Prevention and Management of Electrocautery-enhanced Lumen-apposing Metal Stent (EC-LAMS) Complications

Electrocautery-enhanced lumen apposing metal stents (EC-LAMS) have dramatically expanded the therapeutic capabilities of endoscopic ultrasound (EUS). Originally developed to make pseudocyst drainage more efficient, they are increasingly used to facilitate pancreatic necrosectomy, perform gallbladder and bile duct drainage, to create endoscopic gastroenterostomy, and as a conduit to the excluded stomach to facilitate endoscopic retrograde cholangiopancreatography (ERCP) in Roux en Y gastric bypass (RYGB) anatomy, among many other uses. In these settings, EC-LAMS offers substantial advantages to other available approaches. Yet, a major limitation to widespread adoption outside of high-volume referral centers is the high rate of adverse events (AEs) with EC-LAMS, which can occur in up to 1 in 5 patients. Misdeployment is a particularly dreaded complication; other common AEs include bleeding, peritoneal leak, stent occlusion, and stent migration. In this narrative review, we discuss risk factors associated with AEs for different EC-LAMS procedures and review general and procedure-specific measures to prevent complications. We also highlight techniques to successfully manage AEs.