From the Guidelines
The migration rate of lumen-apposing metal stents (LAMS) for choledochogastrostomy is reported to be around 4.8% to 22% in the literature, with a recent study suggesting a rate of 10.7% 1. When performing a choledochogastrostomy, which creates a connection between the bile duct and stomach for biliary drainage, LAMS are preferred over traditional stents due to their wider diameter and anti-migration features like dumbbell-shaped ends. Despite these design improvements, migration can still occur due to anatomical changes, improper stent sizing, or insufficient tissue apposition. To minimize migration risk, proper technique is essential, including:
- Accurate measurement of the bile duct
- Appropriate stent selection (typically 8-10mm diameter LAMS)
- Ensuring complete deployment with good tissue contact Patients should be monitored for signs of migration such as recurrent jaundice, abdominal pain, or cholangitis. Migration risk is highest in the first few weeks after placement, and decreases as tissue remodeling occurs around the stent. Regular follow-up with imaging is recommended to assess stent position and function, as suggested by recent studies 1. It is also important to consider the location of the stent placement, with some studies suggesting a higher risk of inward stent migration in the gastric antrum due to gastric contraction forces 1. Overall, the use of LAMS for choledochogastrostomy has been shown to be effective and safe, with high technical and clinical success rates, and a lower risk of complications compared to traditional stents 1.
From the Research
Migration Rate of LAMS for Choledochogastrostomy
- The migration rate of LAMS for choledochogastrostomy is not directly addressed in the provided studies, but we can look at the migration rates of LAMS in similar procedures:
- A study on LAMS for benign luminal gastrointestinal strictures reported a stent migration rate of 8.0% 2.
- A systematic review and meta-analysis on EUS-guided choledochoduodenostomy using LAMS or SEMS reported pooled rates of adverse events, including migration, but did not provide a specific migration rate for LAMS 3.
- A systematic review and meta-analysis on CDD using LAMS reported a pooled rate of post-procedure adverse events, including migration, of 5.2% 4.
- It's worth noting that the use of a dedicated over-the-scope fixation device may help prevent LAMS migration, as reported in a feasibility study on single-session EDGE procedures 5.
Comparison of LAMS and SEMS
- A systematic review and meta-analysis compared the efficacy and safety of LAMS and SEMS for EUS-guided choledochoduodenostomy, and found that they are comparable in terms of clinical and technical success, adverse events, and reintervention rates 3.
Safety and Efficacy of LAMS
- The provided studies suggest that LAMS are a safe and effective option for various endoscopic procedures, including choledochogastrostomy and choledochoduodenostomy 2, 6, 3, 4.
- However, the migration rate of LAMS for choledochogastrostomy is not well established, and further studies are needed to assess the safety and efficacy of LAMS for this specific procedure.