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Da Riz F, Béguin J, Manassero M, Faucher M, Freiche V. Outcome of dogs and cats with benign oesophageal strictures after balloon dilatation or stenting: 27 cases (2002-2019). J Small Anim Pract 2021; 62:886-894. [PMID: 34159606 DOI: 10.1111/jsap.13392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/26/2021] [Accepted: 05/24/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Acquired oesophageal strictures remain challenging to manage in canine and feline patients. The aims of this study were to describe the treatment, complications, short-term outcome and long-term follow-up of benign oesophageal strictures treated by balloon dilatation or stenting in dogs and cats and to describe adjunctive techniques to minimise the complication rate of stent placement. MATERIALS AND METHODS Retrospective analysis of medical records of dogs and cats with benign oesophageal stricture diagnosed under endoscopy between 2002 and 2019. RESULTS Eighteen dogs and nine cats were included, representing 39 strictures. Balloon dilatation was used as first-line therapy, with a good outcome in 59% of cases. Stents were placed in eight cases due to stricture recurrence; 88% had a long-term satisfactory outcome. Short-term complications occurred in six of eight cases; migration and aberrant mucosal reaction were uncommon. In three cases, progressive mesh cutting during follow-up reduced discomfort and trichobezoars formation and improved long-term stent tolerance. Overall median survival time was 730 days. CLINICAL SIGNIFICANCE Long-term prognosis of balloon dilatation as a first-line therapy for esophageal strictures and of stenting as a rescue therapy was considered satisfactory. Although discomfort associated with stenting was frequent, tolerability might be improved by per-endoscopic adjunctive techniques.
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Affiliation(s)
- F Da Riz
- Service de Médecine interne, Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est, Maisons-Alfort, F-94700, France
| | - J Béguin
- Service de Médecine interne, Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est, Maisons-Alfort, F-94700, France
| | - M Manassero
- Service de Chirurgie, Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est, Maisons-Alfort, F-94700, France
| | - M Faucher
- Clinique Vétérinaire Alliance, Bordeaux, France
| | - V Freiche
- Clinique Vétérinaire Alliance, Bordeaux, France
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Kappelle WF, van Hooft JE, Spaander MCW, Vleggaar FP, Bruno MJ, Maluf-Filho F, Bogte A, van Halsema E, Siersema PD. Treatment of refractory post-esophagectomy anastomotic esophageal strictures using temporary fully covered esophageal metal stenting compared to repeated bougie dilation: results of a randomized controlled trial. Endosc Int Open 2019; 7:E178-E185. [PMID: 30705950 PMCID: PMC6338544 DOI: 10.1055/a-0777-1856] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 09/24/2018] [Indexed: 12/31/2022] Open
Abstract
Background and study aims Fully covered self-expanding metal stents (FCSEMS) provide an alternative to bougie dilation (BD) for refractory benign esophageal strictures. Controlled studies comparing temporary placement of FCSES to repeated BD are not available. Patients and methods Patients with refractory anastomotic esophageal strictures, dysphagia scores ≥ 2, and two to five prior BD were randomized to 8 weeks of FCSEMS or to repeated BD. The primary endpoint was the number of BD during the 12 months after baseline treatment. Results Eighteen patients were included (male 67 %, median age 66.5; 9 received metal stents, 9 received BD). Technical success rate of stent placement and stent removal was 100 %. Recurrent dysphagia occurred in 13 patients (72 %) during follow-up. No significant difference was found between the stent and BD groups for mean number of BD during follow-up (5.4 vs. 2.4, P = 0.159), time to recurrent dysphagia (median 36 days vs. 33 days, Kaplan-Meier: P = 0.576) and frequency of reinterventions per month (median 0.3 vs. 0.2, P = 0.283). Improvement in quality of life score was greater in the stent group compared to the BD group at month 12 (median 26 % vs. 4 %, P = 0.011). Conclusions The current data did not provide evidence for a statistically significant difference between the two groups in the number of BD during the 12 months after initial treatment. Metal stenting offers greater improvement in quality of life from baseline at 12 months compared to repeated BD for patients with refractory anastomotic esophageal strictures.
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Affiliation(s)
- W. F. Kappelle
- University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - F. P. Vleggaar
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - M. J. Bruno
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | - F. Maluf-Filho
- Instituto do Cancer do Estado de Sao Paulo, Sao Paulo, Brazil
| | - A. Bogte
- University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - P. D. Siersema
- University Medical Center Utrecht, Utrecht, The Netherlands,Radboud University Medical Center, Nijmegen, The Netherlands,Corresponding author Peter D. Siersema, MD, PhD Dept. of Gastroenterology and HepatologyRadboud University Medical CenterNijmegenThe Netherlands+31 10 465 8520
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Garbey M, Salmon R, Fikfak V, Clerc CO. Esophageal stent migration: Testing few hypothesis with a simplified mathematical model. Comput Biol Med 2016; 79:259-265. [DOI: 10.1016/j.compbiomed.2016.10.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/21/2016] [Accepted: 10/24/2016] [Indexed: 12/29/2022]
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van den Berg MW, Kerbert AC, van Soest EJ, Schwartz MP, Bakker CM, Gilissen LPL, van Hooft JE. Safety and efficacy of a fully covered large-diameter self-expanding metal stent for the treatment of upper gastrointestinal perforations, anastomotic leaks, and fistula. Dis Esophagus 2016; 29:572-9. [PMID: 25893629 DOI: 10.1111/dote.12363] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Upper gastrointestinal perforations, fistula, and anastomotic leaks are severe conditions with high mortality. Temporary endoscopic placement of fully covered self-expanding metal stent (fSEMS) has emerged as treatment option. Stent migration is a major drawback of currently used stents. Migration is often attributed to a relatively too small stent diameter as esophageal stents were initially intended for the treatment of strictures. This study aimed to investigate the safety and efficacy of a large-diameter fSEMS for treatment of these conditions. Data were retrospectively collected from patients who received this stent in the Netherlands between March 2011 and August 2013. Clinical success was defined as sufficient leak closure after stent removal as confirmed by endoscopy or X-ray with oral contrast without surgical intervention or placement of another type of stent. Adverse events were graded according a standardized grading system. Stent placement was performed in 34 patients for the following indications: perforation (n = 6), anastomotic leak (n = 26), and fistula (n = 2). Technical success rate was 97% (33/34). Clinical success rate was 44% (15/34) after one stent and 50% (17/34) after an additional stent. There were no severe adverse events and stent-related mortality. The overall adverse event rate was 50% (all graded 'moderate'). There were 14 (41%) stent migrations (complete n = 8, partial n = 6). Other adverse events were bleeding (n = 2) and aspiration pneumonia (n = 1). Reinterventions for failure of the large-diameter fSEMS were placement of another type of fSEMS (n = 4), surgical repair (n = 3), or esophagectomy (n = 1). Eleven patients (32%) died in-hospital because of persisting intrathoracic sepsis (n = 10) or preexistent bowel ischemia (n = 1). This study suggests that temporary placement of a large-diameter fSEMS for the treatment of upper gastrointestinal perforations, fistula, and anastomotic leaks is safe in terms of severe adverse events and stent-related mortality. The larger diameter does not seem to prevent stent migration.
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Affiliation(s)
- M W van den Berg
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - A C Kerbert
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - E J van Soest
- Department of Gastroenterology and Hepatology, Kennemer Gasthuis Hospital, Haarlem, the Netherlands
| | - M P Schwartz
- Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, the Netherlands
| | - C M Bakker
- Department of Gastroenterology and Hepatology, Atrium Medical Center, Heerlen, the Netherlands
| | - L P L Gilissen
- Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, the Netherlands
| | - J E van Hooft
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Stenting as a palliative method in the management of advanced squamous cell carcinoma of the oesophagus and gastro-oesophageal junction. Wideochir Inne Tech Maloinwazyjne 2016; 11:1-8. [PMID: 28133493 PMCID: PMC4840189 DOI: 10.5114/wiitm.2016.58979] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 03/07/2016] [Indexed: 11/17/2022] Open
Abstract
Advanced squamous cell carcinoma of the oesophagus and gastroesophageal junction usually requires palliative treatment, and the method of choice is stenting. There are several types of stents currently available, including: self-expandable metallic stents (fully or partially covered); self-expandable plastic stents; biodegradable stents. Each of the mentioned stents has its advantages and limitations, and requires a proper, patient-tailored selection. Due to the close anatomical relationship between the oesophagus and bronchial tree, some patients may require bilateral stenting. Oesophageal stenting may not only be considered as a palliative procedure, but can also be implemented to alleviate dysphagia during preoperative chemotherapy and/or radiotherapy.
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Hamer PW, Griffiths EA, Devitt PG. Tracheo-oesophageal fistula after palliative treatment of oesophageal cancer. J Gastrointest Oncol 2015; 6:E86-8. [PMID: 26487957 DOI: 10.3978/j.issn.2078-6891.2015.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We present a case of an 86-year-old male who presented with severe pneumonia in the context of having undergone radiotherapy and then an oesophageal stent insertion for palliation of oesophageal cancer. He was diagnosed with a tracheo-oesophageal fistula (TOF) which was successfully managed by deploying a second stent within the first stent.
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Affiliation(s)
- Peter W Hamer
- Professorial and Oesophagogastric Surgery, Department of Surgery, Royal Adelaide Hospital, Adelaide, Australia
| | - Ewen A Griffiths
- Professorial and Oesophagogastric Surgery, Department of Surgery, Royal Adelaide Hospital, Adelaide, Australia
| | - Peter G Devitt
- Professorial and Oesophagogastric Surgery, Department of Surgery, Royal Adelaide Hospital, Adelaide, Australia
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Abstract
BACKGROUND AND STUDY AIMS Migration is the most common complication of the fully covered metallic self-expanding esophageal stent (FCSEMS). Recent studies have demonstrated migration rates between 30% and 60%. The aim of this study was to determine the effect of fixation of the FCSEMS by endoscopic suturing on migration rate. PATIENT AND METHODS Patients who underwent stent placement for esophageal strictures and leaks over the last year were captured and reviewed retrospectively. Group A, cases, were patients who underwent suture placement and group B, controls, were patients who had stents without sutures. Basic demographics, indications, and adverse events (AEs) were collected. Kaplan-Meier analysis and Cox regression modeling were conducted to determine estimates and predictors of stent migration in patients with and without suture placement. RESULTS Thirty-seven patients (18 males, 48.65%), mean age 57.2 years (±16.3 y), were treated with esophageal FCSEMS. A total of 17 patients received sutures (group A) and 20 patients received stents without sutures (group B). Stent migration was noted in a total of 13 of the 37 patients (35%) [2 (11%) in group A and 11 (55%) in group B]. Using Kaplan-Meier analysis and log-rank analysis, fixation of the stent with suturing reduced the risk of migration (P=0.04). There were no AEs directly related to suture placement. CONCLUSIONS Anchoring of the upper flare of the FCSEMS with endoscopic sutures is technically feasible and significantly reduces stent migration rate when compared with no suturing, and is a safe procedure with very low AEs rates.
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Initial Outcomes of Symmetrically Flared Covered Nitinol Stents for Esophageal Pathologies. Surg Laparosc Endosc Percutan Tech 2015; 25:420-3. [PMID: 25654183 DOI: 10.1097/sle.0000000000000127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND A recently available, low profile, fully covered metal stent with symmetrical flares (FCMSF) may offer improved resistance to migration in esophageal disease. MATERIALS AND METHODS A retrospective review of 58 esophageal FCMSF placed in 46 consecutive patients was performed. Pathologies included stricture and leak of benign and malignant etiology. RESULTS Sixteen of 58 stents (28%) were placed urgently/emergently. All patients had successful stent deployment with 0% stent-related hospital mortality. Postoperative morbidity occurred in 15 of the 58 (26%) stents and included stent migration, atrial fibrillation, pneumonia, pneumothorax, urinary retention, hemodynamic instability, and chronic obstructive pulmonary disease exacerbation. In patients with stricture (n=29), mean dysphagia scores were reduced from 3.1±0.6 preoperatively to 1.1±0.8 postoperatively (P<0.001). For leak, stent therapy (±drainage) avoided formal esophageal operation in 95% (21/22). Four stents (6.9%) were removed for stent migration, 2 of which migrated after adjuvant chemoradiation. Adjuvant chemoradiation therapy was an independent risk factor for stent migration (odds ratio=1.6; P=0.02) by multivariable regression analysis. The mean duration of stent therapy was 65±62 days for stricture (27/34 remain in situ) and 57±57 days for leak (10/22 remain in situ). The median hospital length of stay was 2 days. CONCLUSIONS FCMSF provide a safe and effective therapy for both benign and malignant esophageal dysphagia and leaks. The symmetrical property may contribute to the overall low observed migration rate while still allowing for simple and safe stent retrieval.
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Mezes P, Krokidis ME, Katsanos K, Spiliopoulos S, Sabharwal T, Adam A. Palliation of esophageal cancer with a double-layered covered nitinol stent: long-term outcomes and predictors of stent migration and patient survival. Cardiovasc Intervent Radiol 2014; 37:1444-9. [PMID: 24390360 DOI: 10.1007/s00270-013-0829-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 12/07/2013] [Indexed: 02/05/2023]
Abstract
PURPOSE To evaluate the long-term clinical outcomes and the negative predictors after the deployment of double-layered stents in malignant esophageal strictures. METHODS This is a single-center study of patients who received a double-layered covered stent for the palliation of dysphagia due to malignant esophageal strictures in a 3-year period. 56 patients fulfilled the inclusion criteria. The study's primary end points were technical success, dysphagia improvement, stent migration, and complication rates; secondary end points were the stent's primary patency and overall survival. Cox regression analysis was used to adjust for confounding variables and to identify predictors of survival outcomes. RESULTS Technical success was 95%. Median dysphagia score improved significantly after stenting (p < 0.0001). Stent migration rate was 7.1% and occurred exclusively in the group of patients who received chemoradiotherapy (p < 0.01). The median stent patency was 87 days (range 5-444 days). Dysphagia reoccurred in 39.3% and was successfully managed with restenting in 98.2%. The median survival was 127 days (range 15-1480 days). Chemoradiotherapy and baseline histology did not influence survival outcomes. Survival was adversely affected by metastases (p = 0.005) and poor oral intake (p = 0.048). Patient survival was improved by repeat stenting in case of tissue overgrowth (p = 0.06). CONCLUSION The device is safe and effective for the treatment of patients with dysphagia due to esophageal cancer. Migration rate is zero for patients who do not receive chemoradiotherapy. Reintervention when required is a positive survival predictor.
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Affiliation(s)
- Peter Mezes
- Department of Radiology, Guy's and St. Thomas' Hospitals, NHS Foundation Trust, London, UK
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Zhang J, Ren L, Huo J, Zhu Z, Liu D. The use of retrievable fully covered self-expanding metal stent in refractory postoperative restenosis of benign esophageal stricture in children. J Pediatr Surg 2013; 48:2235-40. [PMID: 24210192 DOI: 10.1016/j.jpedsurg.2013.06.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Revised: 04/19/2013] [Accepted: 06/07/2013] [Indexed: 12/30/2022]
Abstract
PURPOSE This study analyzes the efficacy and safety of a retrievable, fully covered self-expanding metal stent (cSEMS) in the treatment of refractory benign esophageal restenosis in children. METHODS This is a retrospective analysis of the application of a newly designed cSEMS in treating refractory benign postoperative restenosis in five children with ages ranging from 16 months to 8 years. Efficacy and safety were evaluated during the follow-up period. RESULTS cSEMS with or without an antireflux valve at the distal end were successfully placed and removed in five children. These five patients were followed up for 4-12 months after stent removal. Among the five patients, ulcerative stricture was observed in two patients because of reflux esophagitis, while three patients showed no signs of stricture recurrence. Stent migration was observed in three patients, two of which required the stent to be reset. The narrow esophagus was successfully expended to a diameter of 12-13 mm. Besides the observation of mild granulation tissue growth in one case, no severe complications were observed during surgery and after stent placement. CONCLUSION Our study suggests that a retrievable, fully covered SEMS is safe and partially effective for treating refractory benign postoperative esophageal restenosis in children during short-term observation.
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Affiliation(s)
- Jie Zhang
- Department of Gastroenterology, Xiangya 2nd hospital, Central South University, Changsha, Hunan 410011, PR China
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Donatelli G, Dhumane P, Perretta S, Dallemagne B, Vix M, Mutter D, Dritsas S, Doffoel M, Marescaux J. Endoscopic placement of fully covered self expanding metal stents for management of post-operative foregut leaks. J Minim Access Surg 2012; 8:118-24. [PMID: 23248437 PMCID: PMC3523447 DOI: 10.4103/0972-9941.103109] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 12/07/2011] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND: Fully covered self-expanding metal stent (SEMS) placement has been successfully described for the treatment of malignant and benign conditions. The aim of this study is to evaluate our experience of fully covered SEMS placement for post-operative foregut leaks. MATERIALS AND METHODS: Retrospective analysis was done for indications, outcomes and complications of SEMS placed in homogeneous population of 15 patients with post-operative foregut leaks in our tertiary-care centre from December 2008 to December 2010. Stent placement and removal, clinical and radiological evidence of leak healing, migration and other complications were the main outcomes analyzed. RESULTS: Twenty-three HANAROSTENT® SEMS were successfully placed in 14/15 patients (93%) with post-operative foregut leaks for an average duration of 28.73 days (range=1-42 days) per patient and 18.73 days per SEMS. Three (20%) patients needed to be re-stented for persistent leaks ultimately resulting in leak closure. Total 5/15 (33.33%) patients and 7/23 (30.43%) stents showed migration; 5/7 (71.42%) migrated stents could be retrieved endoscopically. There were mucosal ulceration in 2/15 (13.33%) and pain in 1/15 (6.66%) patients. CONCLUSIONS: Stenting with SEMS seems to be a feasible option as a primary care modality for patients with post-operative foregut leaks.
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Affiliation(s)
- Gianfranco Donatelli
- IRCAD/EITS, Department of Gastrointestinal and Endocrinal Surgery, University of Strasbourg, Strasbourg, France
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Esophageal stent fixation with endoscopic suturing device (with video). Gastrointest Endosc 2012; 76:1251-5. [PMID: 23031249 DOI: 10.1016/j.gie.2012.08.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 08/01/2012] [Indexed: 12/14/2022]
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Ye W, Liu PF, Xiang B, Zhang W, Shen WD, Sun F. Implantation of esophageal stents under transnasal gastroscopy: An analysis of 40 cases. Shijie Huaren Xiaohua Zazhi 2012; 20:3252-3255. [DOI: 10.11569/wcjd.v20.i33.3252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the clinical value of transnasal gastroscopy in the implantation of esophageal stents.
METHODS: Forty patients with advanced esophageal or cardiac carcinoma developed dysphagia and received implantation of esophageal stents under transnasal gastroscopy. Pre-dilatation to 7 mm was performed in cases of severe esophageal stenosis with a cone-shaped Savary-gilliard expander. X-ray monitoring was not used during the whole procedure. The success rate, accuracy, complications of implantation, and improvement of dysphagia were analyzed.
RESULTS: The success rate of implantation of esophageal stents was 100%. The stents was accurately placed and well self-expanded. Dysphagia was improved significantly (dysphagia score: 3.52 ± 0.41 vs 1.05 ± 0.38, P < 0.05). One case developed late-onset perforation, and the rate of severe complications was 2.5%.
CONCLUSION: Implantation of esophageal stents under transnasal gastroscopy is simple, safe, and has a high success rate and good patient compliance.
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Plaza S, Barba R, Zapatero A, Losa JE, Canora J, Marco J. [Invasive procedures in patients hospitalized in Spanish internal medicine departments]. Rev Clin Esp 2012; 212:513-9. [PMID: 22836024 DOI: 10.1016/j.rce.2012.05.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 05/19/2012] [Accepted: 05/28/2012] [Indexed: 11/30/2022]
Abstract
AIMS Invasive procedures (IP) have become routine techniques that benefit an important number of patients on improving their quality of life or avoiding more aggressive treatments. We have conducted a study on the IPs performed in Spanish Internal Medicine (IM) Departments between 2005 and 2009. PATIENTS AND METHODS IP performed to patients admitted to Spanish Internal Medicine departments were analyzed based on the information obtained from the Minimum Basis Data Set (CMBD). IP was defined as the following: filter placement in the inferior vena cava, chest tube placement, biliary, esophageal and colon prosthesis placement, pleurodesis, nephrostomy, external biliary drain placement, gastrostomy tube placement, thoracocentesis and peritoneal catheter placement. RESULTS During the study period, a total of 75,853 invasive procedures on 70,239 admittances were performed in 2,766,673 patients (2.5%). IP subjects were younger (68.1 vs 71.4; P<.001), predominantly male (61.9 vs 53.2%; P<.001), with higher mortality (14.6 vs 9.9%; P<.001) and longer stay (18.4 vs 9.6 days; P<0.001). Cost of admittance was clearly higher than the rest of the patients (5,600€ vs 3,835€; P<.001). CONCLUSIONS IPs are performed on a low percentage of IM Department hospitalized patients. They are costly, entail high mortality and a longer stay period compared to the mean population admitted to IM. A considerable proportion of the patients receiving IP suffer from neoplastic diseases, frequently in advances stages, which justifies the high inhospital mortality of this population.
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Affiliation(s)
- S Plaza
- Servicio de Medicina Interna, Hospital Severo Ochoa, Leganés, Madrid, España
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Ananthakrishnan N, Lakshmi CP, Kate V. Esophageal stents in benign and malignant diseases. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2011. [DOI: 10.1016/s2222-1808(11)60074-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Matsumoto S, Miyatani H, Yoshida Y, Nokubi M. Cicatricial stenosis after endoscopic submucosal dissection of esophageal cancer effectively treated with a temporary self-expandable metal stent. Gastrointest Endosc 2011; 73:1309-12. [PMID: 21272877 DOI: 10.1016/j.gie.2010.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Accepted: 11/04/2010] [Indexed: 12/31/2022]
Affiliation(s)
- Satohiro Matsumoto
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Omiya, Saitama, Japan
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Keswani RN. Esophageal stenting for leaks and strictures: a benign intervention for a benign indication? Dig Dis Sci 2010; 55:3297-9. [PMID: 20972852 DOI: 10.1007/s10620-010-1450-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Abstract
The use of self-expanding metallic stents in the upper gastrointestinal tract, placed under radiologic imaging or endoscopic guidance, is the current treatment of choice for the palliation of malignant gastrointestinal outlet obstructions. Advances in metallic stent design and delivery systems have progressed to the stage where this treatment is now considered a minimally invasive therapy. Metallic stent placement will broaden further into the field of nonsurgical therapy for the gastrointestinal tract. To date, metallic stents placed in the esophagus, gastric outlet, colorectum, and bile ducts are not intended to be curative, but rather to provide a palliative treatment for obstructions. The evolution of metallic stent technology will render such procedures not only palliative but also therapeutic, by enabling local drug delivery, and the use of biodegradable materials will reduce procedure-related complications.
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Affiliation(s)
- Sung-Gwon Kang
- Department of Interventional Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
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