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Lumen-apposing metal stents: How far are we from standardization? An Italian survey

1 Gastroenterology and Digestive Endoscopy Unit, Forlì Cesena Hospitals, AUSL Romagna, Italy
2 Digestive Endoscopy Unit, Humanitas Clinical and Research Center–IRCCS, via Manzoni, Rozzano (MI), Italy
3 Department of Diagnostic and Therapeutic Services, Endoscopy Service, IRCCS-ISMETT, Palermo, Italy
4 The members of iEUS group are listed at the end of the article.

Correspondence Address:
Chiara Coluccio,
Gastroenterology and Digestive Endoscopy Unit, Forlì‑ Cesena Hospitals, AUSL Romagna, Via Carlo Forlanini 34, 47121, Forlì
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/EUS-D-21-00015

PMID: 34677143

Background and Objectives: EUS-guided transluminal drainage has increasingly developed, especially after the era of lumen-apposing metal stent (LAMS): a fully covered, barbell-shaped, metal stent with anti-migratory properties allowing direct therapeutic interventions through a wide and short channel. The aim of this survey is to investigate the current management of patients undergoing LAMS placement nationwide. Materials and Methods: Forty-eight questions were submitted to Italian centers about expertise, peri- and intra-procedural aspects, budget/refund, and future perspectives. Statistical analyzer was SPSS®. Results: Thirty-six centers completed the survey. Indications for LAMS positioning are pancreatic fluid collection drainage (PFCD, 97.2%), biliary drainage (BD, 80.5%), gallbladder drainage (GBD, 75%), and gastroentero-anastomosis (GEA, 19.4%). A total of 77.7% of the endoscopists perform only on-label procedures and 22.2% both on-label and off-label. 38.8% attended a training preliminary course, 27.7% were just supported by an expert, 22.2% had both the opportunities, and 8.3% none of them. Management of antiplatelets and sedation protocol is very heterogeneous. Only 50% involves a multidisciplinary meeting and 30.5% has a specialized clinic for follow-up. Acid suppression is usually continued after PFCD. The type and timing of postprocedural imaging varies widely. 8.3% of the endoscopists work without fluoroscopy. Refund for LAMS is mostly not guaranteed. Main future growing indications appear to be BD, GBD, and GEA (69.4%, 55.5%, and 55.5%, respectively). Conclusions: This is the first survey assessing the state of the art on LAMS almost 10 years after their advent. There are currently wide variations in practice nationwide, which demonstrates a pressing need to define technical, qualitative, and peri-procedural requirements to carry out this procedure, toward a standardization.

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