P4488 - Novel Use of Biliary Fully Covered Self-Expanding Metal Stent for Management of Intraluminal Transmural Defects

Khushboo Gala, MBBS¹, Mayank Goyal, MBBS², Anmol Bains, MBBS², Ashwariya Ohri, MBBS², Fnu Deepali, MBBS², Navtej Buttar, MD^2
1Mayo Clinic School of Graduate Medical Education, Rochester, MN; ²Mayo Clinic, Rochester, MN

Introduction: Transmural defects like leaks, perforations, or fistulae involving a disruption in the wall of the gastrointestinal (GI) lumen are increasingly being managed endoscopically. Intraluminal stenting with fully covered self-expanding metal stents (FC-SEMS) in conjunction with other modalities is the cornerstone of management in these cases. A new biliary endoprosthesis with multiple expanded covered wire loops (“fins”) that serve as anchors to prevent stent migration is a unique FC-SEMS. Our study is the first reported use of this device for the management of intraluminal transmural defects.

Methods: We performed a retrospective review of all cases using this specific biliary endoprosthesis for intraluminal indications in our tertiary care endoscopic unit between 2011-2024. An acute defect was defined as one ≤30 days of diagnosis. Patient demographic and medical information were abstracted from the electronic medical records. Continuous variables were reported as mean ± standard deviation (SD), while categorical variables were reported as frequencies (%). Logistic regression modeling was performed to determine predictors of response to therapy.

Results: Our cohort comprised 199 patients, who were 38.7% (77) female with a mean age of 58.1 ± 15.0 years, with a mean follow-up of 397.4 ± 494 days (Table 1A). Defects were acute in 32.7% (65) of cases, most commonly benign stenosis and fistulae (Table 1B). Adjunctive therapies were used in 35.2% (70) cases, including hemostatic clips (10.6%), endoscopic suturing (9.6%), and dilation (7.5%). A median of one stent was placed, most commonly with a width of 10 mm (79.9%) and length of 10 cm (60.6%). Immediate technical success was seen in 98% (195) of cases. Favorable response was seen in 95% (189) of the cohort, with a complete response noted in 25.1% (50) cases; when sub-divided by indication of case, response rates were similar (Figure 1A and 1B). Predictors of complete response include acute defect (p < 0.01) and a non-IBD lesion (p = 0.01). Severe complications (requirement of ICU or emergency surgery, AGREE classification IIIb and beyond) only occurred in 1% (2) cases (Table 1C).

Discussion: The use of an anchored biliary FC-SEMS in the management of a variety of intraluminal transmural defects is safe, with immediate technical success in 98% of cases, and favorable response in 95% of cases. Higher success is noted in the management of lesions that are acutely diagnosed.



Disclosures:


Khushboo Gala, MBBS¹, Mayank Goyal, MBBS², Anmol Bains, MBBS², Ashwariya Ohri, MBBS², Fnu Deepali, MBBS², Navtej Buttar, MD². P4488 - Novel Use of Biliary Fully Covered Self-Expanding Metal Stent for Management of Intraluminal Transmural Defects, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.