Takahashi K, Minami N, Horie K, Sudo T, Yamada N, Iwanaga T, Sakuma T, Kamezaki H. Long-term lumen-apposing metal stents in endoscopic ultrasound-guided gallbladder drainage: Late adverse events and stent removal. World J Gastrointest Endosc 2026; 18(9): 125352 [DOI: 10.4253/wjge.125352]
Corresponding Author of This Article
Koji Takahashi, MD, Department of Gastroenterology, Eastern Chiba Medical Center, 3-6-2, Okayamadai, Togane 283-8686, Chiba, Japan. takahashi.koji@chiba-u.jp
Research Domain of This Article
Gastroenterology & Hepatology
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review-article
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Takahashi K, Minami N, Horie K, Sudo T, Yamada N, Iwanaga T, Sakuma T, Kamezaki H. Long-term lumen-apposing metal stents in endoscopic ultrasound-guided gallbladder drainage: Late adverse events and stent removal. World J Gastrointest Endosc 2026; 18(9): 125352 [DOI: 10.4253/wjge.125352]
Koji Takahashi, Noa Minami, Kohei Horie, Taiga Sudo, Nana Yamada, Terunao Iwanaga, Takafumi Sakuma, Hidehiro Kamezaki, Department of Gastroenterology, Eastern Chiba Medical Center, Togane 283-8686, Chiba, Japan
Author contributions: Takahashi K conceived and designed the review and wrote the manuscript; Minami N, Horie K, and Sudo T performed the literature search and screened and selected the relevant studies; Yamada N and Iwanaga T assessed study eligibility, extracted the evidence and interpreted the findings; Sakuma T analyzed the extracted evidence and prepared the tables and figures; Kamezaki H supervised the review and critically revised the manuscript for important intellectual content; and all authors contributed to drafting or critically revising the manuscript, and have read and approved the final version.
AI contribution statement: No artificial intelligence tools were used during the preparation of this manuscript.
Supported by the Godo Shigen Grant for Academic Activities.
Conflict-of-interest statement: All authors declare that they have no conflicting interests related to this work.
Corresponding author: Koji Takahashi, MD, Department of Gastroenterology, Eastern Chiba Medical Center, 3-6-2, Okayamadai, Togane 283-8686, Chiba, Japan. takahashi.koji@chiba-u.jp
Received: July 8, 2026 Revised: August 17, 2026 Accepted: September 4, 2026 Published online: September 16, 2026 Processing time: 64 Days and 16.8 Hours
Abstract
Endoscopic ultrasound-guided gallbladder drainage with a lumen-apposing metal stent (LAMS) is an accepted alternative to percutaneous drainage for acute cholecystitis in patients unfit for surgery. Short-term technical and clinical success exceeds 95% in expert series, although rates in nationwide data are lower. The optimal subsequent management of the stent remains unresolved: It may be removed, exchanged for a plastic stent, or left in place indefinitely. This minireview summarizes the PubMed-indexed evidence on long-term indwelling LAMSs, focusing on late adverse events and removal. We group late events—food impaction, occlusion, buried LAMS syndrome, tissue overgrowth, bleeding, migration, and recurrent cholecystitis—by mechanism rather than name, and treat the three management strategies as a competing risks problem in which death is a competing event, not simply a censoring event. Removal eliminates stent-specific late events but introduces the risk of recurrence, whereas the apparently benign course of permanent stents partly reflects the reliance on crude proportions from cohorts whose follow-up is truncated by death. We propose deciding the stent’s fate at the index procedure, according to whether the patient is temporarily unfit for surgery or permanently inoperable. Prospective registries reporting cumulative incidence and a randomized comparison of removal vs retention are needed before this decision can become evidence-based.
Core Tip: Lumen-apposing metal stents were designed for short-term drainage, yet after endoscopic ultrasound-guided gallbladder drainage, many remain in place for years. We reframe the choice to remove, exchange, or retain as a competing risks decision. Removal prevents late stent-specific events but risks recurrent cholecystitis, whereas the apparent safety of permanent stents partly reflects the truncated follow-up of a high-mortality population. We argue for deciding the fate of the stent at the index procedure based on the clinical trajectory of the patient, reserving permanent placement for those who will never become surgical candidates, and we outline the prospective studies needed.
