NDLI: Placing a lumen-apposing metal stent despite ascites: feasibility and safety.

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Placing a lumen-apposing metal stent despite ascites: feasibility and safety.

Content Provider	Europe PMC
Author	Irani, Shayan
Copyright Year	2020
Abstract	Background and AimsPlacing a lumen-apposing metal stent (LAMS) through ascites carries serious risks, including death from leakage around the LAMS and failure to create a mature fistula between the 2 lumens. However, sometimes no options exist or are equally dangerous. We present 5 patients who underwent LAMS placement despite ascites in 2 different locations.MethodsThis is a retrospective review of 5 patients who underwent LAMS placement despite ascites in 2 different locations from 2016 to 2018.ResultsThree patients with cholecystitis and 2 patients with afferent limb syndrome and severe ascites were treated with a combination of preprocedural and intraprocedural paracentesis. Serum ascites albumin gradient was measured. Weight was recorded daily. Patients were encouraged to sleep at an incline, and periodic paracentesis (every 3-7 days) was performed when ascites reaccumulated over 4 weeks. Median volume of ascites aspirated was 2 L preprocedurally and 300 mL intraprocedurally. Only 1 patient had ascites with a high serum ascites albumin gradient and was treated with diuretics. Technical and clinical success was achieved in all 5 patients without any adverse events over a median follow-up of 28 weeks.ConclusionsIn situations in which no better options remain, LAMS placement appears to be safe after adequate and aggressive treatment of the underlying ascites pre-, intra-, and postprocedurally. Larger studies are needed to establish the safety of this approach.
Journal	VideoGIE
Volume Number	5
PubMed Central reference number	PMC7652702
Issue Number	11
PubMed reference number	33204927
e-ISSN	24684481
DOI	10.1016/j.vgie.2020.07.017
Language	English
Publisher	Elsevier
Publisher Date	2020-08-21
Access Restriction	Open
Rights License	This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). © 2020 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc.
Subject Keyword	EUS-GBD, endoscopic ultrasound-guided gallbladder drainage EUS-GE, endoscopic ultrasound-guided gastroenterostomy LAMS, lumen-apposing metal stent SAAG, serum ascites albumin gradient
Content Type	Text
Resource Type	Article
Subject	Gastroenterology Radiology, Nuclear Medicine and Imaging

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