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Yang Y, Yang Y, Hou Z, Wang T, Wu P, Shen L, Li P, Zhang K, Yang L, Sun S. Comprehensive review of materials, applications, and future innovations in biodegradable esophageal stents. Front Bioeng Biotechnol 2023; 11:1327517. [PMID: 38125305 PMCID: PMC10731276 DOI: 10.3389/fbioe.2023.1327517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023] Open
Abstract
Esophageal stricture (ES) results from benign and malignant conditions, such as uncontrolled gastroesophageal reflux disease (GERD) and esophageal neoplasms. Upper gastrointestinal endoscopy is the preferred diagnostic approach for ES and its underlying causes. Stent insertion using an endoscope is a prevalent method for alleviating or treating ES. Nevertheless, the widely used self-expandable metal stents (SEMS) and self-expandable plastic stents (SEPS) can result in complications such as migration and restenosis. Furthermore, they necessitate secondary extraction in cases of benign esophageal stricture (BES), rendering them unsatisfactory for clinical requirements. Over the past 3 decades, significant attention has been devoted to biodegradable materials, including synthetic polyester polymers and magnesium-based alloys, owing to their exceptional biocompatibility and biodegradability while addressing the challenges associated with recurring procedures after BES resolves. Novel esophageal stents have been developed and are undergoing experimental and clinical trials. Drug-eluting stents (DES) with drug-loading and drug-releasing capabilities are currently a research focal point, offering more efficient and precise ES treatments. Functional innovations have been investigated to optimize stent performance, including unidirectional drug-release and anti-migration features. Emerging manufacturing technologies such as three-dimensional (3D) printing and new biodegradable materials such as hydrogels have also contributed to the innovation of esophageal stents. The ultimate objective of the research and development of these materials is their clinical application in the treatment of ES and other benign conditions and the palliative treatment of malignant esophageal stricture (MES). This review aimed to offer a comprehensive overview of current biodegradable esophageal stent materials and their applications, highlight current research limitations and innovations, and offer insights into future development priorities and directions.
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Affiliation(s)
- Yaochen Yang
- Department of Gastroenterology, Endoscopic Center, Engineering Research Center of Ministry of Education for Minimally Invasive Gastrointestinal Endoscopic Techniques, Shengjing Hospital of China Medical University, Shenyang, China
- Research Center for Biomedical Materials, Engineering Research Center of Ministry of Education for Minimally Invasive Gastrointestinal Endoscopic Techniques, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yuanyuan Yang
- Department of Gastroenterology, Endoscopic Center, Engineering Research Center of Ministry of Education for Minimally Invasive Gastrointestinal Endoscopic Techniques, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhipeng Hou
- Research Center for Biomedical Materials, Engineering Research Center of Ministry of Education for Minimally Invasive Gastrointestinal Endoscopic Techniques, Shengjing Hospital of China Medical University, Shenyang, China
| | - Tingting Wang
- Department of Gastroenterology, Endoscopic Center, Engineering Research Center of Ministry of Education for Minimally Invasive Gastrointestinal Endoscopic Techniques, Shengjing Hospital of China Medical University, Shenyang, China
| | - Peng Wu
- Department of Gastroenterology, Endoscopic Center, Engineering Research Center of Ministry of Education for Minimally Invasive Gastrointestinal Endoscopic Techniques, Shengjing Hospital of China Medical University, Shenyang, China
| | - Lufan Shen
- Department of Gastroenterology, Endoscopic Center, Engineering Research Center of Ministry of Education for Minimally Invasive Gastrointestinal Endoscopic Techniques, Shengjing Hospital of China Medical University, Shenyang, China
| | - Peng Li
- Liaoning Research Institute for Eugenic Birth and Fertility, China Medical University, Shenyang, China
| | - Kai Zhang
- Department of Gastroenterology, Endoscopic Center, Engineering Research Center of Ministry of Education for Minimally Invasive Gastrointestinal Endoscopic Techniques, Shengjing Hospital of China Medical University, Shenyang, China
| | - Liqun Yang
- Research Center for Biomedical Materials, Engineering Research Center of Ministry of Education for Minimally Invasive Gastrointestinal Endoscopic Techniques, Shengjing Hospital of China Medical University, Shenyang, China
- Liaoning Research Institute for Eugenic Birth and Fertility, China Medical University, Shenyang, China
| | - Siyu Sun
- Department of Gastroenterology, Endoscopic Center, Engineering Research Center of Ministry of Education for Minimally Invasive Gastrointestinal Endoscopic Techniques, Shengjing Hospital of China Medical University, Shenyang, China
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Kailla E, Rezai F, Kansci AK, Akande O, Gossage J. SX-ELLA biodegradable stent for benign oesophageal strictures: a systematic review and proportion meta-analysis. Surg Endosc 2022; 37:2476-2484. [PMID: 36481820 PMCID: PMC10082093 DOI: 10.1007/s00464-022-09767-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 11/06/2022] [Indexed: 12/13/2022]
Abstract
Abstract
Background
This systematic review aimed to analyse the use of the SX-ELLA biodegradable stent (BDS) for benign oesophageal strictures through the assessment of clinical and technical success, differences in pre- and post-BDS insertion dysphagia scores, rates of stent migration, and safety.
Methods
A systematic review was reported according to PRISMA guidelines, with a prospectively registered protocol. The databases PubMed, Embase, SCOPUS, and ClinicalTrials.gov were searched up to March 2022. Studies assessing the use of the SX-ELLA BDS in adults with benign oesophageal strictures were included. A pooled data analysis was conducted to analyse the clinical and technical success associated with BDS use, rate of stent migration, and safety.
Results
Of the 1509 articles identified, 16 studies treating 246 patients were eligible for inclusion. BDS was clinically successful in 41.9% of cases (95% CI = 35.7 – 48.1%), defined as those who experienced complete symptom resolution following BDS insertion. Technical success was achieved in 97.2% of patients (95% CI = 95.1 – 99.3%). A pooled analysis concluded a decrease in mean dysphagia score of 1.8 points (95% CI = 1.68 – 1.91) following BDS insertion. Re-intervention was required in 89 patients (36.2%, 95% CI = 30.2 – 42.2%), whilst stent migration occurred in 6.5% of patients (95% CI = 3.4 – 9.6%). A total of 37 major clinical complications related to BDS insertion were reported (15.0%, 95% CI = 10.5 – 19.5%).
Conclusion
The pooled data analysis demonstrates the high technical and moderate clinical success of the SX-ELLA biodegradable stent, supporting its use for benign oesophageal strictures in adults. However, greater evidence is required for more robust conclusions to be made in terms of success when compared to alternative methods of intervention, such as endoscopic dilation.
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Affiliation(s)
- Elisha Kailla
- GKT School of Medical Education, King's College London, London, UK
- University of Birmingham Medical School, Birmingham, UK
| | - Fatema Rezai
- GKT School of Medical Education, King's College London, London, UK
| | | | | | - James Gossage
- Department of Upper Gastrointestinal Surgery, St Thomas' Hospital, London, UK.
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Daoud ND, Ghoz H, Mzaik O, Zaver HB, McKinney M, Brahmbhatt B, Woodward T. Endoscopic Management of Luminal Strictures: Beyond Dilation. Dig Dis Sci 2022; 67:1480-1499. [PMID: 35212884 DOI: 10.1007/s10620-022-07396-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2022] [Indexed: 12/19/2022]
Abstract
Luminal strictures can occur as part of many different gastrointestinal (GI) disorders anywhere along the GI tract and affect all age groups. The end goal of managing any stricture is to re-establish an adequate and durable luminal patency that is sufficient to resolve the presenting clinical symptoms. Treatment options can be generally categorized into medical, endoscopic, and surgical. However, within each of these categories, multiple different options are available. Therefore, choosing the best treatment modality is often challenging and depends on multiple factors including the type, location, and complexity of the stricture, as well as the preference of the treating physician. In this article, we will review the most current literature regarding foregut strictures, particularly esophageal and gastric, beyond dilation.
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Affiliation(s)
- Nader D Daoud
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Hassan Ghoz
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Obaie Mzaik
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Himesh B Zaver
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Micah McKinney
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Bhaumik Brahmbhatt
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
| | - Timothy Woodward
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
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Kotha S, Berry P, Raja U, Wong T. Benign biliary strictures: utility of novel biodegradable biliary stents in surgically altered anatomy. Endoscopy 2021; 53:E281-E282. [PMID: 33003216 DOI: 10.1055/a-1261-2800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Sreelakshmi Kotha
- Department of Gastroenterology, Guy's and St Thomas' Foundation Trust, London, United Kingdom
| | - Philip Berry
- Department of Gastroenterology, Guy's and St Thomas' Foundation Trust, London, United Kingdom
| | - Usman Raja
- Department of Interventional Radiology, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Terry Wong
- Department of Gastroenterology, Guy's and St Thomas' Foundation Trust, London, United Kingdom
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Maishman T, Sheikh H, Boger P, Kelly J, Cozens K, Bateman A, Davies S, Fay M, Sharland D, Jackson A. A Phase II Study of Biodegradable Stents Plus Palliative Radiotherapy in Oesophageal Cancer. Clin Oncol (R Coll Radiol) 2021; 33:e225-e231. [PMID: 33402268 DOI: 10.1016/j.clon.2020.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/02/2020] [Accepted: 12/10/2020] [Indexed: 01/21/2023]
Abstract
AIMS Self-expanding metal stents provide rapid improvement of dysphagia in oesophageal cancer but are associated with complications. The aim of the present study was to test the effectiveness of an alternative treatment of combining biodegradable stents with radiotherapy. MATERIALS AND METHODS A Simon two-stage single-arm prospective phase II trial design was used to determine the efficacy of biodegradable stents plus radiotherapy in patients with dysphagia caused by oesophagus cancer who were unsuitable for radical treatment. Fourteen patients were recruited and data from 12 were included in the final analyses. RESULTS Five of 12 patients met the primary end point: one stent-related patient death; four further interventions for dysphagia within 16 weeks of stenting (41.7%, 95% confidence interval 15.2-72.3%). The median time to a 10-point deterioration of quality of life was 2.7 weeks. Nine patients died within 52 weeks of registration. The median time to death from any cause was 15.0 weeks (95% confidence interval 9.6-not reached). CONCLUSION The high re-intervention observed, which met the pre-defined early stopping criteria, meant that the suggested alternative treatment was not sufficiently effective to be considered for a larger scale trial design. Further work is needed to define the place of biodegradable stents in the management of malignant oesophageal strictures.
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Affiliation(s)
- T Maishman
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - H Sheikh
- The Christie NHS Foundation Trust, Manchester, UK
| | - P Boger
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - J Kelly
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - K Cozens
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - A Bateman
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - S Davies
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - M Fay
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - D Sharland
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - A Jackson
- University Hospital Southampton NHS Foundation Trust, Southampton, UK.
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Silver nanoparticle-coated self-expandable metallic stent suppresses tissue hyperplasia in a rat esophageal model. Surg Endosc 2021; 36:66-74. [PMID: 33398571 DOI: 10.1007/s00464-020-08238-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 12/08/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND To evaluate the efficacy of a silver nanoparticle (AgNP)-coated self-expandable metallic stent (SEMS) for suppressing tissue hyperplasia in a rat esophageal model. METHODS Twenty-four male Sprague-Dawley rats were randomly assigned to four groups. Animals in group A underwent uncoated SEMS placement, whereas animals in groups B, C, and D underwent 6, 12, and 24 mg/mL AgNP-coated SEMS placement, respectively. All animals were euthanized 4 weeks after SEMS placement, and a gross examination and histological analyses were performed. RESULTS All rats achieved technical success and survived until the end of the study. The gross examination showed moderate to severe tissue hyperplasia in 5 rats in group A and 2 rats in group B. In contrast, no animals in groups C and D had moderate or severe tissue hyperplasia. The gross examination revealed no complications. The percentage of granulation tissue area, number of epithelial layers, thickness of submucosal fibrosis, percentage of connective tissue area, inflammatory cell infiltration grade, degree of collagen deposition, and degrees of Ki67, TUNEL, and α-SMA-positive deposition were significantly lower in groups C and D than in group A (all p < 0.05). However, only the percentage of granulation tissue area, number of epithelial layers, thickness of submucosal fibrosis, and percentage of connective tissue area were significantly lower in group B than in group A (all p < 0.05). No histological parameters were significantly different between group D and group C (all p > 0.05). CONCLUSION AgNP-coated SEMSs suppressed tissue hyperplasia in a rat esophageal model.
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Zhao F, Xu H, Xue W, Li Y, Sun J, Wang F, Jiang G, Li L, Wang L. Iodinated poly( p-dioxanone) as a facile platform for X-ray imaging of resorbable implantable medical devices. J Biomater Appl 2020; 35:39-48. [PMID: 32192387 DOI: 10.1177/0885328220912842] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Currently, implantable fibrous medical devices still suffer from invisibility under current clinical imaging techniques. To address this problem, 2, 3, 5-triiodobenzoic acid (TIBA) was recruited as a contrast agent, and then a set of iodinated poly(p-dioxanone) (PPDO) fibers was fabricated via melt-spinning hybrid blends of PPDO with TIBA (PPDO/TIBA). The impact of TIBA content on the rheological behavior of blends was evaluated firstly. The physical, chemical, and thermal properties of PPDO/TIBA fibers were investigated accordingly by SEM, FTIR, DSC, and TGA. Moreover, the radiopaque property of PPDO/TIBA hybrid fibers as a potential radio-opacifying platform for medical devices was verified in vitro and in vivo. Finally, the accumulated release results of the hybrid fibers during in vitro degradation indicate the continual X-ray visibility of the hybrid fibers maintains for 22 days. This intriguing iodinated platform may pave the way for constructing fibrous materials with in-situ X-ray tracking property.
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Affiliation(s)
- Fan Zhao
- College of Textiles, Donghua University, Shanghai, China.,Key laboratory of Textile Science and Technology, Ministry of Education, Donghua University, Songjiang, Shanghai, China
| | - Haiyan Xu
- College of Textiles, Donghua University, Shanghai, China.,Key laboratory of Textile Science and Technology, Ministry of Education, Donghua University, Songjiang, Shanghai, China
| | - Wen Xue
- College of Textiles, Donghua University, Shanghai, China.,Key laboratory of Textile Science and Technology, Ministry of Education, Donghua University, Songjiang, Shanghai, China
| | - Yan Li
- College of Textiles, Donghua University, Shanghai, China.,Key laboratory of Textile Science and Technology, Ministry of Education, Donghua University, Songjiang, Shanghai, China
| | - Jing Sun
- Department of Pediatric Cardiology of Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fujun Wang
- College of Textiles, Donghua University, Shanghai, China.,Key laboratory of Textile Science and Technology, Ministry of Education, Donghua University, Songjiang, Shanghai, China
| | - Guansen Jiang
- Hangzhou Rejoin Mastin Medical Device Co., Ltd, Hangzhou, China
| | - Lingchen Li
- Hangzhou Rejoin Mastin Medical Device Co., Ltd, Hangzhou, China
| | - Lu Wang
- College of Textiles, Donghua University, Shanghai, China.,Key laboratory of Textile Science and Technology, Ministry of Education, Donghua University, Songjiang, Shanghai, China
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8
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Ahmed O, Bolger JC, O'Neill B, Robb WB. Use of esophageal stents to relieve dysphagia during neoadjuvant therapy prior to esophageal resection: a systematic review. Dis Esophagus 2020; 33:5673617. [PMID: 31828290 DOI: 10.1093/dote/doz090] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Esophageal cancer stenting offers symptomatic relief for patients suffering from dysphagia. There are limited data to support their use to relieve dysphagia and improve nutrition during neoadjuvant therapy with some concern that they may negatively impact oncological outcomes. The aim of this systematic review was to quantify the impact of esophageal stents on outcomes prior to resection with curative intent. A literature search was performed using Embase, Medline, PubMed, PubMed Central, the Cochrane library for articles pertaining to esophageal stent use prior to or during neoadjuvant chemotherapy or chemoradiotherapy in patients planned for curative esophagectomy. Data extracted included basic demographics, clinical, nutritional and oncologic outcomes. A total of 9 studies involving 465 patients were included. Esophageal stent use resulted in a significant improvement in mean dysphagia scores in the immediate post stent period but failed to demonstrate any positive changes in weight, body mass index (BMI) or albumin. Only 33% of stented patients ultimately progressed to potential curative surgical resection and stents were associated with reduced R0 resection rates and lower overall survival. This systematic review shows that, although esophageal stenting is associated with improvements in dysphagia during neoadjuvant therapy, their effect on improving patient nutritional status is less clear and they may be associated with poorer long-term oncological outcomes. Stents should be used with caution in patients who are being considered for potentially curative resection of esophageal malignancies and other strategies of nutritional supplementation should be considered.
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Affiliation(s)
- O Ahmed
- Department of Upper Gastrointestinal Surgery, Beaumont Hospital, Dublin 9, Ireland
| | - J C Bolger
- Department of Upper Gastrointestinal Surgery, Beaumont Hospital, Dublin 9, Ireland.,Department of Surgery, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - B O'Neill
- Department of Radiation Oncology, Beaumont Hospital, Dublin 9, Ireland
| | - W B Robb
- Department of Upper Gastrointestinal Surgery, Beaumont Hospital, Dublin 9, Ireland.,Department of Surgery, Royal College of Surgeons in Ireland, Dublin 2, Ireland
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Biodegradable oesophageal stents: A potentially useful adjunct in the treatment of dysphagia in patients undergoing radiotherapy for oesophageal carcinoma. JOURNAL OF RADIOTHERAPY IN PRACTICE 2019. [DOI: 10.1017/s1460396919000207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractAim:Dysphagia is common in patients presenting with oesophageal malignancy. This study aimed to determine the clinical effectiveness of biodegradable stents to help with malignant dysphagia due to radiotherapy for oesophageal cancer and furthermore to establish the complication and re-intervention rates associated with their use.Methods:This was a retrospective, observational study of 22 patients between 2008 and 2013. Complications within 2 weeks and episodes of re-intervention required within 4 months of stent insertion prior to radiotherapy were recorded.Results:Pre-stent insertion, the mean O’Rourke dysphagia score was 3·5 (median 3, range 2–5). This improved to a mean score of 2·8 (median 3, range 1–4) 1–3 weeks following stent insertion. Complications occurred in seven patients (32%) in an immediate 2-week period, including: pain (2), dysphagia requiring dilatation (1), food obstruction not requiring intervention (1), food obstruction requiring intervention (2) and upper gastrointestinal bleed not requiring intervention (1). Re-intervention was required in 18% within a 4-month period.Findings:We propose that biodegradable oesophageal stents are safe and may have benefit over self-expanding metal stents. We recommend they are placed alongside a radiologically inserted gastrostomy in a combined procedure prior to radiotherapy planning.
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10
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Biocompatible Polymer Materials with Antimicrobial Properties for Preparation of Stents. NANOMATERIALS 2019; 9:nano9111548. [PMID: 31683612 PMCID: PMC6915381 DOI: 10.3390/nano9111548] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 10/15/2019] [Accepted: 10/29/2019] [Indexed: 12/17/2022]
Abstract
Biodegradable polymers are promising materials for use in medical applications such as stents. Their properties are comparable to commercially available resistant metal and polymeric stents, which have several major problems, such as stent migration and stent clogging due to microbial biofilm. Consequently, conventional stents have to be removed operatively from the patient's body, which presents a number of complications and can also endanger the patient's life. Biodegradable stents disintegrate into basic substances that decompose in the human body, and no surgery is required. This review focuses on the specific use of stents in the human body, the problems of microbial biofilm, and possibilities of preventing microbial growth by modifying polymers with antimicrobial agents.
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11
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Jeong SJ, Park J. Endoscopic Management of Benign Colonic Obstruction and Pseudo-Obstruction. Clin Endosc 2019; 53:18-28. [PMID: 31645090 PMCID: PMC7003002 DOI: 10.5946/ce.2019.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 08/05/2019] [Indexed: 02/07/2023] Open
Abstract
There are a variety of causes of intestinal obstruction, with the most common cause being malignant diseases; however, volvulus, inflammatory bowel disease or diverticulitis, radiation injury, ischemia, and pseudo-obstruction can also cause colonic obstruction. These are benign conditions; however, delayed diagnosis of acute intestinal obstruction owing to these causes can cause critical complications, such as perforation. Therefore, high levels of clinical suspicion and appropriate treatment are crucial. There are variable treatment options for colonic obstruction, and endoscopic treatment is known to be a less invasive and an effective option for such. In this article, the authors review the causes of benign colonic obstruction and pseudo-obstruction and the role of endoscopy in treating them.
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Affiliation(s)
- Su Jin Jeong
- Division of Gastroenterology, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jongha Park
- Division of Gastroenterology, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
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12
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Balloon-Expandable Biodegradable Stents Versus Self-Expandable Metallic Stents: A Comparison Study of Stent-Induced Tissue Hyperplasia in the Rat Urethra. Cardiovasc Intervent Radiol 2019; 42:1343-1351. [DOI: 10.1007/s00270-019-02239-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/02/2019] [Indexed: 01/26/2023]
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13
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Richardson T, Naidoo G, Rupasinghe N, Smart H, Bhattacharya S. Biodegradable Stents in Resistant Peptic Oesophageal Stricture: Is It the Right Way to Go? CLINICAL MEDICINE INSIGHTS. GASTROENTEROLOGY 2019; 11:1179552218819492. [PMID: 30627002 PMCID: PMC6309028 DOI: 10.1177/1179552218819492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 11/14/2018] [Indexed: 12/22/2022]
Abstract
Peptic oesophageal stricture can be considered as the end result of prolonged gastro-oesophageal reflux. The 'gold standard' treatment for peptic stricture is endoscopic dilatation with balloon or bougie. It is predicted that up to 40% of patients remain symptomatic with dysphagia due to refractory (resistant to treatment) or recurrent strictures, needing frequent interventions at short intervals. Such patients have poor nutritional status due to the primary disease and are susceptible to complications related to repeated endoscopic dilatation such as bleeding and perforation. This general review aims to analyse existing published evidence and address the role of biodegradable stents in resistant peptic strictures as an alternative treatment to provide long-term dysphagia-free intervals.
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Affiliation(s)
- Tom Richardson
- Department of Digestive Diseases, Warrington Hospital, Warrington and Halton Hospitals NHS Foundation Trust, Warrington, UK
| | - Gerlin Naidoo
- Department of Digestive Diseases, Warrington Hospital, Warrington and Halton Hospitals NHS Foundation Trust, Warrington, UK
| | - Namal Rupasinghe
- Department of Digestive Diseases, Warrington Hospital, Warrington and Halton Hospitals NHS Foundation Trust, Warrington, UK
| | - Howard Smart
- Endoscopy Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Sayantan Bhattacharya
- Department of Digestive Diseases, Warrington Hospital, Warrington and Halton Hospitals NHS Foundation Trust, Warrington, UK.,Consultant Upper GI Surgeon, Warrington, UK.,Department of General Surgery, Warrington Hospital, Warrington and Halton Hospitals NHS Foundation Trust, Warrington, UK
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14
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Lin M, Firoozi N, Tsai CT, Wallace MB, Kang Y. 3D-printed flexible polymer stents for potential applications in inoperable esophageal malignancies. Acta Biomater 2019; 83:119-129. [PMID: 30366130 DOI: 10.1016/j.actbio.2018.10.035] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 10/09/2018] [Accepted: 10/22/2018] [Indexed: 01/19/2023]
Abstract
Palliation therapy for dysphagia using esophageal stents is the current treatment of choice for those patients with inoperable esophageal malignancies. However, the metallic and plastic stents currently used in the clinical setting may cause complications, such as tumor ingrowth and stent migration into the stomach. To effectively reduce/overcome these complications, we designed a tubular, flexible polymer stent with spirals. The parameters of the spirals were computationally optimized by using a finite element analysis. The designed polymer stents with optimized spirals were then printed by a 3D printing technique. 3D-printed tubular polymer stents without spirals served as controls. The self-expansion and anti-migration properties of the printed stent were characterized in an ex vivo normal porcine esophagus. The biodegradability test of the stent was performed in a neutral buffer and acidic gastric buffer. The cytotoxicity of the new stent was examined through the viability test of human esophagus epithelial cells. Results showed the self-expansion force of the 3D-printed polymer stent with spirals was higher than the stent without spirals. The anti-migration force of the 3D-printed stent with spirals was significantly higher than that of the stent without spirals. Furthermore, the stent with spirals significantly decreased the migration distance compared to the non-spiral 3D-printed polymer stent. Degradation study showed that the polymer materials started to degrade after six weeks and the compressive strength of the stent was not significantly decreased with time. In vitro cell viability results further indicated that the polymer stent does not have any cytotoxicity. Together, these results showed that the 3D-printed stent with spirals has potential applications in the treatment of inoperable esophageal malignancies. STATEMENT OF SIGNIFICANCE: In this study, we developed a new 3D-printed flexible tubular polymeric stent with spirals. The mechanical properties of the 3D-printed polymer stent are modulated by changing the ratios of PLA to TPU. The stent is flexible enough to be compressed in a clinically available stent delivery system, and can self-expand after it is released. The self-expansion force of the stent with spirals is higher than that of non-spiral stents. The spirals on the outside of the stent significantly increased the anti-migration force compared to non-spiral stents in an ex vivo normal pig esophagus. Together, the 3D-printed stent with spirals will bring promising potential in the treatment of inoperable esophagus malignancies or benign strictures.
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Affiliation(s)
- Maohua Lin
- Department of Ocean and Mechanical Engineering, College of Engineering and Computer Science, Florida Atlantic University, Boca Raton, FL 33431, USA
| | - Negar Firoozi
- Department of Ocean and Mechanical Engineering, College of Engineering and Computer Science, Florida Atlantic University, Boca Raton, FL 33431, USA
| | - Chi-Tay Tsai
- Department of Ocean and Mechanical Engineering, College of Engineering and Computer Science, Florida Atlantic University, Boca Raton, FL 33431, USA
| | - Michael B Wallace
- Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Yunqing Kang
- Department of Ocean and Mechanical Engineering, College of Engineering and Computer Science, Florida Atlantic University, Boca Raton, FL 33431, USA; Department of Biomedical Science, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, USA.
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15
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Emre A, Sertkaya M, Akbulut S, Erbil O, Yurttutan N, Kale İT, Bülbüloğlu E. Self-expandable metallic stent application for the management of upper gastrointestinal tract disease. Turk J Surg 2018; 34:101-105. [PMID: 30023972 PMCID: PMC6048644 DOI: 10.5152/turkjsurg.2017.3740] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 05/18/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The aim of the present study was to share our experiences of the use of self-expandable metallic stent for the upper gastrointestinal tract disease. MATERIAL AND METHODS We retrospectively reviewed the medical records of 18 patients who underwent self-expandable metallic stent implantation procedure for anastomosis stricture, anastomosis leak, or spontaneous fistula of the upper gastrointestinal tract at two different surgery clinics. Self-expandable metallic stent implantation procedures were performed while keeping the patient under sedation and the correct stent localization was verified using fluoroscopy. The stent localization and possible stent migration were checked using X-ray films taken a few days after the stenting procedure. RESULTS Overall, 25 self-expandable metallic stents were implanted in 18 patients (malignant, 13; benign, 5) aged between 19 and 89 years. The indications for self-expandable metallic stent implantation were as follows: malignant gastric stricture (inoperable; n=6), malignant esophageal stricture (inoperable; n=4), staple line leak (laparoscopic sleeve gastrectomy; n=4), esophagojejunostomy anastomotic leak (total gastrectomy+Roux-en-Yesophagojejunostomy; n=2), and stricture (total gastrectomy+Roux-en-Yesophagojejunostomy; n=1), and esophagopleural fistula (pulmonary tuberculosis; n=1). A favorable outcome was achieved in a single session in 15 patients, whereas more than two sessions of stenting were necessary in the remaining three patients. Among the patients who underwent esophagojejunal anastomosis (n=3), self-expandable metallic stents were successfully deployed in a single session in two patients to relieve anastomosis leak (n=1) and anastomosis stricture (n=1); the remaining patients underwent four self-expandable metallic stent implantation procedures to relieve anastomosis leak and subsequent recurrent strictures. No complications developed during the stenting procedure. Three of the four patients who developed mortality had advanced stage esophageal cancer, whereas one patient had morbid obesity and developed staple line leakage. CONCLUSION Endoscopic self-expandable metallic stent implantation under fluoroscopic guidance is a low-morbidity and effective procedure for the management of advanced stage tumors of the gastrointestinal tract and the elimination of postoperative complications.
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Affiliation(s)
- Arif Emre
- Department of General Surgery, Sütçü İmam University School of Medicine, Kahramanmaraş, Turkey
| | - Mehmet Sertkaya
- Department of General Surgery, Sütçü İmam University School of Medicine, Kahramanmaraş, Turkey
| | - Sami Akbulut
- Department of General Surgery, İnönü University School of Medicine, Malatya, Turkey
| | - Ozan Erbil
- Department of General Surgery, Gebze State Hospital, İzmit, Turkey
| | - Nursel Yurttutan
- Department of Radiology, Sütçü İmam University School of Medicine, Kahramanmaraş, Turkey
| | - İlhami Taner Kale
- Department of General Surgery, Sütçü İmam University School of Medicine, Kahramanmaraş, Turkey
| | - Ertan Bülbüloğlu
- Department of General Surgery, Sütçü İmam University School of Medicine, Kahramanmaraş, Turkey
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16
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Francis SR, Orton A, Thorpe C, Stoddard G, Lloyd S, Anker CJ. Toxicity and Outcomes in Patients With and Without Esophageal Stents in Locally Advanced Esophageal Cancer. Int J Radiat Oncol Biol Phys 2017; 99:884-894. [DOI: 10.1016/j.ijrobp.2017.06.2457] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 05/25/2017] [Accepted: 06/19/2017] [Indexed: 12/22/2022]
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17
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Najran PS, Mullan D, Laasch HU. Biodegradable stent insertion for ischaemic colorectal strictures: Tiger country. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2017. [DOI: 10.18528/gii160011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Pavan Singh Najran
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
| | - Damian Mullan
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
| | - Hans-Ulrich Laasch
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
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18
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19
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Poincloux L, Rouquette O, Abergel A. Endoscopic treatment of benign esophageal strictures: a literature review. Expert Rev Gastroenterol Hepatol 2017; 11:53-64. [PMID: 27835929 DOI: 10.1080/17474124.2017.1260002] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Benign esophageal strictures arise from various etiologies and are frequently encountered. Although endoscopic dilation is still the first-line therapy, recurrent strictures do occur in approximately 10% of the cases and remains a challenge to gastroenterologists. Areas covered: A literature search was performed using PubMed and Google Scholar databases for original and review articles on endoscopic treatment of benign esophageal strictures. This review outlines the main available treatment options and its controversies in the management of refractory benign esophageal strictures. Expert commentary: Adding local steroid injections to dilation can be effective for peptic stenosis and strictures after endoscopic submucosal dissection, but remains uncertain for anastomotic strictures. Intralesional injections of mitomycin-C could be useful in corrosive strictures. Incisional therapy can be a reliable alternative in Schatzki rings and in anastomotic strictures, in experienced hands. By contrast, long-term outcome with endoprosthetic treatment is disappointing, and stent placement should be carefully considered and individualized.
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Affiliation(s)
- Laurent Poincloux
- a Department of Digestive and Hepatobiliary Diseases , Estaing University Hospital , Clermont-Ferrand , France.,b UMR Auvergne University/CNRS 6284 ISIT (Image Sciences for Innovations Techniques) , Clermont-Ferrand , France
| | - Olivier Rouquette
- a Department of Digestive and Hepatobiliary Diseases , Estaing University Hospital , Clermont-Ferrand , France
| | - Armand Abergel
- a Department of Digestive and Hepatobiliary Diseases , Estaing University Hospital , Clermont-Ferrand , France.,b UMR Auvergne University/CNRS 6284 ISIT (Image Sciences for Innovations Techniques) , Clermont-Ferrand , France
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20
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McCain S, McCain S, Quinn B, Gray R, Morton J, Rice P. The role of biodegradable stents in the management of benign and malignant oesophageal strictures: A cohort study. Surgeon 2016; 14:322-326. [DOI: 10.1016/j.surge.2015.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 01/27/2015] [Indexed: 12/29/2022]
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21
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Mullan D, Uberoi R. The obstructed afferent loop: Percutaneous options. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2016. [DOI: 10.18528/gii160019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Damian Mullan
- Department of Interventional Radiology, The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - Raman Uberoi
- Department of Interventional Radiology, Oxford University Hospitals NHS Trust, Oxford, UK
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22
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Sigounas DE, Siddhi S, Plevris JN. Biodegradable esophageal stents in benign and malignant strictures - a single center experience. Endosc Int Open 2016; 4:E618-23. [PMID: 27556067 PMCID: PMC4993895 DOI: 10.1055/s-0042-105433] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 03/07/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Biodegradable (BD) esophageal stents were recently developed mainly for refractory benign strictures, but experience and available literature are limited. PATIENTS AND METHODS This was a retrospective observational study. All patients who had BD stents inserted due to refractory benign esophageal strictures or malignant strictures, or were awaiting radical radiotherapy/chemotherapy or neo-adjuvant therapy and esophagectomy between March 2011 and July 2015 were included. RESULTS Stent placement was successful in all patients. Ten patients with benign strictures (3 male, median age 80.5 years, IQR: 68.75 - 89.5) were followed-up for a median of 171.5 weeks (IQR: 24 - 177.25). The interval between dilatations prior to the first BD stent placement (median: 34.25 days, IQR: 23.06 - 48.29) was significantly shorter than the interval between the first BD stent placement and the first intervention required (median: 149.5 days, IQR: 94.25 - 209.5) and this difference was statistically significant (P = 0.012). Ten patients with esophageal cancer (8 male, median age: 69 years, IQR: 59.25 - 80.75) were included and they were followed up for a median of 36 weeks (IQR: 26 - 58). Only 1 completed radical radiotherapy successfully, but developed refractory post-radiotherapy stricture. No one proceeded to esophagectomy and 50 % required a self-expanding metal stent (SEMS) at a median of 134 days (IQR: 100 - 263) following stent placement. CONCLUSIONS BD stents were successfully deployed in both benign and malignant strictures. They offered a prolonged dilatation-free interval in benign strictures, yet in the majority of patients, strictures recurred. In malignant strictures, stent patency was similar to that of benign strictures, which suggests a potential value in ensuring adequate oral intake during oncologic therapy. In our cohort, however, use of stents did not contribute to improved outcome.
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Affiliation(s)
- Dimitrios E. Sigounas
- Centre for Liver & Digestive Disorders, The Royal Infirmary, University of Edinburgh, Edinburgh, Scotland, UK
| | - Sandeep Siddhi
- Centre for Liver & Digestive Disorders, The Royal Infirmary, University of Edinburgh, Edinburgh, Scotland, UK
| | - John N. Plevris
- Centre for Liver & Digestive Disorders, The Royal Infirmary, University of Edinburgh, Edinburgh, Scotland, UK,Corresponding author Professor John N. Plevris Centre for Liver & Digestive DisordersThe Royal InfirmaryUniversity of Edinburgh51 Little France CrescentEdinburgh EH16 4SAScotland, UK
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23
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Yang K, Ling C, Yuan T, Zhu Y, Cheng Y, Cui W. Polymeric Biodegradable Stent Insertion in the Esophagus. Polymers (Basel) 2016; 8:E158. [PMID: 30979258 PMCID: PMC6432023 DOI: 10.3390/polym8050158] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 04/03/2016] [Accepted: 04/08/2016] [Indexed: 12/11/2022] Open
Abstract
Esophageal stent insertion has been used as a well-accepted and effective alternative to manage and improve the quality of life for patients diagnosed with esophageal diseases and disorders. Current stents are either permanent or temporary and are fabricated from either metal or plastic. The partially covered self-expanding metal stent (SEMS) has a firm anchoring effect and prevent stent migration, however, the hyperplastic tissue reaction cause stent restenosis and make it difficult to remove. A fully covered SEMS and self-expanding plastic stent (SEPS) reduced reactive hyperplasia but has a high migration rate. The main advantage that polymeric biodegradable stents (BDSs) have over metal or plastic stents is that removal is not require and reduce the need for repeated stent insertion. But the slightly lower radial force of BDS may be its main shortcoming and a post-implant problem. Thus, strengthening support of BDS is a content of the research in the future. BDSs are often temporarily effective in esophageal stricture to relieve dysphagia. In the future, it can be expect that biodegradable drug-eluting stents (DES) will be available to treat benign esophageal stricture, perforations or leaks with additional use as palliative modalities for treating malignant esophageal stricture, as the bridge to surgery or to maintain luminal patency during neoadjuvant chemoradiation.
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Affiliation(s)
- Kai Yang
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, 600 Yi Shan Road, Shanghai 200233, China.
| | - Christopher Ling
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Orthopedic Institute, Soochow University, 708 Renmin Road, Suzhou 215006, China.
- Nanotechnology Engineering, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada.
| | - Tianwen Yuan
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, 600 Yi Shan Road, Shanghai 200233, China.
| | - Yueqi Zhu
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, 600 Yi Shan Road, Shanghai 200233, China.
| | - Yingsheng Cheng
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, 600 Yi Shan Road, Shanghai 200233, China.
| | - Wenguo Cui
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Orthopedic Institute, Soochow University, 708 Renmin Road, Suzhou 215006, China.
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24
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Kim EJ, Kim YJ. Stents for colorectal obstruction: Past, present, and future. World J Gastroenterol 2016; 22:842-852. [PMID: 26811630 PMCID: PMC4716082 DOI: 10.3748/wjg.v22.i2.842] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 10/22/2015] [Accepted: 11/19/2015] [Indexed: 02/06/2023] Open
Abstract
Since the development of uncovered self-expanding metal stents (SEMS) in the 1990s, endoscopic stents have evolved dramatically. Application of new materials and new designs has expanded the indications for enteral SEMS. At present, enteral stents are considered the first-line modality for palliative care, and numerous types of enteral stents are under development for extended clinical usage, beyond a merely palliative purpose. Herein, we will discuss the current status and the future development of lower enteral stents.
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25
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Ohashi S, Miyamoto S, Kikuchi O, Goto T, Amanuma Y, Muto M. Recent Advances From Basic and Clinical Studies of Esophageal Squamous Cell Carcinoma. Gastroenterology 2015; 149:1700-15. [PMID: 26376349 DOI: 10.1053/j.gastro.2015.08.054] [Citation(s) in RCA: 384] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 08/17/2015] [Accepted: 08/17/2015] [Indexed: 02/08/2023]
Abstract
Esophageal squamous cell carcinoma (ESCC) is one of the most aggressive squamous cell carcinomas and is highly prevalent in Asia. Alcohol and its metabolite, acetaldehyde, are considered definite carcinogens for the esophagus. Polymorphisms in the aldehyde dehydrogenase 2 gene, which encodes an enzyme that eliminates acetaldehyde, have been associated with esophageal carcinogenesis. Studies of the mutagenic and carcinogenic effects of acetaldehyde support this observation. Several recent large-scale comprehensive analyses of the genomic alterations in ESCC have shown a high frequency of mutations in genes such as TP53 and others that regulate the cell cycle or cell differentiation. Moreover, whole genome and whole exome sequencing studies have frequently detected somatic mutations, such as G:C→A:T transitions or G:C→C:G transversions, in ESCC tissues. Genomic instability, caused by abnormalities in the Fanconi anemia DNA repair pathway, is also considered a pathogenic mechanism of ESCC. Advances in diagnostic techniques such as magnifying endoscopy with narrow band imaging or positron emission tomography have increased the accuracy of diagnosis of ESCC. Updated guidelines from the National Comprehensive Cancer Network standardize the practice for the diagnosis and treatment of esophageal cancer. Patients with ESCC are treated endoscopically or with surgery, chemotherapy, or radiotherapy, based on tumor stage. Minimally invasive treatments help improve the quality of life of patients who undergo such treatments. We review recent developments in the diagnosis and treatment of ESCC and advances gained from basic and clinical research.
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Affiliation(s)
- Shinya Ohashi
- Department of Therapeutic Oncology, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Clinical Oncology, Kyoto University Hospital Cancer Center, Kyoto, Japan
| | - Shin'ichi Miyamoto
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Osamu Kikuchi
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tomoyuki Goto
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yusuke Amanuma
- Department of Therapeutic Oncology, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Clinical Oncology, Kyoto University Hospital Cancer Center, Kyoto, Japan
| | - Manabu Muto
- Department of Therapeutic Oncology, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Clinical Oncology, Kyoto University Hospital Cancer Center, Kyoto, Japan.
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26
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Literature Analysis of the Treatment of Benign Esophageal Disease with Stent. Indian J Surg 2015; 78:6-13. [PMID: 27186033 DOI: 10.1007/s12262-015-1294-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Accepted: 05/20/2015] [Indexed: 12/31/2022] Open
Abstract
To analyze the efficacy and safety of benign esophageal disease used biodegradable (BD) stent or metal stent. The English literatures of benign esophageal disease that were treated by biodegradable or metal stents implantation were retrieved and summarized. In all 323 benign esophageal disease, the most common etiologies were benign refractory stricture, surgical anastomotic stricture and esophageal fistula/leak/perforation, but the main characteristics between the two groups were not significantly different. One hundred fifty-four cases were completely healed by using BD stents or self-expandable metal stents (SEMS) (47.7 %). Clinical success was achieved in 47.7 % of all patients and there was no significant difference between BD stents (51 %) and SEMS (46.2 %) (P = 0.472), while stent migration occurred more frequently with SEMS (33.9 %) than with BD stent (19.6 %) (P ≤ 0.05), and tissue in- or overgrowth occurred more frequently with SEMS (22.2 %) than with BD stents (8.8 %) (P ≤ 0.05). Furthermore, the time about degradation of BD stents in esophageal was longer than removal of SEMS from the esophagus (P ≤ 0.05). Placement of BD stents or SEMS provides effective and safe relief for benign esophageal disease. Clinical success and mortality were not significantly different. BD stents offers an advantage of fewer complications. Although stent placement is a viable strategy in patients with benign esophageal disease, the ideal treatment strategy and further randomized trials with large number of patients are needed.
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27
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Mullan D, Shepherd D, Laasch HU. Percutaneous biodegradable stent insertion for a benign biliary stricture complicating choledochojejunostomy. GASTROINTESTINAL INTERVENTION 2015. [DOI: 10.1016/j.gii.2015.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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28
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Malgras B, Lo Dico R, Pautrat K, Dohan A, Boudiaf M, Pocard M, Soyer P. Gastrointestinal stenting: Current status and imaging features. Diagn Interv Imaging 2015; 96:593-606. [PMID: 25953525 DOI: 10.1016/j.diii.2015.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 04/02/2015] [Indexed: 12/13/2022]
Abstract
The use of stents in the gastrointestinal tract has been subjected to major changes. Initially, the use of stents was restricted to malignant strictures in patients with metastatic disease. But thanks to reduction of the morbidity and mortality rates, they are now used with curative intention and in patients with benign diseases after careful selection. However, for patients presenting with colon obstruction due to an advanced colon carcinoma, the mortality and morbidity are still high. The purpose of this review is to provide an overview of indications, techniques and further developments of the stents in the gastrointestinal tract and to highlight the predominant role of multidetector row computed tomography (MDCT) in the detection of potential complications.
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Affiliation(s)
- B Malgras
- Department of Surgical Oncology, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France.
| | - R Lo Dico
- Department of Surgical Oncology, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - K Pautrat
- Department of Surgical Oncology, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - A Dohan
- Department of Abdominal and Interventional Imaging, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France; Sorbonne Paris Cité, université Diderot - Paris 7, 10, avenue de Verdun, 75010 Paris, France; UMR Inserm 965, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - M Boudiaf
- Department of Abdominal and Interventional Imaging, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - M Pocard
- Department of Surgical Oncology, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France; Sorbonne Paris Cité, université Diderot - Paris 7, 10, avenue de Verdun, 75010 Paris, France; UMR Inserm 965, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - P Soyer
- Department of Abdominal and Interventional Imaging, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France; Sorbonne Paris Cité, université Diderot - Paris 7, 10, avenue de Verdun, 75010 Paris, France; UMR Inserm 965, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
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29
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van Boeckel PGA, Siersema PD. Refractory esophageal strictures: what to do when dilation fails. CURRENT TREATMENT OPTIONS IN GASTROENTEROLOGY 2015; 13:47-58. [PMID: 25647687 PMCID: PMC4328110 DOI: 10.1007/s11938-014-0043-6] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Benign esophageal strictures arise from a diversity of causes, for example esophagogastric reflux, esophageal resection, radiation therapy, ablative therapy, or the ingestion of a corrosive substance. Most strictures can be treated successfully with endoscopic dilation using bougies or balloons, with only a few complications. Nonetheless, approximately one third of patients develop recurrent symptoms after dilation within the first year. The majority of these patients are managed with repeat dilations, depending on their complexity. Dilation combined with intra lesional steroid injections can be considered for peptic strictures, while incisional therapy has been demonstrated to be effective for Schatzki rings and anastomotic strictures. When these therapeutic options do not resolve the stenosis, stent placement should be considered. Self bougienage can be proposed to a selected group of patients with a proximal stenosis. As a final step surgery is an option, but even then the risk of stricture formation at the anastomotic site remains. This chapter reviews refractory benign esophageal strictures and the treatment options that are currently available.
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Affiliation(s)
- Petra G A van Boeckel
- Department of Gastroenterology and Hepatology, HP: F02.618, University Medical Center, Heidelberglaan 100, 3584, CX, Utrecht, Netherlands,
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30
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Stavropoulos SN, Modayil R, Friedel D. Closing perforations and postperforation management in endoscopy: esophagus and stomach. Gastrointest Endosc Clin N Am 2015; 25:29-45. [PMID: 25442956 DOI: 10.1016/j.giec.2014.09.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Luminal perforation after endoscopy is a dreaded complication that is associated with significant morbidity and mortality, longer and more costly hospitalization, and the specter of potential future litigation. The management of such perforations requires a multidisciplinary approach. Until recently, surgery was required. However, nowadays the endoscopist has a burgeoning armamentarium of devices and techniques that may obviate surgery. This article discusses the approach to endoscopic perforations in the esophagus and stomach.
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Affiliation(s)
- Stavros N Stavropoulos
- Department of Gastroenterology, Hepatology and Nutrition, Winthrop University Hospital, 222 Station Plaza North, Suite 429, Mineola, NY 11501, USA.
| | - Rani Modayil
- Department of Gastroenterology, Hepatology and Nutrition, Winthrop University Hospital, 222 Station Plaza North, Suite 429, Mineola, NY 11501, USA
| | - David Friedel
- Department of Gastroenterology, Hepatology and Nutrition, Winthrop University Hospital, 222 Station Plaza North, Suite 429, Mineola, NY 11501, USA
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31
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Should oesophageal stents be used before neo-adjuvant therapy to treat dysphagia in patients awaiting oesophagectomy? Best evidence topic (BET). Int J Surg 2014; 12:1172-80. [DOI: 10.1016/j.ijsu.2014.09.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 08/02/2014] [Accepted: 09/15/2014] [Indexed: 11/22/2022]
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32
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van den Berg MW, Walter D, de Vries EMG, Vleggaar FP, van Berge Henegouwen MI, van Hillegersberg R, Siersema PD, Fockens P, van Hooft JE. Biodegradable stent placement before neoadjuvant chemoradiotherapy as a bridge to surgery in patients with locally advanced esophageal cancer. Gastrointest Endosc 2014; 80:908-13. [PMID: 25070907 DOI: 10.1016/j.gie.2014.06.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 06/02/2014] [Indexed: 02/08/2023]
Affiliation(s)
- Maarten W van den Berg
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Daisy Walter
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, The Netherlands
| | - Elisabeth M G de Vries
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Frank P Vleggaar
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, The Netherlands
| | | | | | - Peter D Siersema
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, The Netherlands
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Endoprosthetics in the treatment of benign esophageal strictures. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2014. [DOI: 10.1016/j.tgie.2014.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Lorenzo-Zúñiga V, Moreno-de-Vega V, Marín I, Boix J. Biodegradable stents in gastrointestinal endoscopy. World J Gastroenterol 2014; 20:2212-2217. [PMID: 24605020 PMCID: PMC3942826 DOI: 10.3748/wjg.v20.i9.2212] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 10/22/2013] [Accepted: 12/04/2013] [Indexed: 02/06/2023] Open
Abstract
Biodegradable stents (BDSs) are an attractive option to avoid ongoing dilation or surgery in patients with benign stenoses of the small and large intestines. The experience with the currently the only BDS for endoscopic placement, made of Poly-dioxanone, have shown promising results. However some aspects should be improved as are the fact that BDSs lose their radial force over time due to the degradable material, and that can cause stent-induced mucosal or parenchymal injury. This complication rate and modest clinical efficacy has to be carefully considered in individual patients prior to placement of BDSs. Otherwise, the price of these stents therefore it is nowadays an important limitation.
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van Boeckel PGA, Vleggaar FP, Siersema PD. Biodegradable stent placement in the esophagus. Expert Rev Med Devices 2014; 10:37-43. [DOI: 10.1586/erd.12.45] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Krokidis M, Burke C, Spiliopoulos S, Gkoutzios P, Hynes O, Ahmed I, Dourado R, Sabharwal T, Mason R, Adam A. The use of biodegradable stents in malignant oesophageal strictures for the treatment of dysphagia before neoadjuvant treatment or radical radiotherapy: a feasibility study. Cardiovasc Intervent Radiol 2013; 36:1047-54. [PMID: 23150121 DOI: 10.1007/s00270-012-0503-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 09/27/2012] [Indexed: 02/05/2023]
Abstract
PURPOSE To evaluate the clinical results of the use of biodegradable oesophageal stents in malignant strictures. METHODS Eleven patients were included in this prospective analysis in which a woven polydioxanone biodegradable oesophageal stent was used. The inclusion criterion was that the patient underwent neoadjuvant treatment or radical radiotherapy after the stent insertion. Primary end points were dysphagia score at discharge, stent patency, and complication rate. Secondary end points were overall survival and surgical outcome of surgery. RESULTS There was a 100% procedure technical success rate. Early complications occurred in three patients resulting in failure to restore oral nutrition. In the remaining eight patients, dysphagia was significantly improved at discharge. Mean stent patency rate in this group was 71.5 days. Stent dysfunction occurred in five of eight patients (62.5%); in two of five patients this was due to local inflammatory reaction, and in three of five patients it was due to tumour growth after a mean time of 97.8 days, and a new metallic stent was consequently placed in four of five patients. One patient was successfully treated with esophagectomy. At the end of follow-up (mean time 102.1 days), three of eight stents were patent. The overall patient survival rate was 81.8%. CONCLUSION Although short-term dysphagia scores improved, biodegradable stents do not appear to offer a clear beneficial effect in most cases of malignant strictures, particularly due to a local inflammatory reaction that may be induced. Technical improvement of the device and delineation of the patient group that would benefit from its use is necessary if further studies are to be conducted in the future.
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Affiliation(s)
- Miltiadis Krokidis
- Department of Radiology, Guy's and St. Thomas' NHS Trust, St Thomas' Hospital, 1st Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH, UK.
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Abstract
Complications following esophagectomy significantly affect the outcome, including perioperative mortality, costs and survival. Pulmonary complications and anastomotic leaks still remain the most serious complications and early recognition and appropriate initial treatment are essential. Mortality associated with esophageal leaks is decreasing due in part to the increased use of computed tomography (CT) scanning and endoscopy for diagnosis and subsequent appropriate multidisciplinary therapy. In this respect, it is critically important to differentiate between leaks and conduit necrosis, and endoscopic examination is the best method for making this assessment. Endoscopic and interventional radiology techniques are being applied increasingly for detection of intrathoracic leaks but appropriate patient selection is important. Adequate external drainage of the leak and prevention of further contamination are the primary therapeutic goals. The spectrum of therapeutic options ranges from simple conservative treatment for smaller, well drained leaks, interventional placement of drains, to endoscopic intervention with closure of the fistula or placement of stents and reoperation or discontinuity resection for conduit necrosis.
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