BSG Interim Position on LAMS Use After AXIOS Recall: FG | April 2026

Introduction

Lumen-apposing metal stents (LAMS) have become central to therapeutic endoscopic ultrasound (T-EUS), especially for pancreatic fluid collection drainage, EUS-guided gallbladder drainage, choledochoduodenostomy, gastrojejunostomy, and EDGE procedures. In December 2025, the urgent recall of selected Hot AXIOS stents created an immediate gap in the delivery of several urgent and complex interventions. Because AXIOS has been widely used in the UK, this recall has major practical implications for endoscopists, referral networks, and patient safety.

Problem Statement

The recall of commonly used AXIOS stent sizes has disrupted routine T-EUS practice, creating uncertainty about which alternative devices, rescue techniques, and governance pathways should be used to maintain safe and effective care.

Summary

This British Society of Gastroenterology interim technical review provides pragmatic guidance for clinicians navigating the post-recall period. The key message is that T-EUS can continue safely, but endoscopists must adapt device choice and technique according to the indication. For pancreatic fluid collections and EUS-guided gallbladder drainage, unaffected AXIOS sizes and alternative LAMS such as HOT SPAXUS and Z-EUS remain reasonable substitutes, while plastic stents or percutaneous drainage may be used when appropriate.

The greatest technical challenge is in malignant distal biliary obstruction, because the recalled smaller AXIOS sizes were commonly used for EUS-guided biliary drainage. In these situations, clinicians may need to consider larger LAMS in selected patients, alternative LAMS platforms, tubular metal stents, rendezvous procedures, hepaticogastrostomy, or antegrade stenting depending on anatomy and expertise. For EUS-guided gastrojejunostomy and EDGE, the review advises greater caution, use of staged approaches, and careful case selection.

An important contribution of this paper is its emphasis on salvage strategies for maldeployment or failure of expansion, reminding clinicians that recognition must be immediate and that rescue plans should be predefined. Just as important, the document stresses governance: regional collaboration, expert case discussion, careful documentation, and prospective data capture are essential while device availability remains unstable.

Overall, this is a highly practical position statement. Its value lies not in introducing a new technique, but in helping clinicians preserve procedural safety, maintain access to urgent T-EUS interventions, and standardize decision-making during a period of device limitation.