International Consensus Recommendations for Safe Use of LAMS for On- and Off-Label Indications Using a Modified...

Area of Science:

• Gastroenterology
• Interventional Endoscopy

Background:

• Lumen-apposing metal stents (LAMSs) are increasingly used for various gastrointestinal procedures.
• Standardized guidelines for their safe application are crucial for optimal patient outcomes.

Purpose of the Study:

• To establish international consensus recommendations for the safe use of LAMSs.
• To address both on-label and off-label indications for LAMS placement.

Main Methods:

• A modified Delphi process involving international LAMS experts.
• Formulation and evidence grading of statements using the GRADE methodology.
• Iterative refinement of statements based on expert feedback to achieve consensus.

Main Results:

• 93.3% of 60 formulated statements were accepted, with 58.3% consensus in the first round.
• Consensus reached on optimal learning curves, imaging, safety measures, and procedural techniques.
• Specific recommendations developed for peripancreatic fluid collections, biliary/gallbladder drainage, and gastroenterostomy.

Conclusions:

• Developed general and indication-specific, evidence- and experience-based recommendations for safe LAMS use.
• The Delphi process facilitated international agreement on critical aspects of LAMS application.
• These recommendations aim to improve safety and efficacy in LAMS procedures.