{"id":4874,"date":"2021-04-27T09:00:11","date_gmt":"2021-04-27T09:00:11","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/pt\/?p=4874"},"modified":"2023-03-13T15:31:27","modified_gmt":"2023-03-13T15:31:27","slug":"protese-metalica-de-aposicao-luminal-lams-2","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/protese-metalica-de-aposicao-luminal-lams-2\/","title":{"rendered":"Pr\u00f3tese met\u00e1lica de aposi\u00e7\u00e3o luminal (LAMS)"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"4874\" class=\"elementor elementor-4874\">\n\t\t\t\t\t\t<section class=\"penci-section penci-disSticky penci-structure-10 elementor-section elementor-top-section elementor-element elementor-element-38c0d6b7 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"38c0d6b7\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"penci-ercol-100 penci-ercol-order-1 penci-sticky-ct    elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-733eb3a9\" data-id=\"733eb3a9\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-4dd60545 elementor-widget elementor-widget-text-editor\" data-id=\"4dd60545\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<span style=\"font-weight: 400;\">As pr\u00f3teses met\u00e1licas de aposi\u00e7\u00e3o luminal, <\/span><i><span\n        style=\"font-weight: 400;\">lumen-apposing metal stents<\/span><\/i><span style=\"font-weight: 400;\"> (LAMS),\n    representam um avan\u00e7o significativo devido ao seu desenho com flanges perpendiculares e capacidade de segurar duas\n    estruturas luminais em aposi\u00e7\u00e3o.<\/span>\n\n<span style=\"font-weight: 400;\">S\u00e3o compostas de uma malha de nitinol tran\u00e7ada e totalmente recobertas por uma membrana\n    de silicone, prevenindo assim vazamentos, <\/span><i><span style=\"font-weight: 400;\">ingrowth<\/span><\/i><span\n    style=\"font-weight: 400;\"> (crescimento interno de tecido) e possibilitando sua remo\u00e7\u00e3o com certa facilidade.<\/span>\n\n<span style=\"font-weight: 400;\">Sua forma de haltere e amplo di\u00e2metro interno oferecem uma melhor drenagem interna,\n    redu\u00e7\u00e3o da taxa de oclus\u00e3o, preven\u00e7\u00e3o da migra\u00e7\u00e3o, bem como passagem interna do endosc\u00f3pio para procedimentos\n    terap\u00eauticos adicionais [1].<\/span>\n\n<img fetchpriority=\"high\" decoding=\"async\" class=\"size-medium wp-image-7748 aligncenter\"\n    src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/04\/FIGURA-1-300x300.jpg\" alt=\"\" width=\"300\"\n    height=\"300\" srcset=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/04\/FIGURA-1-300x300.jpg 300w, https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/04\/FIGURA-1-150x150.jpg 150w, https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/04\/FIGURA-1-70x70.jpg 70w, https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/04\/FIGURA-1.jpg 460w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/>\n<p style=\"text-align: center;\">Figura 1: pr\u00f3tese de aposi\u00e7\u00e3o luminal Axios (Boston Scientific\u2122<\/p>\n<strong>1\u00aa Gera\u00e7\u00e3o<\/strong><span style=\"font-weight: 400;\"><strong>:<\/strong> requerem uma abordagem em m\u00faltiplas\n    etapas. As les\u00f5es s\u00e3o acessadas por pun\u00e7\u00e3o com agulha 19-G, seguido da passagem de um fio guia de 0,025 ou 0,035\n    polegadas para manter a posi\u00e7\u00e3o e subsequente dilata\u00e7\u00e3o (com cist\u00f3tomo ou <\/span><i><span\n        style=\"font-weight: 400;\">needle knife<\/span><\/i><span style=\"font-weight: 400;\"> seguido de bal\u00e3o hidrost\u00e1tico)\n    do trato para passagem do dispositivo de introdu\u00e7\u00e3o do LAMS. O introdutor LAMS \u00e9 passado pelo aparelho, e o flange\n    distal \u00e9 liberado sob controle ecoendosc\u00f3pico. Uma vez que o flange distal est\u00e1 totalmente aberto, uma leve tens\u00e3o \u00e9\n    aplicada para opor as 2 estruturas antes da libera\u00e7\u00e3o do flange proximal sob visualiza\u00e7\u00e3o endosc\u00f3pica direta\n    [1].<\/span>\n\n<strong>2\u00aa Gera\u00e7\u00e3o <i>(hot)<\/i><i>:<\/i><\/strong><span style=\"font-weight: 400;\"> possibilitam a realiza\u00e7\u00e3o em etapa\n    \u00fanica usando eletrocauteriza\u00e7\u00e3o. A inser\u00e7\u00e3o <\/span><i><span style=\"font-weight: 400;\">hot<\/span><\/i><span\n    style=\"font-weight: 400;\"> \u00e9 feita por meio da aplica\u00e7\u00e3o de corrente de corte de alta frequ\u00eancia pela ponta do\n    dispositivo, permitindo o acesso transmural sem dilata\u00e7\u00e3o pr\u00e9via do trato. A inser\u00e7\u00e3o em uma \u00fanica etapa minimiza\n    trocas de acess\u00f3rios, reduzindo erros t\u00e9cnicos e tempo de procedimento [1].<\/span>\n\n<img decoding=\"async\" class=\"size-medium wp-image-7749 aligncenter\"\n    src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/04\/FIGURA-2-300x300.jpg\" alt=\"\" width=\"300\"\n    height=\"300\" srcset=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/04\/FIGURA-2-300x300.jpg 300w, https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/04\/FIGURA-2-150x150.jpg 150w, https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/04\/FIGURA-2-70x70.jpg 70w, https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/04\/FIGURA-2.jpg 461w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/>\n<p style=\"text-align: center;\">Figura 2: sistema de libera\u00e7\u00e3o da LAMS<\/p>\n\n<h2>Axios (Boston Scientific\u2122)<\/h2>\n<span style=\"font-weight: 400;\">\u00c9 a mais utilizada e bem estudada da literatura. Devido \u00e0 facilidade de manejo,\n    atualmente, \u00e9 mais optada a vers\u00e3o Hot Axios (2\u00aa gera\u00e7\u00e3o). Apresenta tamanhos de di\u00e2metro de l\u00famen de 6, 8, 10, 15 e\n    20 mm.<\/span>\n\n<span style=\"font-weight: 400;\">O sistema de libera\u00e7\u00e3o \u00e9 controlado por um \u00fanico operador e \u00e9 dividido em um controle de\n    introdu\u00e7\u00e3o do cateter (inferior) e um controle de libera\u00e7\u00e3o do <\/span><i><span\n        style=\"font-weight: 400;\">stent<\/span><\/i><span style=\"font-weight: 400;\"> (superior). O mecanismo de libera\u00e7\u00e3o\n    do cateter tamb\u00e9m oferece uma parada r\u00edgida entre a implanta\u00e7\u00e3o do flange distal e proximal, evitando libera\u00e7\u00e3o\n    inadvertida no l\u00famen do cisto.<\/span>\n\n<span style=\"font-weight: 400;\">Veja abaixo o v\u00eddeo do sistema de libera\u00e7\u00e3o:<\/span>\n\n<div  id=\"_ytid_19383\"  width=\"600\" height=\"300\"  data-origwidth=\"600\" data-origheight=\"300\" data-facadesrc=\"https:\/\/www.youtube.com\/embed\/jc7riFg-dPY?enablejsapi=1&#038;autoplay=0&#038;cc_load_policy=0&#038;cc_lang_pref=&#038;iv_load_policy=1&#038;loop=0&#038;rel=1&#038;fs=1&#038;playsinline=0&#038;autohide=2&#038;theme=dark&#038;color=red&#038;controls=1&#038;disablekb=0&#038;\" class=\"__youtube_prefs__ epyt-facade __youtube_prefs_widget__  epyt-is-override  no-lazyload\" data-epautoplay=\"1\" ><img decoding=\"async\" data-spai-excluded=\"true\" class=\"epyt-facade-poster skip-lazy\" loading=\"lazy\"  alt=\"YouTube player\"  src=\"https:\/\/i.ytimg.com\/vi\/jc7riFg-dPY\/maxresdefault.jpg\"  \/><button class=\"epyt-facade-play\" aria-label=\"Play\"><svg data-no-lazy=\"1\" height=\"100%\" version=\"1.1\" viewBox=\"0 0 68 48\" width=\"100%\"><path class=\"ytp-large-play-button-bg\" d=\"M66.52,7.74c-0.78-2.93-2.49-5.41-5.42-6.19C55.79,.13,34,0,34,0S12.21,.13,6.9,1.55 C3.97,2.33,2.27,4.81,1.48,7.74C0.06,13.05,0,24,0,24s0.06,10.95,1.48,16.26c0.78,2.93,2.49,5.41,5.42,6.19 C12.21,47.87,34,48,34,48s21.79-0.13,27.1-1.55c2.93-0.78,4.64-3.26,5.42-6.19C67.94,34.95,68,24,68,24S67.94,13.05,66.52,7.74z\" fill=\"#f00\"><\/path><path d=\"M 45,24 27,14 27,34\" fill=\"#fff\"><\/path><\/svg><\/button><\/div>\n\n<span style=\"font-weight: 400;\">Outros modelos de LAMS s\u00e3o: as sul-coreanas Spaxus (Taewoong Medical<\/span><span\n    style=\"font-weight: 400;\">\u2122<\/span><span style=\"font-weight: 400;\">), Nagi (Taewoong Medical<\/span><span\n    style=\"font-weight: 400;\">\u2122<\/span><span style=\"font-weight: 400;\">) e Hanarostent (M.I. Tech<\/span><span\n    style=\"font-weight: 400;\">\u2122<\/span><span style=\"font-weight: 400;\">), al\u00e9m da alem\u00e3 Aixstent (Leufen\n    Medical<\/span><span style=\"font-weight: 400;\">\u2122<\/span><span style=\"font-weight: 400;\">).<\/span>\n<h2>Indica\u00e7\u00f5es <span style=\"font-weight: 400;\">[2]<\/span><\/h2>\n<ul>\n    <li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Drenagem de cole\u00e7\u00f5es pancre\u00e1ticas\n            (pseudocisto e <\/span><i><span style=\"font-weight: 400;\">walled-off necrosis<\/span><\/i><span\n            style=\"font-weight: 400;\">);<\/span><\/li>\n    <li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Drenagem da via biliar:\n            coledocoduodenostomia;<\/span><\/li>\n    <li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Drenagem da ves\u00edcula biliar\n            (colecistite);<\/span><\/li>\n    <li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Gastrojejunostomia (obstru\u00e7\u00f5es\n            gastroduodenais);<\/span><\/li>\n    <li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Confec\u00e7\u00e3o de f\u00edstula gastrog\u00e1strica\n            (acesso \u00e0 CPRE em paciente com <\/span><i><span style=\"font-weight: 400;\">by-pass<\/span><\/i><span\n            style=\"font-weight: 400;\">);<\/span><\/li>\n    <li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Realiza\u00e7\u00e3o de enteroenteroanastomose\n            (tratamento da s\u00edndrome da al\u00e7a aferente);<\/span><\/li>\n    <li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Estenoses benignas do trato\n            gastrointestinal (seu formato diminui a taxa de migra\u00e7\u00e3o comparado com pr\u00f3teses tradicionais);<\/span><\/li>\n    <li style=\"font-weight: 400;\" aria-level=\"1\">Drenagem de cole\u00e7\u00f5es cavit\u00e1rias<b>.<\/b><\/li>\n<\/ul>\n<h3>Drenagem de cole\u00e7\u00f5es pancre\u00e1ticas<\/h3>\n<span style=\"font-weight: 400;\">Representam um grupo heterog\u00eaneo de doen\u00e7as, e a decis\u00e3o de usar um LAMS em vez de\n<\/span><i><span style=\"font-weight: 400;\">stents<\/span><\/i><span style=\"font-weight: 400;\"> pl\u00e1sticos permanece uma\n    escolha caso a caso. Os <\/span><i><span style=\"font-weight: 400;\">stents<\/span><\/i><span style=\"font-weight: 400;\">\n    pl\u00e1sticos parecem ter efic\u00e1cia equivalente para drenagem de pseudocisto simples e provavelmente s\u00e3o mais baratos\n    quando usados nesse cen\u00e1rio. Cole\u00e7\u00f5es heterog\u00eaneas e <\/span><i><span style=\"font-weight: 400;\">walled off\n        necrosis<\/span><\/i><span style=\"font-weight: 400;\"> parecem mais adequados para o uso de LAMS, e resultados\n    cl\u00ednicos superiores mostram essa dire\u00e7\u00e3o [1]. Recente revis\u00e3o sistem\u00e1tica e metan\u00e1lise que incluiu 1534 pacientes\n    confirmou que o LAMS apresenta vantagens sobre os <\/span><i><span style=\"font-weight: 400;\">stents<\/span><\/i><span\n    style=\"font-weight: 400;\"> pl\u00e1sticos, com maior taxa de sucesso cl\u00ednico e menor taxa de infec\u00e7\u00e3o e oclus\u00e3o [3].\n    Outro benef\u00edcio dos LAMS nas cole\u00e7\u00f5es complicadas \u00e9 a possibilidade de acesso endosc\u00f3pico direto para realiza\u00e7\u00e3o de\n    sess\u00f5es de necrosectomias (LAMS de 15 e 20 mm). Os LAMS n\u00e3o podem ficar locados definitivamente, se ap\u00f3s 3 ou 4\n    semanas a cole\u00e7\u00e3o j\u00e1 tiver sido resolvida, eles devem ser retirados e, apenas nos casos de ruptura de ducto\n    pancre\u00e1tico n\u00e3o resolvida, colocados <\/span><i><span style=\"font-weight: 400;\">stents<\/span><\/i><span\n    style=\"font-weight: 400;\"> pl\u00e1sticos duplos pigtail.<\/span>\n\n<div style=\"position:relative;padding-top:56.25%;\"><iframe id=\"panda-b6d18034-0151-4f2a-add8-c97aa0371326\"\n        src=\"https:\/\/player-vz-a75e9d45-986.tv.pandavideo.com.br\/embed\/?v=b6d18034-0151-4f2a-add8-c97aa0371326\"\n        style=\"border:none;position:absolute;top:0;left:0;\"\n        allow=\"accelerometer;gyroscope;autoplay;encrypted-media;picture-in-picture\" allowfullscreen=true width=\"100%\"\n        height=\"100%\" fetchpriority=\"high\"><\/iframe><\/div>\n\n<span style=\"font-weight: 400;\">V\u00eddeo 1: uso de LAMS seguido de passagem de pr\u00f3tese duplo pigtail na drenagem de\n    pseudocisto. Cortesia do Dr. Gustavo Lu\u00eds Rodela Silva, GLR.<\/span>\n<h3>Drenagem biliar<\/h3>\n<span style=\"font-weight: 400;\">S\u00e3o utilizados os stents de 6 e 8 mm. As indica\u00e7\u00f5es mais comuns para esse procedimento\n    s\u00e3o a falha na canula\u00e7\u00e3o papilar por neoplasia maligna avan\u00e7ada ou falta de acesso \u00e0 papila devido \u00e0 anatomia\n    alterada cirurgicamente. Em revis\u00e3o sistem\u00e1tica e metan\u00e1lise publicada em 2020, demonstrou seguran\u00e7a e efetividade\n    do uso de LAMS nos casos de falha na <\/span><a\n    href=\"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/cpre-em-pacientes-com-y-de-roux\/\"><span\n        style=\"font-weight: 400;\">CPRE<\/span><\/a><span style=\"font-weight: 400;\"> [4], entretanto, outra recente\n    revis\u00e3o, apesar da facilidade t\u00e9cnica do uso das LAMS, demonstrou resultados semelhantes comparado \u00e0 drenagem\n    ecoguiada com pr\u00f3teses met\u00e1licas biliares tradicionais [6].<\/span>\n<h3>Colecistite<\/h3>\n<span style=\"font-weight: 400;\">Em pacientes sem condi\u00e7\u00f5es cir\u00fargicas, a drenagem ecoendosc\u00f3pica demonstrou sucesso\n    t\u00e9cnico e cl\u00ednico compar\u00e1vel com a drenagem percut\u00e2nea, al\u00e9m de menor tempo de interna\u00e7\u00e3o, dor e necessidade de\n    reinterven\u00e7\u00f5es [6].<\/span>\n<h3>Gastrojejunostomia<\/h3>\n<span style=\"font-weight: 400;\">Esse procedimento \u00e9 uma alternativa nos casos de obstru\u00e7\u00e3o gastroduodenal, especialmente\n    tumoral, perante a passagem de pr\u00f3tese met\u00e1lica ou mesmo a gastrojejunostomia cir\u00fargica. A t\u00e9cnica consiste em uma\n    pun\u00e7\u00e3o atrav\u00e9s da parede g\u00e1strica de uma al\u00e7a jejunal distendida por l\u00edquido infundido previamente, ou mesmo por um\n    bal\u00e3o preenchido, permitindo a identifica\u00e7\u00e3o da al\u00e7a. O procedimento ecoendosc\u00f3pico tem o potencial de oferecer\n    permeabilidade luminal de longa dura\u00e7\u00e3o, evitando o <\/span><i><span\n        style=\"font-weight: 400;\">ingrowth<\/span><\/i><span style=\"font-weight: 400;\"> que ocorre nas pr\u00f3teses duodenais\n    e tem menor morbidade comparado a um procedimento cir\u00fargico. Foi demonstrando um sucesso t\u00e9cnico de at\u00e9 90% [7] e\n    taxa de reinterven\u00e7\u00e3o de 6,1%, comparado aos 30,3% nos <\/span><i><span style=\"font-weight: 400;\">stents\n    <\/span><\/i><span style=\"font-weight: 400;\">duodenais [8].<\/span>\n<h3>Confec\u00e7\u00e3o de f\u00edstula gastrog\u00e1strica<\/h3>\n<span style=\"font-weight: 400;\">Nos pacientes com doen\u00e7as pancreatobiliares com necessidade de CPRE, por\u00e9m com anatomia\n    cir\u00fargica alterada (gastroplastia redutora em Y de Roux), \u00e9 poss\u00edvel a realiza\u00e7\u00e3o de f\u00edstula com est\u00f4mago excluso,\n    seguida de espera de 2 a 3 semanas para matura\u00e7\u00e3o local e posterior passagem do duodenosc\u00f3pio para acesso \u00e0 papila.\n    Apesar de rebuscada, pode ser uma op\u00e7\u00e3o \u00e0 enteroscopia ou mesmo \u00e0 realiza\u00e7\u00e3o de gastrostomia cir\u00fargica para passagem\n    do duodenosc\u00f3pio.<\/span>\n<h3><b>C<\/b>onfec\u00e7\u00e3o de enteroenteroanastomose<\/h3>\n<span style=\"font-weight: 400;\">Na s\u00edndrome da al\u00e7a aferente ocorre uma obstru\u00e7\u00e3o na al\u00e7a biliopancre\u00e1tica, levando a\n    dor, v\u00f4mitos biliosos e distens\u00e3o da al\u00e7a. Apesar do tratamento ser tradicionalmente cir\u00fargico, uma op\u00e7\u00e3o de menor\n    morbidade \u00e9 a coloca\u00e7\u00e3o de LAMS drenando o segmento obstru\u00eddo, criando um pertuito para drenagem local.<\/span>\n<h3>Estenoses benignas do trato gastrointestinal<\/h3>\n<span style=\"font-weight: 400;\">Em algumas estenoses complexas, ou mesmo nos casos em que ocorreu migra\u00e7\u00e3o pr\u00e9via de\n    pr\u00f3tese met\u00e1lica tradicional, o uso do LAMS pode ser uma op\u00e7\u00e3o de resgate no tratamento dessas condi\u00e7\u00f5es. Outra\n    indica\u00e7\u00e3o \u00e9 para casos de estenoses em reto distal, em que pr\u00f3teses longas causam tenesmo.<\/span>\n<h3>Drenagem de cole\u00e7\u00f5es cavit\u00e1rias<\/h3>\n<span style=\"font-weight: 400;\">O uso de LAMS para drenagem de abscessos surgiu como uma alternativa \u00e0 t\u00e9cnica\n    percut\u00e2nea, devido inclusive a algumas limita\u00e7\u00f5es, como interposi\u00e7\u00e3o de \u00f3rg\u00e3os e desconforto do paciente com a\n    drenagem externa. A drenagem ecoguiada n\u00e3o tem essas limita\u00e7\u00f5es, e os abscessos costumam estar pr\u00f3ximos ao trato\n    gastrointestinal [9].<\/span>\n\n<span style=\"font-weight: 400;\">Outra poss\u00edvel aplica\u00e7\u00e3o futura pode ser no tratamento da obesidade. Ap\u00f3s a sutura\n    endosc\u00f3pica do piloro, uma f\u00edstula gastrojejunal pode ser criada usando LAMS, semelhante a uma gastroplastia em Y de\n    Roux [9].<\/span>\n<h2>Eventos adversos <span style=\"font-weight: 400;\">[9]<\/span><\/h2>\n<h3>Sangramento intraprocedimento<\/h3>\n<span style=\"font-weight: 400;\">O sangramento da mucosa pode ser interrompido pela aplica\u00e7\u00e3o local de corrente pelo\n    eletrocaut\u00e9rio. Quando a hemorragia intralesional \u00e9 observada, um fio guia pode ser avan\u00e7ado atrav\u00e9s do l\u00famen do\n    sistema introdutor do LAMS e trocado por uma agulha FNA 19-G. A ponta da agulha FNA \u00e9 ent\u00e3o posicionada no local do\n    sangramento, e a epinefrina pode ser administrada at\u00e9 que o sangramento cesse. Se o sangramento for persistente, a\n    radiointerven\u00e7\u00e3o pode ser necess\u00e1ria.<\/span>\n<h3>Sangramento tardio<\/h3>\n<span style=\"font-weight: 400;\">S\u00e3o geralmente secund\u00e1rios \u00e0 coagulopatia, entretanto podem ocorrer devido \u00e0 trauma do\n    LAMS em vasos adjacentes, especialmente ap\u00f3s drenagens pancre\u00e1ticas. Dessa forma, ap\u00f3s a resolu\u00e7\u00e3o da cole\u00e7\u00e3o, devem\n    ser retirados para prevenir esse tipo de complica\u00e7\u00e3o.<\/span>\n<h3>Ades\u00e3o \u00e0 parede (burried)<\/h3>\n<span style=\"font-weight: 400;\">Ap\u00f3s longos per\u00edodos, o LAMS pode ficar aderido \u00e0 parede g\u00e1strica, com dificuldade de\n    sua retirada. Nesses casos, deve ser realizada uma dilata\u00e7\u00e3o do l\u00famen para 15 mm, seguido de tra\u00e7\u00e3o com pin\u00e7a de\n    corpo estranho.<\/span>\n<h3>Obstru\u00e7\u00e3o biliar<\/h3>\n<span style=\"font-weight: 400;\">Nas drenagens no <a\n        href=\"https:\/\/endoscopiaterapeutica.net\/pt\/categoria\/imagens\/orgao\/duodeno\/\">duodeno<\/a> proximal, uma vez que a\n    cole\u00e7\u00e3o foi resolvida, o flange distal do LAMS pode comprimir a via biliar causando icter\u00edcia. A remo\u00e7\u00e3o do LAMS e a\n    coloca\u00e7\u00e3o de um stent pl\u00e1stico resolver\u00e3o a complica\u00e7\u00e3o.<\/span>\n\n<span style=\"font-weight: 400;\">\u00a0<\/span><span style=\"font-weight: 400;\">As LAMS representam um grande avan\u00e7o t\u00e9cnico na\n    <a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/\" target=\"_blank\" rel=\"noopener\">endoscopia terap\u00eautica<\/a>\n    transluminal, possibilitando o acesso de estruturas adjacentes, levando a uma gama de interven\u00e7\u00f5es e diminuindo a\n    necessidade de acesso cir\u00fargico e\/ou percut\u00e2neo. Sua pesquisa e desenvolvimento dever\u00e3o aprimorar sua seguran\u00e7a, bem\n    como expans\u00e3o de sua aplica\u00e7\u00e3o para outras indica\u00e7\u00f5es.<\/span>\n\n<span style=\"font-weight: 400;\">Veja tamb\u00e9m alguns casos com a utiliza\u00e7\u00e3o dos LAMS:<\/span>\n<ul>\n    <li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.youtube.com\/watch?v=krzHx0WFS-0\"><span\n                style=\"font-weight: 400;\">Drenagem ecoguiada de forma\u00e7\u00e3o pseudoc\u00edstica pancre\u00e1tica<\/span><\/a><span\n            style=\"font-weight: 400;\">;<\/span><\/li>\n    <li style=\"font-weight: 400;\" aria-level=\"1\"><a\n            href=\"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/tratamento-endoscopico-de-sindrome-da-alca-aferente-com-axios-stent\/\"><span\n                style=\"font-weight: 400;\">Tratamento endosc\u00f3pico da s\u00edndrome da al\u00e7a aferente com LAMS<\/span><\/a><span\n            style=\"font-weight: 400;\">;<\/span><\/li>\n    <li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.youtube.com\/watch?v=qcrv3S0TIZQ\"><span\n                style=\"font-weight: 400;\">Gastroenterostomia guiada por EUS<\/span><\/a><span\n            style=\"font-weight: 400;\">.<\/span><\/li>\n<\/ul>\n<span style=\"font-weight: 400;\">Quer saber mais sobre a pr\u00f3tese Hot Axios? Links com v\u00eddeos passo a passo da\n    utiliza\u00e7\u00e3o:<\/span>\n\n<div  id=\"_ytid_65062\"  width=\"600\" height=\"300\"  data-origwidth=\"600\" data-origheight=\"300\" data-facadesrc=\"https:\/\/www.youtube.com\/embed\/jc7riFg-dPY?enablejsapi=1&#038;autoplay=0&#038;cc_load_policy=0&#038;cc_lang_pref=&#038;iv_load_policy=1&#038;loop=0&#038;rel=1&#038;fs=1&#038;playsinline=0&#038;autohide=2&#038;theme=dark&#038;color=red&#038;controls=1&#038;disablekb=0&#038;\" class=\"__youtube_prefs__ epyt-facade __youtube_prefs_widget__  epyt-is-override  no-lazyload\" data-epautoplay=\"1\" ><img decoding=\"async\" data-spai-excluded=\"true\" class=\"epyt-facade-poster skip-lazy\" loading=\"lazy\"  alt=\"YouTube player\"  src=\"https:\/\/i.ytimg.com\/vi\/jc7riFg-dPY\/maxresdefault.jpg\"  \/><button class=\"epyt-facade-play\" aria-label=\"Play\"><svg data-no-lazy=\"1\" height=\"100%\" version=\"1.1\" viewBox=\"0 0 68 48\" width=\"100%\"><path class=\"ytp-large-play-button-bg\" d=\"M66.52,7.74c-0.78-2.93-2.49-5.41-5.42-6.19C55.79,.13,34,0,34,0S12.21,.13,6.9,1.55 C3.97,2.33,2.27,4.81,1.48,7.74C0.06,13.05,0,24,0,24s0.06,10.95,1.48,16.26c0.78,2.93,2.49,5.41,5.42,6.19 C12.21,47.87,34,48,34,48s21.79-0.13,27.1-1.55c2.93-0.78,4.64-3.26,5.42-6.19C67.94,34.95,68,24,68,24S67.94,13.05,66.52,7.74z\" fill=\"#f00\"><\/path><path d=\"M 45,24 27,14 27,34\" fill=\"#fff\"><\/path><\/svg><\/button><\/div>\n\n<div  id=\"_ytid_30119\"  width=\"600\" height=\"300\"  data-origwidth=\"600\" data-origheight=\"300\" data-facadesrc=\"https:\/\/www.youtube.com\/embed\/AX4wo7ufuQs?enablejsapi=1&#038;autoplay=0&#038;cc_load_policy=0&#038;cc_lang_pref=&#038;iv_load_policy=1&#038;loop=0&#038;rel=1&#038;fs=1&#038;playsinline=0&#038;autohide=2&#038;theme=dark&#038;color=red&#038;controls=1&#038;disablekb=0&#038;\" class=\"__youtube_prefs__ epyt-facade __youtube_prefs_widget__  epyt-is-override  no-lazyload\" data-epautoplay=\"1\" ><img decoding=\"async\" data-spai-excluded=\"true\" class=\"epyt-facade-poster skip-lazy\" loading=\"lazy\"  alt=\"YouTube player\"  src=\"https:\/\/i.ytimg.com\/vi\/AX4wo7ufuQs\/maxresdefault.jpg\"  \/><button class=\"epyt-facade-play\" aria-label=\"Play\"><svg data-no-lazy=\"1\" height=\"100%\" version=\"1.1\" viewBox=\"0 0 68 48\" width=\"100%\"><path class=\"ytp-large-play-button-bg\" d=\"M66.52,7.74c-0.78-2.93-2.49-5.41-5.42-6.19C55.79,.13,34,0,34,0S12.21,.13,6.9,1.55 C3.97,2.33,2.27,4.81,1.48,7.74C0.06,13.05,0,24,0,24s0.06,10.95,1.48,16.26c0.78,2.93,2.49,5.41,5.42,6.19 C12.21,47.87,34,48,34,48s21.79-0.13,27.1-1.55c2.93-0.78,4.64-3.26,5.42-6.19C67.94,34.95,68,24,68,24S67.94,13.05,66.52,7.74z\" fill=\"#f00\"><\/path><path d=\"M 45,24 27,14 27,34\" fill=\"#fff\"><\/path><\/svg><\/button><\/div>\n\n&nbsp;\n\n<span style=\"font-weight: 400;\">D\u00ea uma conferida no site da empresa: <\/span><a\n    href=\"https:\/\/www.bostonscientific.com\/pt-BR\/produtos\/stents-gastrointestinais\/axios-stent-e-sistema-de-entrega-aprimorado-de-eletrocautery.html\"><span\n        style=\"font-weight: 400;\">https:\/\/www.bostonscientific.com\/pt-BR\/produtos\/stents-gastrointestinais\/axios-stent-e-sistema-de-entrega-aprimorado-de-eletrocautery.html<\/span><\/a>\n<h2>Agradecimentos<\/h2>\n<span style=\"font-weight: 400;\">Agrade\u00e7o ao Dr. Gustavo Lu\u00eds Rodela Silva pela cess\u00e3o do v\u00eddeo sobre LAMS.<\/span>\n<h3>Como citar este artigo<\/h3>\n<span style=\"font-weight: 400;\">Oliveira JF. Pr\u00f3tese Met\u00e1lica de Aposi\u00e7\u00e3o Luminal (LAMS). Endoscopia Terap\u00eautica; 2021.\n    Dispon\u00edvel em:\n    https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/protese-metalica-de-aposicao-luminal-lams-2\/<\/span>\n<h3>Refer\u00eancias<\/h3>\n<ol>\n    <li><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/29519333\/\">Stier MW, Waxman I. Lumen-Apposing Metal Stents: Which One\n            and Why? Gastrointest Endosc Clin N Am. 2018 Apr;28(2):207-217. doi: 10.1016\/j.giec.2017.11.008. Epub 2018\n            Feb 3. PMID: 29519333.<\/a><\/li>\n    <li><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/29519332\/\">Saumoy M, Yarber C, Kahaleh M. Novel Uses of Lumen-Apposing\n            Metal Stents. Gastrointest Endosc Clin N Am. 2018 Apr;28(2):197-205. doi: 10.1016\/j.giec.2017.11.007. PMID:\n            29519332.<\/a><\/li>\n    <li><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/32382266\/\">Tan S, Zhong C, Ren Y, et al. Are Lumen-Apposing Metal\n            Stents More Effective Than Plastic Stents for the Management of Pancreatic Fluid Collections: An Updated\n            Systematic Review and Meta-analysis. Gastroenterol Res Pract. 2020 Apr 20;2020:4952721. doi:\n            10.1155\/2020\/4952721. PMID: 32382266; PMCID: PMC7189322.<\/a><\/li>\n    <li><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/32140862\/\">Krishnamoorthi R, Dasari CS, Thoguluva Chandrasekar V, et\n            al. Effectiveness and safety of EUS-guided choledochoduodenostomy using lumen-apposing metal stents (LAMS):\n            a systematic review and meta-analysis. Surg Endosc. 2020 Jul;34(7):2866-2877. doi:\n            10.1007\/s00464-020-07484-w. Epub 2020 Mar 5. PMID: 32140862.<\/a><\/li>\n    <li><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/33246343\/\">Amato A, Sinagra E, Celsa C, et al. Efficacy of\n            lumen-apposing metal stents or self-expandable metal stents for endoscopic ultrasound-guided\n            choledochoduodenostomy: a systematic review and meta-analysis. Endoscopy. 2020 Nov 27. doi:\n            10.1055\/a-1324-7919. Epub ahead of print. PMID: 33246343.<\/a><\/li>\n    <li><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/28043931\/\">Irani S, Ngamruengphong S, Teoh A, et al. Similar Efficacies\n            of Endoscopic Ultrasound Gallbladder Drainage With a Lumen-Apposing Metal Stent Versus Percutaneous\n            Transhepatic Gallbladder Drainage for Acute Cholecystitis. Clin Gastroenterol Hepatol. 2017\n            May;15(5):738-745. doi: 10.1016\/j.cgh.2016.12.021. Epub 2016 Dec 30. PMID: 28043931.<\/a><\/li>\n    <li><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/28032663\/\">Itoi T, Baron TH, Khashab MA, Tsuchiya T, Irani S, Dhir V,\n            Bun Teoh AY. Technical review of endoscopic ultrasonography-guided gastroenterostomy in 2017. Dig Endosc.\n            2017 May;29(4):495-502. doi: 10.1111\/den.12794. Epub 2017 Jan 27. PMID: 28032663.<\/a><\/li>\n    <li><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/30725254\/\">Ge PS, Young JY, Dong W, Thompson CC. EUS-guided\n            gastroenterostomy versus enteral stent placement for palliation of malignant gastric outlet obstruction.\n            Surg Endosc. 2019 Oct;33(10):3404-3411. doi: 10.1007\/s00464-018-06636-3. Epub 2019 Feb 6. PMID: 30725254;\n            PMCID: PMC6684873.<\/a><\/li>\n    <li><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/31050068\/\">Bang JY, Varadarajulu S. Lumen-apposing metal stents for\n            endoscopic ultrasonography-guided interventions. Dig Endosc. 2019 Nov;31(6):619-626. doi: 10.1111\/den.13428.\n            Epub 2019 Jun 5. PMID: 31050068.<\/a><\/li>\n<\/ol>\n<strong>Saiba mais<\/strong>: <a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/classificacao\/classificacao-de-sidney\/\"\n    target=\"_blank\" rel=\"noopener\">Pangastrite enantematosa leve<\/a>\n\n<span style=\"font-weight: 400;\">Acesse o <\/span><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/\"><span\n        style=\"font-weight: 400;\">Endoscopia Terap\u00eautica<\/span><\/a><span style=\"font-weight: 400;\"> para tomar contato\n    com mais <\/span><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/artigos-comentados\/\"><span\n        style=\"font-weight: 400;\">artigos comentados<\/span><\/a><span style=\"font-weight: 400;\">, <\/span><a\n    href=\"https:\/\/endoscopiaterapeutica.net\/pt\/assuntos-gerais\/\"><span style=\"font-weight: 400;\">assuntos\n        gerais<\/span><\/a><span style=\"font-weight: 400;\">, <\/span><a\n    href=\"https:\/\/endoscopiaterapeutica.net\/pt\/casos-clinicos\/\"><span style=\"font-weight: 400;\">casos\n        cl\u00ednicos<\/span><\/a><span style=\"font-weight: 400;\">, <\/span><a\n    href=\"https:\/\/endoscopiaterapeutica.net\/pt\/quizes\/\"><span style=\"font-weight: 400;\">quizzes<\/span><\/a><span\n    style=\"font-weight: 400;\">, <\/span><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/classificacoes\/\"><span\n        style=\"font-weight: 400;\">classifica\u00e7\u00f5es<\/span><\/a><span style=\"font-weight: 400;\"> e mais!<\/span>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>As pr\u00f3teses met\u00e1licas de aposi\u00e7\u00e3o luminal, lumen-apposing metal stents (LAMS), representam um avan\u00e7o significativo&hellip;<\/p>\n","protected":false},"author":2592,"featured_media":7748,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[151],"tags":[],"ano":[262],"tipo":[154],"volume":[263],"class_list":["post-4874","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-assuntosgerais","ano-262","tipo-ecoendoscopia","volume-volume-i"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.2 (Yoast SEO v27.2) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Pr\u00f3tese met\u00e1lica de aposi\u00e7\u00e3o luminal (LAMS) &#8226; Endoscopia Terapeutica<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/protese-metalica-de-aposicao-luminal-lams-2\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Pr\u00f3tese met\u00e1lica de aposi\u00e7\u00e3o luminal (LAMS)\" \/>\n<meta property=\"og:description\" content=\"As pr\u00f3teses met\u00e1licas de aposi\u00e7\u00e3o luminal, lumen-apposing metal stents (LAMS), representam um avan\u00e7o significativo devido ao seu desenho com flanges\" \/>\n<meta property=\"og:url\" content=\"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/protese-metalica-de-aposicao-luminal-lams-2\/\" \/>\n<meta property=\"og:site_name\" content=\"Endoscopia Terapeutica\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/endoscopiaterapeutica\" \/>\n<meta property=\"article:published_time\" content=\"2021-04-27T09:00:11+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2023-03-13T15:31:27+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/04\/FIGURA-1.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"460\" \/>\n\t<meta property=\"og:image:height\" content=\"460\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Joel Fernandez de Oliveira\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Escrito por\" \/>\n\t<meta name=\"twitter:data1\" content=\"Joel Fernandez de Oliveira\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. tempo de leitura\" \/>\n\t<meta name=\"twitter:data2\" content=\"11 minutos\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/protese-metalica-de-aposicao-luminal-lams-2\/#article\",\"isPartOf\":{\"@id\":\"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/protese-metalica-de-aposicao-luminal-lams-2\/\"},\"author\":{\"name\":\"Joel Fernandez de Oliveira\",\"@id\":\"https:\/\/endoscopiaterapeutica.net\/pt\/#\/schema\/person\/44154e75b8892daa6137c7c3e9f6acd0\"},\"headline\":\"Pr\u00f3tese met\u00e1lica de aposi\u00e7\u00e3o luminal (LAMS)\",\"datePublished\":\"2021-04-27T09:00:11+00:00\",\"dateModified\":\"2023-03-13T15:31:27+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/protese-metalica-de-aposicao-luminal-lams-2\/\"},\"wordCount\":2025,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\/\/endoscopiaterapeutica.net\/pt\/#organization\"},\"image\":{\"@id\":\"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/protese-metalica-de-aposicao-luminal-lams-2\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/04\/FIGURA-1.jpg\",\"articleSection\":[\"Assuntos Gerais\"],\"inLanguage\":\"pt-BR\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/protese-metalica-de-aposicao-luminal-lams-2\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/protese-metalica-de-aposicao-luminal-lams-2\/\",\"url\":\"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/protese-metalica-de-aposicao-luminal-lams-2\/\",\"name\":\"Pr\u00f3tese met\u00e1lica de aposi\u00e7\u00e3o luminal (LAMS) &#8226; 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