Original article Clinical endoscopy| Volume 95, ISSUE 1, P115-122, January 2022

Download started.


Safety and efficacy of a novel electrocautery-enhanced lumen-apposing metal stent in interventional EUS procedures (with video)

Published:August 02, 2021DOI:

      Background and Aims

      Electrocautery-tip lumen-apposing metal stents (EC-LAMSs) have extended the indications of therapeutic EUS. We aimed to retrospectively evaluate safety and technical and clinical success of a newly developed EC-LAMS, the Hot-Spaxus (Taewoong Medical Co, Gimpo, Korea), for various EUS-guided procedures.


      We included and retrospectively analyzed consecutive patients at 8 tertiary care referral centers who had undergone EUS interventional procedures using the Hot-Spaxus between October 2018 and February 2021.


      Of 58 included patients (male-to-female, 36:22; mean age, 63.5 ± 14.9 years), 29 had undergone pancreatic fluid collection drainage (50%), 22 (37.9%) biliary drainage for malignant distal obstruction, 3 (5.1%) gallbladder drainage for acute cholecystitis, 3 gastroenteroanastomoses, and 1 (1.7%) pelvic collection drainage. Technical success was achieved in 54 of 58 patients (93.1%) and clinical success in all 58. Adverse events occurred in 6 patients (11.1%): 2 early (3.7%), 1 late (1.8%), and 3 long term (5.6%). The outcomes were similar to those observed in a control group of patients treated with the Hot-Axios (Boston Scientific, Marlborough, Mass, USA), the other available EC-LAMS.


      Our study showed that the novel EC-LAMS has high technical and clinical success rates for various interventional EUS indications. Future multicenter prospective studies will better clarify the role of this new EC-LAMS for different indications.

      Graphical abstract


      AE (adverse event), EUS-GBD (EUS-guided gallbladder drainage), EUS-GJ (EUS-guided gastrojejunostomy), EC-LAMS (electrocautery-tip lumen-apposing metal stent), GBD (gallbladder drainage), GOO (gastric outlet obstruction), LAMS (lumen-apposing metal stent), PFC (pancreatic fluid collection)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Gastrointestinal Endoscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Li J.
        • Basseri H.
        • Donnellan F.
        • et al.
        Lumen-apposing metals stents in advanced endoscopic ultrasound-guided interventions: novel applications, potential complications and radiologic assessment.
        Abdom Radiol. 2021; 46: 776-791
        • Wang A.Y.
        • Ellen K.
        • Berg C.L.
        • et al.
        Fully covered self-expandable metallic stents in the management of complex biliary leaks: preliminary data—a case series.
        Endoscopy. 2009; 41: 781-786
        • Teoh A.Y.
        • Ng E.K.
        • Chan S.M.
        • et al.
        Ex vivo comparison of the lumen-apposing properties of EUS-specific stents (with video).
        Gastrointest Endosc. 2016; 84: 62-68
        • Gupta K.
        • Perez-Miranda M.
        • Kahaleh M.
        • et al.
        Endoscopic ultrasound-assisted bile duct access and drainage: multicenter, long-term analysis of approach, outcomes, and complications of a technique in evolution.
        J Clin Gastroenterol. 2014; 48: 80-87
        • Artifon E.L.
        • Marson F.P.
        • Gaidhane M.
        • et al.
        Hepaticogastrostomy or choledochoduodenostomy for distal malignant biliary obstruction after failed ERCP: Is there any difference?.
        Gastrointest Endosc. 2015; 81: 950-959
        • Park S.W.
        • Lee S.S.
        Which are the most suitable stents for interventional. Endoscopic ultrasound?.
        J Clin Med. 2020; 9: 3595
        • Rinninella E.
        • Kunda R.
        • Dollhopf M.
        • et al.
        EUS-guided drainage of pancreatic fluid collections using a novel lumen-apposing metal stent on an electrocautery-enhanced delivery system: a large retrospective study (with video).
        Gastrointest Endosc. 2015; 82: 1039-1046
        • Kunda R.
        • Pérez-Miranda M.
        • Will U.
        • et al.
        EUS-guided choledochoduodenostomy for malignant distal biliary obstruction using a lumen-apposing fully covered metal stent after failed ERCP.
        Surg Endosc. 2016; 30: 5002-5008
        • Dollhopf M.
        • Larghi A.
        • Will U.
        • et al.
        EUS-guided gallbladder drainage in patients with acute cholecystitis and high surgical risk using an electrocautery-enhanced lumen-apposing metal stent device.
        Gastrointest Endosc. 2017; 86: 636-643
        • Schawkat K.
        • Luo M.
        • Lee K.
        • et al.
        Lumen-apposing covered self-expanding metallic stent for symptomatic pancreatic fluid collections: assessment of outcomes and complications with CT and MRI.
        Abdom Radiol (NY). 2021; 46: 757-767
        • Krishnamoorthi R.
        • Dasari C.S.
        • Thoguluva Chandrasekar V.
        • et al.
        Effectiveness and safety of EUS-guided choledochoduodenostomy using lumen-apposing metal stents (LAMS): a systematic review and meta-analysis.
        Surg Endosc. 2020; 34: 2866-2877
        • Luk S.W.
        • Irani S.
        • Krishnamoorthi R.
        • et al.
        Endoscopic ultrasound-guided gallbladder drainage versus percutaneous cholecystostomy for high risk surgical patients with acute cholecystitis: a systematic review and meta-analysis.
        Endoscopy. 2019; 51: 722-732
        • Antonelli G.
        • Kovacevic B.
        • Karstensen J.G.
        • et al.
        Endoscopic ultrasound-guided gastro-enteric anastomosis: a systematic review and meta-analysis.
        Dig Liver Dis. 2020; 52: 1294-1301
        • Mangiavillano B.
        • Auriemma F.
        • Bianchetti M.
        • et al.
        A cholecystoduodenostomy with a new type of lumen-apposing metal stent.
        Dig Liver Dis. 2020; (Epub 2020 Sept 1)
        • Yoo H.W.
        • Moon J.H.
        • Jo S.J.
        • et al.
        A novel electrocautery-enhanced delivery system for one-step endoscopic ultrasound-guided drainage of the gallbladder and bile duct using a lumen-apposing metal stent: a feasibility study.
        Endoscopy. 2021; 53: 922-926
        • Mangiavillano B.
        • Sosa-Valencia L.
        • Deprez P.
        • et al.
        Tissue acquisition and pancreatic masses: Which needle and which acquisition technique should be used?.
        Endosc Int Open. 2020; 8: E1315-E1320
        • Sharma V.
        • Rana S.S.
        • Bhasin D.K.
        Endoscopic ultrasound guided interventional procedures.
        World J Gastrointest Endosc. 2015; 7: 628-642
        • Hakim S.
        • Khan Z.
        • Shrivastava A.
        • et al.
        Endoscopic gastrointestinal anastomosis using lumen-apposing metal stent (LAMS) for benign or malignant etiologies: a systematic review and meta-analysis.
        J Clin Gastroenterol. 2021; 55: e56-e65
        • Mangiavillano B.
        • Auriemma F.
        • Mezzanzanica M.
        • et al.
        Fine needle biopsy plus EUS-guided cholecystojejunostomy by LAMS with a water-filled technique in a patient with Roux-en-Y reconstruction.
        Am J Gastroenterol. 2020; 115: 1572
        • Mangiavillano B.
        • Carrara S.
        • Eusebi L.H.
        • et al.
        Water-filled technique for therapeutic pancreato-biliary EUS in patients with surgically altered anatomy.
        Endosc Int Open. 2021; 9: E487-E489
        • Mangiavillano B.
        • Khashab M.A.
        • Tarantino I.
        • et al.
        Success and safety of endoscopic treatments for concomitant biliary and duodenal malignant stenosis: a review of the literature.
        World J Gastrointest Surg. 2019; 11: 53-61
        • Mangiavillano B.
        • Kunda R.
        • Robles-Medranda C.
        • et al.
        Lumen-apposing metal stent through the meshes of duodenal metal stents for palliation of malignant jaundice.
        Endosc Int Open. 2021; 9: E324-E330
        • Dorrell R.
        • Pawa S.
        • Pawa R.
        Endoscopic management of pancreatic fluid collections.
        J Clin Med. 2021; 10: 284