Copyright ©The Author(s) 2020.
World J Gastroenterol. Jun 7, 2020; 26(21): 2715-2728
Published online Jun 7, 2020. doi: 10.3748/wjg.v26.i21.2715
Table 1 Clinical pearls when performing procedures with lumen apposing metal stent
Type of procedureSummary of keys to success
Pancreatic fluid collection and walled-off necrosisTransgastric approach is typically recommended
Ensure collection is within one cm of the gastric wall
May be less effective for large collections extending into the paracolic gutters
EUS-guided gallbladder drainageEnsure the echoendoscope is advanced into the gastric antrum or duodenal bulb
Transgastric or transduodenal approach is recommended (transgastric preferred)
Freehand placement or over a wire after fine needle injection and dilation of tract
EUS-guided choledochoduodenostomyUse of a pigtail stent through LAMS to decrease risk of sump syndrome
Reserve LAMS use for optimal candidates for traditional metal stent placement
Gastric access temporary for endoscopyAvoid penetration of the diaphragm to minimize patient discomfort
Avoidance of gastric staple line to reduce risk of persistent gastro-gastric fistula
Consider gastro-gastric fistula to decrease risk of LAMS dislodgement
EUS-guided gastroenterostomyProne/swimmer’s positioning prior to beginning procedure
Distention of the bowel with dilute contrast and sterile water
Use of glucagon to decrease motility of the bowel
Placement of a wire may push small bowel away from the stomach
Benign gastrointestinal stricturesFirst traverse entire length of stricture (if possible)
Use of a guidewire is also important to prevent trauma
Post-surgical fluid collectionsFavorable collection locations include adjacent to stomach, duodenum, or rectum