Clinical Fellow
UHN/MSH
HS

Hila Shmilovich, MD

General Surgery Clinical Fellow
TGH
Eran Shlomovitz, MD FACS

Surgeon Interventional Radiologist
Toronto General Hospital

Disclosure(s):

Erez Klein, MD: No financial relationships to disclose

Purpose: Lumen apposing metal stents (LAMS) are rapidly gaining in popularity, being used for different applications with increasing numbers, including intra-abdominal collection drainage, biliary and gastrointestinal interventions. LAMS are primarily placed using endoscopic ultrasound guidance. Building on our prior experience with percutaneous cholecysto-enteric anastomoses using LAMS, we now present our preliminary experience with the percutaneous creation of gastro-jejunal and jejunal to jejunal bypass anastomoses using LAMS for the treatment of afferent loop syndrome.

Materials and Methods: A retrospective single center review identified 3 patients with complex surgical histories presenting with clinical and radiographic signs of afferent loop syndrome. These patients underwent percutaneous creation of gastro-jejunal and jejunal-jejunal anastomoses using LAMS (Axios stent, Boston Scientific, Marlborough, MA, USA). The anastomoses were created using a percutaneous approach guided by ultrasonography, and fluoroscopy. As this is early in the development of the technique, passive endoscopic observation was also utilized.

Results: In all patients small bowel access was made in a direct percutaneous approach. In two patients a gastrojejunal anastomosis was created and in one patient a jejunal-jejunal bypass anastomosis created. Technical and clinical success was achieved in all patients with no intra-procedural or post procedural complications. One patient developed an additional more distal obstruction in the efferent limb treated with endoscopic placement of jejunal stents. Mean follow up for these patients was 871 days without reported clinical obstructive symptoms at anastomotic site or long term complications.

Conclusion: Percutaneous creation of enteric anastomosis using LAMS appears to be a safe and effective techniques on this very preliminary experience. The use of LAMS in Interventional Radiology should be further explored and expanded.