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Aboelezz AF, Othman MO. Endoscopic Management of Colonic Obstruction. Gastrointest Endosc Clin N Am 2024; 34:141-153. [PMID: 37973225 DOI: 10.1016/j.giec.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Large bowel obstruction is a serious event that occurs in approximately 25% of all intestinal obstructions. It is attributed to either benign, malignant, functional (pseudo-obstruction), or mechanical conditions. Benign etiologies of colonic obstructions include colon volvulus, anastomotic strictures, radiation injury, ischemia, inflammatory processes such as Crohn's disease, diverticulitis, bezoars, and intussusception.
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Affiliation(s)
- Ahmad F Aboelezz
- Department of Internal Medicine, Gastroenterology and Hepatology Section, Faculty of Medicine, Tanta University, El Bahr Street, Tanta Qism 2, Tanta 1, Gharbia Governorate 31111, Egypt
| | - Mohamed O Othman
- Department of Internal Medicine, Gastroenterology and Hepatology Section, Baylor College of Medicine, Gastroenterology Section at Baylor St Luke's Medical Center, 7200 Cambridge Street. Suite 8A, Houston, TX 77030, USA.
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Liu MC, Wang YS, Yang YJ, Lai FP. Case Report: Successful Use of Biliary Stent for Iatrogenic Esophageal Perforation Following Balloon Dilation in a 7-Month-Old Infant. Front Pediatr 2020; 8:545760. [PMID: 33194887 PMCID: PMC7655732 DOI: 10.3389/fped.2020.545760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 10/06/2020] [Indexed: 11/17/2022] Open
Abstract
Esophageal perforation is a rare but critical emergency that requires early detection and prompt management. In the pediatric population, iatrogenic injury is the most common etiology of esophageal perforation, and the majority of cases come from stricture dilation. Treatment options include medical management, endoscopic therapy, and surgery. Usually, conservative treatment is appropriate in most carefully selected patients, especially in the setting of early diagnosis and with the absence of severe sepsis. A surgical approach is reserved for a large tear with mediastinum contamination, or clinical deterioration after unsuccessful conservative management. With the advancement of the endoscopy technique, endoscopy therapy using esophageal stents is an available choice for adult populations who have a complicated protracted healing course or comorbidities precluding surgical attempts. However, this procedure is seldom implemented in children, especially in young infants, owing to unavailable equipment and experts. We report our successful use of a fully-covered self-expandable metal biliary stent in managing esophageal perforation in a seven-month-old infant. In light of this encouraging achievement, this model can be applied to more children who have the same problem.
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Affiliation(s)
- Meng-Chuan Liu
- Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yao-Sheng Wang
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yao-Jong Yang
- Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan
- Institute of Clinical Medicine, Medical College, National Cheng Kung University, Tainan, Taiwan
| | - Fu-Ping Lai
- Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan
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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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Martínez-Alcalá Garcia F, Martínez-Alcalá García Á, Martínez Alcalá F. A non-degraded biodegradable stent in the closure of a defunctionalized rectovaginal fistula. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2019; 111:724. [PMID: 31333040 DOI: 10.17235/reed.2019.4179/2015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The case was a 52-year-old female with a rectovaginal fistula secondary to a rectosigmoid resection with low colorectal anastomosis due to adenocarcinoma. The fistula persisted after surgical reintervention with defunctionalization, a hysterectomy and colostomy in the left iliac fossa.
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Zhou WZ, Song HY, Park JH, Shin JH, Kim JH. Stent placement in benign esophageal strictures. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2015. [DOI: 10.18528/gii1400020] [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: 01/21/2023] Open
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Abstract
Colonic strictures, both benign and malignant, are commonly encountered in clinical practice. Benign strictures are most commonly treated by balloon dilation and less frequently with stents. Balloon dilation can help forestall or obviate surgery in some patients. Colonic strictures of malignant etiology generally need to be managed by stents and/or surgery. This article reviews endoscopic approaches to the management of colonic strictures.
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Affiliation(s)
- Douglas G Adler
- Gastroenterology and Hepatology, Huntsman Cancer Center, University of Utah School of Medicine, 30 North 1900 East 4R118, Salt Lake City, UT 84312, USA.
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WITHDRAWN: Stent Placement in Benign Esophageal Strictures. GASTROINTESTINAL INTERVENTION 2014. [DOI: 10.1016/j.gii.2014.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ham YH, Kim GH. Plastic and biodegradable stents for complex and refractory benign esophageal strictures. Clin Endosc 2014; 47:295-300. [PMID: 25133114 PMCID: PMC4130882 DOI: 10.5946/ce.2014.47.4.295] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 04/15/2014] [Accepted: 04/15/2014] [Indexed: 12/17/2022] Open
Abstract
Endoscopic stent placement is a well-accepted and effective alternative treatment modality for complex and refractory esophageal strictures. Among the currently available types of stents, the partially covered self-expanding metal stent (SEMS) has a firm anchoring effect, preventing stent migration and ensuring effective covering of a narrowed segment. However, hyperplastic tissue reaction driven by the uncovered mesh may prevent easy and safe stent removal. As an alternative, a fully covered SEMS decreases the recurrence of dysphagia caused by hyperplastic tissue ingrowth; however, it has a high migration rate. Likewise, although a self-expanding plastic stent (SEPS) reduces reactive hyperplasia, the long-term outcome is disappointing because of the high rate of stent migration. A biodegradable stent has the main benefit of not requiring stent removal in comparison with SEMS and SEPS. However, it still has a somewhat high rate of hyperplastic reaction, and the long-term outcome does not satisfy expectations. Up to now, the question of which type of stent should be recommended for the effective treatment of complex and refractory benign strictures has no clear answer. Therefore, the selection of stent type for endoscopic treatment should be individualized, taking into consideration the endoscopist's experience as well as patient and stricture characteristics.
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Affiliation(s)
- Young Hee Ham
- Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
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Srinivasan N, Kozarek RA. Stents for colonic strictures: Materials, designs, and more. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2014. [DOI: 10.1016/j.tgie.2014.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Jovani M, Genco C, Bravatà I, Repici A. Stents in the management of benign colorectal strictures. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2014. [DOI: 10.1016/j.tgie.2014.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Lamazza A, Fiori E, Sterpetti AV, Schillaci A, Scoglio D, Lezoche E. Self-expandable metal stents in the treatment of benign anastomotic stricture after rectal resection for cancer. Colorectal Dis 2014; 16:O150-3. [PMID: 24206040 DOI: 10.1111/codi.12488] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 07/29/2013] [Indexed: 12/13/2022]
Abstract
AIM To evaluate the use of self-expandable metallic stents to treat patients with symptomatic benign anastomotic stricture after colorectal resection. METHOD Ten patients with a benign symptomatic anastomotic stricture after colorectal resection were treated with endoscopic placement of a self-expandable metal stent. RESULTS The stent was placed successfully in all 10 patients without any major morbidity. At a mean follow-up of 18 months the stenosis was resolved successfully in 7 out 10 patients (70%). The remaining three patients were subsequently treated successfully with balloon dilatation. CONCLUSION Self-expandable metal stents represent a valid alternative to balloon dilatation to treat patients with benign symptomatic anastomotic stricture after colorectal resection for cancer.
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Affiliation(s)
- A Lamazza
- Istituto Pietro Valdoni-Istituto Paride Stefanini, University of Rome La Sapienza, Rome, Italy
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Lamazza A, Fiori E, Schillaci A, Sterpetti AV, Lezoche E. Treatment of anastomotic stenosis and leakage after colorectal resection for cancer with self-expandable metal stents. Am J Surg 2014; 208:465-9. [PMID: 24560186 DOI: 10.1016/j.amjsurg.2013.09.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Revised: 09/03/2013] [Accepted: 09/09/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Self-expandable metallic stents can be used to treat patients with symptomatic anastomotic complications after colorectal resection. METHODS Twenty patients with symptomatic anastomotic stricture after colorectal resection were treated with endoscopic placement of a self-expandable metal stent. Ten patients had "simple" anastomotic stricture. In the remaining 10 patients, a leak was associated with the stricture. RESULTS The anastomotic leakage healed without evidence of residual stricture or major fecal incontinence in 8 of 10 patients. Overall, the anastomotic stricture was resolved in 14 of the 20 patients. CONCLUSIONS Self-expandable metal stents represent a valid adjunctive to treat patients with symptomatic anastomotic complications after colorectal resection for cancer. They have a complementary role to balloon dilatation in case of simple anastomotic stricture, and they improve the rate of healing when the stricture is associated with a leak.
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Affiliation(s)
- Antonietta Lamazza
- Department "Pietro Valdoni", Department "Paride Stefanini", Sapienza University of Rome, Rome, Italy
| | - Enrico Fiori
- Department "Pietro Valdoni", Department "Paride Stefanini", Sapienza University of Rome, Rome, Italy
| | - Alberto Schillaci
- Department "Pietro Valdoni", Department "Paride Stefanini", Sapienza University of Rome, Rome, Italy
| | - Antonio V Sterpetti
- Department "Pietro Valdoni", Department "Paride Stefanini", Sapienza University of Rome, Rome, Italy.
| | - Emanuele Lezoche
- Department "Pietro Valdoni", Department "Paride Stefanini", Sapienza University of Rome, Rome, Italy
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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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Jee SR, Cho JY, Kim KH, Kim SG, Cho JH. Evidence-based recommendations on upper gastrointestinal tract stenting: a report from the stent study group of the korean society of gastrointestinal endoscopy. Clin Endosc 2013; 46:342-54. [PMID: 23964331 PMCID: PMC3746139 DOI: 10.5946/ce.2013.46.4.342] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 01/02/2013] [Accepted: 01/03/2013] [Indexed: 12/16/2022] Open
Abstract
Endoscopic stents have evolved dramatically over the past 20 years. With the introduction of uncovered self-expanding metal stents in the early 1990s, they are primarily used to palliate symptoms of malignant obstruction in patients with inoperable gastrointestinal (GI) cancer. At present, stents have emerged as an effective, safe, and less invasive alternative for the treatment of malignant GI obstruction. Clinical decisions about stent placement should be made based on the exact understanding of the patient's condition. These recommendations based on a critical review of the available data and expert consensus are made for the purpose of providing endoscopists with information about stent placement. These can be helpful for management of patients with inoperable cancer or various nonmalignant conditions in the upper GI tract.
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Affiliation(s)
- Sam Ryong Jee
- Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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Repici A, Pagano N, Rando G, Carlino A, Vitetta E, Ferrara E, Strangio G, Zullo A, Hassan C. A retrospective analysis of early and late outcome of biodegradable stent placement in the management of refractory anastomotic colorectal strictures. Surg Endosc 2013; 27:2487-91. [PMID: 23443478 DOI: 10.1007/s00464-012-2762-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 12/07/2012] [Indexed: 01/01/2023]
Abstract
BACKGROUND Benign colorectal strictures are treated conventionally by endoscopic dilation. Experience using SEMS for benign colonic strictures is limited, and outcomes to date have been disappointing. Refractory colorectal strictures remain challenging to be treated with surgery. Polydioxanone-based stent are biodegradable (BD) stent CE approved for esophageal strictures. This study was designed to investigate retrospectively the safety and the efficacy of these stents for the management of strictures refractory to multiple sessions of dilation. METHODS Patients with postsurgical benign strictures located within 20 cm from anal verge, refractory to mechanical or pneumatic dilation (at least 3 sessions) were included in this analysis. Clinical success was defined as the absence of occlusive symptoms and the ability to pass through the stricture with a regular size colonoscope. All patients were predilated before stent placement. Stents were released under fluoroscopic control. All patients were under stool softeners for 3 months. Follow-up was scheduled with endoscopic and fluoroscopic controls within 90 days from stent deployment and afterwards by telephone interview and/or ambulatory consultation. RESULTS Eleven patients (7 males, mean age 62.3 ± 8.5 years) were included. Technical success was achieved in all the patients. Stent migration was observed in four patients within the first 2 weeks after stent placement. Stent migration was followed by recurrence of stricture and obstructive symptoms in all the cases. Among the seven patients who completed the process of stent biodegradation, five of them had complete resolution of the stricture and relief of symptoms. Two of 11 patients required surgical treatment during the follow-up period (mean 19.8 (range 42-15) months). The overall success rate of the BD stent was 45 %. CONCLUSIONS This retrospective analysis of a limited number of patients demonstrated that nondedicated esophageal BD stents are associated with high risk of migration and clinical success in less than 50 % of patients. Dedicated stents with large diameter and antimigration findings could potentially improve the outcome of patients with refractory benign colorectal strictures.
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Affiliation(s)
- A Repici
- Digestive Endoscopy Unit, Istituto Clinico Humanitas, Via Manzoni 56, 20089 Rozzano (Milano), Italy
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Canena JMT, Liberato MJA, Rio-Tinto RAN, Pinto-Marques PM, Romão CMM, Coutinho AVMP, Neves BAHC, Santos-Silva MFCN. A comparison of the temporary placement of 3 different self-expanding stents for the treatment of refractory benign esophageal strictures: a prospective multicentre study. BMC Gastroenterol 2012; 12:70. [PMID: 22691296 PMCID: PMC3447662 DOI: 10.1186/1471-230x-12-70] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 05/24/2012] [Indexed: 12/27/2022] Open
Abstract
Background Refractory benign esophageal strictures (RBESs) have been treated with the temporary placement of different self-expanding stents with conflicting results. We compared the clinical effectiveness of 3 types of stents: self-expanding plastic stents (SEPSs), biodegradable stents, and fully covered self-expanding metal stents (FCSEMSs), for the treatment of RBES. Methods This study prospectively evaluated 3 groups of 30 consecutive patients with RBESs who underwent temporary placement of either SEPSs (12 weeks, n = 10), biodegradable stents (n = 10) or FCSEMSs (12 weeks, n = 10). Data were collected to analyze the technical success and clinical outcome of the stents as evaluated by recurrent dysphagia, complications and reinterventions. Results Stent implantation was technically successful in all patients. Migration occurred in 11 patients: 6 (60%) in the SEPS group, 2 (20%) in the biodegradable group and 3 (30%) in the FCSEMS group (P = 0.16). A total of 8/30 patients (26.6%) were dysphagia-free after the end of follow-up: 1 (10%) in the SEPS group, 3 (30%) in the biodegradable group and 4 (40%) in the FCSEMS group (P = 0.27). More reinterventions were required in the SEPS group (n = 24) than in the biodegradable group (n = 13) or the FCSEMS group (n = 13) (P = 0.24). Multivariate analysis showed that stricture length was significantly associated with higher recurrence rates after temporary stent placement (HR = 1.37; 95% CI = 1.08-1.75; P = 0.011). Conclusions Temporary placement of a biodegradable stent or of a FCSEMS in patients with RBES may lead to long-term relief of dysphagia in 30 and 40% of patients, respectively. The use of SEPSs seems least preferable, as they are associated with frequent stent migration, more reinterventions and few cases of long-term improvement. Additionally, longer strictures were associated with a higher risk of recurrence.
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Hirdes MMC, Vleggaar FP, Siersema PD. Stent placement for esophageal strictures: an update. Expert Rev Med Devices 2012; 8:733-55. [PMID: 22029470 DOI: 10.1586/erd.11.44] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The use of stents for esophageal strictures has evolved rapidly over the past 10 years, from rigid plastic tubes to flexible self-expanding metal (SEMS), plastic (SEPS) and biodegradable stents. For the palliative treatment of malignant dysphagia both SEMS and SEPS effectively provide a rapid relief of dysphagia. SEMS are preferred over SEPS, as randomized controlled trials have shown more technical difficulties and late migration with plastic stents. Despite specific characteristics of recently developed stents, recurrent dysphagia due to food impaction, tumoral and nontumoral tissue overgrowth, or stent migration, remain a major challenge. The efficacy of stents with an antireflux valve for patients with distal esophageal cancer varies between different stent designs. Concurrent treatment with chemotherapy and/or radiotherapy seems to be safe and effective. In the future, it can be expected that removable stents will be used as a bridge to surgery to maintain luminal patency during neoadjuvant treatment. For benign strictures, new stent designs, such as fully covered SEMS and biodegradable stents, may potentially reduce complications during stent removal.
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Varadarajulu S, Banerjee S, Barth B, Desilets D, Kaul V, Kethu S, Pedrosa M, Pfau P, Tokar J, Wang A, Song LMWK, Rodriguez S. Enteral stents. Gastrointest Endosc 2011; 74:455-64. [PMID: 21762904 DOI: 10.1016/j.gie.2011.04.011] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Accepted: 04/06/2011] [Indexed: 02/08/2023]
Abstract
The American Society for Gastrointestinal Endoscopy (ASGE) Technology Committee provides reviews of existing, new, or emerging endoscopic technologies that have an impact on the practice of GI endoscopy. Evidence-based methodology is used, with a MEDLINE literature search to identify pertinent clinical studies on the topic and a MAUDE (U.S. Food and Drug Administration Center for Devices and Radiological Health) database search to identify the reported complications of a given technology. Both are supplemented by accessing the "related articles" feature of PubMed and by scrutinizing pertinent references cited by the identified studies. Controlled clinical trials are emphasized, but in many cases, data from randomized, controlled trials are lacking. In such cases, large case series, preliminary clinical studies, and expert opinions are used. Technical data are gathered from traditional and Web-based publications, proprietary publications, and informal communications with pertinent vendors. Technology Status Evaluation Reports are drafted by 1 or 2 members of the ASGE Technology Committee, reviewed and edited by the committee as a whole, and approved by the Governing Board of the ASGE. When financial guidance is indicated, the most recent coding data and list prices at the time of publication are provided. For this review, the MEDLINE database was searched through August 2010 for articles related to enteral, esophageal, duodenal, and colonic stents. Technology Status Evaluation Reports are scientific reviews provided solely for educational and informational purposes. Technology Status Evaluation Reports are not rules and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment or payment for such treatment.
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van Boeckel PGA, Vleggaar FP, Siersema PD. A comparison of temporary self-expanding plastic and biodegradable stents for refractory benign esophageal strictures. Clin Gastroenterol Hepatol 2011; 9:653-9. [PMID: 21586341 DOI: 10.1016/j.cgh.2011.04.006] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 03/27/2011] [Accepted: 04/05/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS It is a challenge to manage refractory benign esophageal strictures (RBES). We compared the efficacy and safety of self-expanding plastic stents (SEPSs) with placement of biodegradable stents for the treatment of RBES. METHODS We studied 2 groups of consecutive patients with RBES who received temporary placement (6 weeks) of SEPSs (n = 20) or biodegradable stents (n = 18). Data were collected with respect to clinical outcome, complications, recurrent dysphagia, and reinterventions. RESULTS SEPSs were removed in 16 (80%) patients. Stent placement was not successful in 1 patient, while stent removal was not performed in another 3 patients. Six (30%) patients with an SEPS were dysphagia-free after a median follow-up of 385 days (range, 77-924 days). Ten (50%) developed recurrent dysphagia. Major complications occurred in 2 patients (10%; 1 with hemorrhage and 1 with perforation). Six patients (33%) with a biodegradable stent were dysphagia-free after a median follow-up of 166 days (range 21-559 days) (P = .83 compared with SEPS). Twelve patients (67%) had recurrent dysphagia. Major complications occurred in 4 patients (22%; 2 with hemorrhage, 2 with severe retrosternal pain) with a biodegradable stent (P = .30 compared with SEPS). Reinterventions were less frequently indicated after biodegradeble stent than after SEPS placement (15 [mean, 0.8 ± 0.6 per stent placed] vs 21 [mean, 1.3 ± 0.4 per stent placed], respectively; P = .03). CONCLUSIONS Placement of SEPSs or biodegradable stents provides long-term relief of dysphagia in 30% and 33%, respectively, of patients with RBES. Biodegradable stents require fewer procedures than SEPSs, offering an advantage. Although stent placement is a viable strategy in patients with RBES, the ideal strategy still needs to be defined.
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Affiliation(s)
- Petra G A van Boeckel
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, the Netherlands.
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Abstract
Partially covered self-expandable esophageal stents have been associated with unacceptable complications when used for benign esophageal disorders. With the introduction of removable or potentially removable fully covered stents and biodegradable stents, interest in using expandable stents for benign indications has been revived. Although expandable stents can offer a minimally invasive alternative to surgery, they can be associated with serious complications; hence, this approach should be considered in carefully selected patients, preferably on a protocol basis.
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Affiliation(s)
- Kulwinder S Dua
- Division of Gastroenterology and Hepatology, Department of Medicine, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA.
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Xinopoulos D, Kypreos D, Bassioukas SP, Korkolis D, Mavridis K, Scorilas A, Dimitroulopoulos D, Loukou A, Paraskevas E. Comparative study of balloon and metal olive dilators for endoscopic management of benign anastomotic rectal strictures: clinical and cost-effectiveness outcomes. Surg Endosc 2010; 25:756-63. [PMID: 20927548 DOI: 10.1007/s00464-010-1247-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Accepted: 07/08/2010] [Indexed: 12/14/2022]
Abstract
BACKGROUND Postoperative anastomotic strictures frequently complicate colorectal resection. Currently, various endoscopic techniques are being employed in their management, but the establishment of an optimal therapeutic strategy is still pending. The purpose of our study is to compare through-the-scope (TTS) balloon dilators versus Eder-Puestow metal olive dilators in the treatment of postoperative benign rectal strictures, considering the clinical outcome and cost-effectiveness of each method. METHODS A total of 39 patients with benign anastomotic rectal stenosis were retrospectively studied. In group A, 15 patients underwent dilation with Eder-Puestow metal olives, while in group B 19 patients were treated by means of TTS balloon dilators. The technical and clinical success of dilation, complications, number of repeated sessions required, disease-free time intervals, and the overall cost of each procedure were evaluated. RESULTS Dilations were technically successful in all patients. No major complications occurred in either group. The number of dilations needed, rate of stricture recurrence, and duration of stenosis-free time intervals were not statistically significantly different between the two groups. Both methods proved more effective in older patients, given the greater number of dilations required in younger patients of both groups and higher frequency of stricture relapse in younger balloon-dilated patients (median 64.00 years) compared with older ones (median 75.00 years) (p = 0.001). An indisputable advantage of the Eder-Puestow technique, compared with TTS balloon dilators, is the low cost of equipment (median 22.30 compared with 680 , respectively; p < 0.001). CONCLUSION Endoscopic dilation of postoperative benign rectal strictures is equally effective and safe, especially in older patients, when performed by Eder-Puestow bougies or TTS balloon dilators. However, metal olivary tips seem to surpass balloon dilators when considering the obvious economical benefits of the first method.
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Vleggaar FP, Siersema PD. Stents for benign esophageal strictures. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2010. [DOI: 10.1016/j.tgie.2011.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Irani S, Kozarek R. Esophageal stents: past, present, and future. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2010. [DOI: 10.1016/j.tgie.2011.01.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Repici A, Hassan C, Sharma P, Conio M, Siersema P. Systematic review: the role of self-expanding plastic stents for benign oesophageal strictures. Aliment Pharmacol Ther 2010; 31:1268-75. [PMID: 20236257 DOI: 10.1111/j.1365-2036.2010.04301.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Treatment of refractory or recurrent benign oesophageal strictures is demanding and surgery may be the only available option. The role of self-expanding plastic stents (SEPS) in the treatment of these strictures is still controversial because of the conflicting results of various studies. AIM To analyse with regard to SEPS: technical and clinical success, factors associated with outcome, and safety. METHODS Pooled-data analysis of a systematic review of the literature. Clinical success was defined as no need for further endoscopic or surgical treatment after SEPS removal. RESULTS Data of 10 studies with 130 treated patients were included. SEPS insertion was technically successful in 128 of 130 patients (98%, 95% CI = 96-100%). Clinical success was achieved in 68 patients (52%, 95% CI = 44-61%) and this was found to be lower in those with a cervical localization of the stricture (33% vs. 54%; P < 0.05). Early (<4 weeks) migration of the stent was reported in 19 (24%, 95% CI = 14-32%) cases, while post-insertion endoscopic re-intervention was required in 25 (21%, 95% CI = 14-28%). Major clinical complications occurred in 12 patients (9%, 95% CI = 4-14%), resulting in death of one (0.8%) patient. CONCLUSIONS Our pooled-data analysis showed a favourable risk/benefit ratio when SEPS are applied in patients with recurrent or refractory benign oesophageal strictures. This supports the use of SEPS before referring patients to surgery, and they are a valuable alternative to repeat endoscopic dilation.
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Affiliation(s)
- A Repici
- Gastroenterology Department, Digestive Endoscopy Unit, IRCCS Istituto Clinico Humanitas, Milano, Italy.
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Harrison ME, Anderson MA, Appalaneni V, Banerjee S, Ben-Menachem T, Cash BD, Fanelli RD, Fisher L, Fukami N, Gan SI, Ikenberry SO, Jain R, Khan K, Krinsky ML, Maple JT, Shen B, Van Guilder T, Baron TH, Dominitz JA. The role of endoscopy in the management of patients with known and suspected colonic obstruction and pseudo-obstruction. Gastrointest Endosc 2010; 71:669-79. [PMID: 20363408 DOI: 10.1016/j.gie.2009.11.027] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Accepted: 11/13/2009] [Indexed: 02/06/2023]
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Abstract
These recommendations provide an evidence-based approach to the role of esophageal stents in the management of benign and malignant diseases. These guidelines have been developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee and approved by the Board of Trustees. The following guidelines are based on a critical review of the available scientific literature on the topic identified in Medline and PubMed (January 1992-December 2008) using search terms that included stents, self-expandable metal stents, self-expandable plastic stents, esophageal cancer, esophageal adenocarcinoma, esophageal squamous cell carcinoma, esophageal stricture, perforations, anastomotic leaks, tracheoesophageal fistula, and achalasia. These guidelines are intended for use by health-care providers and apply to adult, but not pediatric, patients. As with other practice guidelines, these guidelines are not intended to replace clinical judgment but rather to provide general guidelines applicable to the majority of patients. Clinicians need to integrate recommendations with their own clinical judgment, and with individual patient circumstances, values, and preferences. They are intended to be flexible, in contrast to standards of care, which are inflexible policies designed to be followed in every case. Specific recommendations are based on relevant published information. The quality of evidence and strength of recommendations have been assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system, which is a system that has been adopted by multiple national and international societies. The GRADE system is based on a sequential assessment of quality of evidence, followed by assessment of the balance between benefits vs. downsides (harms, burden, and costs) and subsequent judgment regarding the strength of recommendation.
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Affiliation(s)
- Prateek Sharma
- Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri 64128-2295, USA.
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Best C, Sudel B, Foker JE, Krosch TCK, Dietz C, Khan KM. Esophageal stenting in children: indications, application, effectiveness, and complications. Gastrointest Endosc 2009; 70:1248-53. [PMID: 19836746 DOI: 10.1016/j.gie.2009.07.022] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Accepted: 07/13/2009] [Indexed: 02/08/2023]
Abstract
BACKGROUND Use of esophageal stents is uncommon in children, and there are few reports. We report the first experience in predominantly small children and infants with retrievable, flexible stents designed for tracheobronchial use. OBJECTIVE Evaluation of initial experience with placement of esophageal stents for benign esophageal disorders in children. DESIGN A retrospective study. SETTING A pediatric, academic, tertiary-referral center. PATIENTS This study involved 7 pediatric patients. INTERVENTIONS Covered tracheobronchial stents were endoscopically placed in pediatric patients with benign esophageal conditions. Removal involved using forceps to pull the purse-string suture into the endoscope channel and collapsing the top of the stent for easy removal. MAIN OUTCOME MEASUREMENTS To evaluate the safety and feasibility of performing endoscopic stent placement in children and to establish criteria for early stent removal. RESULTS Six of 7 patients benefitted from stenting. There were no complications of placement. Novel techniques were developed for difficult retrievals. One patient did not benefit from esophageal stent placement, because the stent migrated downward from the uppermost part of the esophagus. One patient had some gagging, which led to early removal of the stent. A stent was removed emergently in 1 patient for respiratory distress. LIMITATION Small number of patients. CONCLUSIONS Retrievable, covered stents are easily placed and removed from the esophagus in small children. They should be considered for severe unrelenting strictures, especially when associated with esophageal leaks. A need exists for development of esophageal stents designed for pediatric use.
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Affiliation(s)
- Chad Best
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota 55455, USA
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Siersema PD, de Wijkerslooth LRH. Dilation of refractory benign esophageal strictures. Gastrointest Endosc 2009; 70:1000-12. [PMID: 19879408 DOI: 10.1016/j.gie.2009.07.004] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Accepted: 07/03/2009] [Indexed: 02/08/2023]
Affiliation(s)
- Peter D Siersema
- Department of Gastroenterology & Hepatology, University Medical Center, Utrecht, The Netherlands
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García-Cano J, Muñoz-Sánchez M, Morillas-Ariño J. Stenting of strictures close to the upper esophageal sphincter with the Polyflex stent. World J Gastrointest Endosc 2009; 1:65-7. [PMID: 21160654 PMCID: PMC2998847 DOI: 10.4253/wjge.v1.i1.65] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2009] [Revised: 03/06/2009] [Accepted: 03/13/2009] [Indexed: 02/05/2023] Open
Abstract
Stent insertion in strictures in the upper cervical esophagus present special difficulties, such as patient discomfort and worry due to continuous neck globus sensation and a metallic taste. Additionally, the endoscopist needs to have great skill to properly adjust the proximal stent end. We present the experience of stenting high cervical esophageal strictures with a self-expanding plastic stent (Polyflex), in three tumoral and one postoperative benign stenosis. Dysphagia disappeared and the endoprosthesis was well tolerated. The Polyflex stent seems to be suitable for insertion in the upper esophagus.
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Affiliation(s)
- Jesús García-Cano
- Jesús García-Cano, Julia Morillas-Ariño, Department of Digestive Diseases, Hospital Virgen de la Luz, Cuenca 16002, Spain
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Abstract
Esophageal dysphagia can arise from a variety of causes such as motility disorders, mechanical and inflammatory diseases. Adequate management includes a detailed history, evaluation with upper endoscopy, barium radiography and manometry. Treatment is usually tailored to the underlying disease process and in some cases, as in inoperable cancer, palliative management may be necessary.
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Affiliation(s)
- Adeyemi Lawal
- Medical College of Wisconsin, Department of Medicine, Division of Gastroenterology and Hepatology, Froedtert East, FEC-4510, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA
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Self-Expanding Stents in Benign Esophageal Strictures. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2008. [DOI: 10.1016/j.tgie.2008.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Farrell JJ, Sack J. Removable colonic stenting: time to expand the indications? Gastrointest Endosc 2008; 68:721-3. [PMID: 18926180 DOI: 10.1016/j.gie.2008.04.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2008] [Accepted: 04/28/2008] [Indexed: 01/15/2023]
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Geiger TM, Miedema BW, Tsereteli Z, Sporn E, Thaler K. Stent placement for benign colonic stenosis: case report, review of the literature, and animal pilot data. Int J Colorectal Dis 2008; 23:1007-12. [PMID: 18594837 DOI: 10.1007/s00384-008-0518-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2008] [Indexed: 02/04/2023]
Abstract
BACKGROUND Permanent metal stent placement for malignant intestinal obstruction has been proven to be efficient. Temporary stents for benign conditions of the colon and rectum are less studied. This is a case study, review of the literature, and observation from an animal model on placement of stents in the colorectum for benign disease. MATERIALS AND METHODS A 55-year-old man presented with recurrent obstructions from a benign stricture of the distal sigmoid colon. After failed balloon dilations, a polyester coated stent was placed. The purpose of the stent was to improve symptoms and avoid surgery. The stent was expelled after 5 days. We conducted a literature review of stents placed for benign colorectal strictures and an animal study to evaluate stent migration. RESULTS In the literature, there were 53 reports of uncovered metal stents, four covered metal stents, and six polyester stents. Patency rates were 71%, and migration rate was 43%. Migration occurred earlier with polyester stents (mean=8 days) versus covered (32 days) or uncovered metal stents (112 days). Severe complications were seen in 23% of patients. Four 45-kg pigs underwent rectosigmoid transection with a 21-mm anastomosis and endoscopic placement of a Polyflex stent. Two stents were secured with suture. Stents without fixation were expelled within 24 h of surgery. Stents with fixation were expelled between postoperative days 2 and 14. CONCLUSION Stents for the treatment of benign colorectal strictures are safe, with comparable patency rates between stent types. Metal stents can cause severe complications. In a pig model, covered polyester stents tend to migrate early even with fixation. Further investigation needs to focus on new stent designs and/or better fixation.
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Affiliation(s)
- Timothy M Geiger
- Division of General Surgery, University of Missouri-Columbia, Columbia, MO 65212, USA
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