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Machado AA, Martins BC, Josino IR, Chen ATC, Hong CBC, Santos ALDR, Lima GRA, Cordero MAC, Safatle-Ribeiro AV, Pennacchi C, Gusmon CC, Paulo GA, Lenz L, Lima MS, Baba ER, Kawaguti FS, Uemura RS, Sallum RAA, Ribeiro U, Maluf-Filho F. Impact of radiotherapy on adverse events of self-expanding metallic stents in patients with esophageal cancer. Dis Esophagus 2023; 36:doad019. [PMID: 37039273 DOI: 10.1093/dote/doad019] [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] [Received: 10/09/2022] [Revised: 01/03/2023] [Indexed: 04/12/2023]
Abstract
Self-expanding metallic stents (SEMS) are considered the treatment of choice for the palliation of dysphagia and fistulas in inoperable esophageal neoplasms. However, the safety of SEMSs in patients who received or who will be submitted to radiotherapy (RT) is uncertain. The study aimed to evaluate the impact of RT on adverse events (AEs) in patients with esophageal cancer with SEMSs. This is a retrospective study conducted at a tertiary cancer hospital from 2009 to 2018. We collected information regarding RT, the histological type of the tumor, the model of SEMSs and AEs after stent placement. Three hundred twenty-three patients with malignant stenosis or fistula were treated with SEMSs. The predominant histological type was squamous cell carcinoma (79.6%). A total of 282 partially covered and 41 fully covered SEMSs were inserted. Of the 323 patients, 182 did not received RT, 118 received RT before SEMS placement and 23 after. Comparing the group that received RT before stent insertion with the group that did not, the first one presented a higher frequency of severe pain (9/118 7.6% vs. 3/182 1.6%; P = 0.02). The group treated with RT after stent placement had a higher risk of global AEs (13/23 56.5% vs. 63/182 34.6%; P = 0.019), ingrowth/overgrowth (6/23 26.1% vs. 21/182 11.5%; P = 0.045) and gastroesophageal reflux (2/23 8.7% vs. 2/182 1.1%; P = 0.034). Treatment with RT before stent placement in patients with inoperable esophageal neoplasm prolongs survival and is associated with an increased risk of severe chest pain. Treatment with RT of patients with an esophageal stent increases the frequency of minor, not life-threatening AEs.
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Affiliation(s)
- Andressa A Machado
- Endoscopy Unit, Cancer Institute of Sao Paulo, University of Sao Paulo, Sao Paulo, Brazil
| | - Bruno C Martins
- Endoscopy Unit, Cancer Institute of Sao Paulo, University of Sao Paulo, Sao Paulo, Brazil
| | - Iatagan R Josino
- Endoscopy Unit, Cancer Institute of Sao Paulo, University of Sao Paulo, Sao Paulo, Brazil
| | - André T C Chen
- Department of Radiotherapy, Cancer Institute of Sao Paulo, University of Sao Paulo, São Paulo, Brazil
| | - Carlos B C Hong
- Department of Radiotherapy, Cancer Institute of Sao Paulo, University of Sao Paulo, São Paulo, Brazil
| | - Alisson L D R Santos
- Endoscopy Unit, Cancer Institute of Sao Paulo, University of Sao Paulo, Sao Paulo, Brazil
| | - Gustavo R A Lima
- Endoscopy Unit, Cancer Institute of Sao Paulo, University of Sao Paulo, Sao Paulo, Brazil
| | - Martin A C Cordero
- Endoscopy Unit, Cancer Institute of Sao Paulo, University of Sao Paulo, Sao Paulo, Brazil
| | | | - Caterina Pennacchi
- Endoscopy Unit, Cancer Institute of Sao Paulo, University of Sao Paulo, Sao Paulo, Brazil
| | - Carla C Gusmon
- Endoscopy Unit, Cancer Institute of Sao Paulo, University of Sao Paulo, Sao Paulo, Brazil
| | - Gustavo A Paulo
- Endoscopy Unit, Cancer Institute of Sao Paulo, University of Sao Paulo, Sao Paulo, Brazil
| | - Luciano Lenz
- Endoscopy Unit, Cancer Institute of Sao Paulo, University of Sao Paulo, Sao Paulo, Brazil
| | - Marcelo S Lima
- Endoscopy Unit, Cancer Institute of Sao Paulo, University of Sao Paulo, Sao Paulo, Brazil
| | - Elisa R Baba
- Endoscopy Unit, Cancer Institute of Sao Paulo, University of Sao Paulo, Sao Paulo, Brazil
| | - Fábio S Kawaguti
- Endoscopy Unit, Cancer Institute of Sao Paulo, University of Sao Paulo, Sao Paulo, Brazil
| | - Ricardo S Uemura
- Endoscopy Unit, Cancer Institute of Sao Paulo, University of Sao Paulo, Sao Paulo, Brazil
| | - Rubens A A Sallum
- Department of Gastroenterology, Cancer Institute of Sao Paulo, University of Sao Paulo, São Paulo, Brazil
| | - Ulysses Ribeiro
- Department of Gastroenterology, Cancer Institute of Sao Paulo, University of Sao Paulo, São Paulo, Brazil
| | - Fauze Maluf-Filho
- Endoscopy Unit, Cancer Institute of Sao Paulo, University of Sao Paulo, Sao Paulo, Brazil
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Ishihara R. Endoscopic Stenting for Malignant Dysphagia in Patients with Esophageal Cancer. Curr Oncol 2023; 30:5984-5994. [PMID: 37504308 PMCID: PMC10378447 DOI: 10.3390/curroncol30070447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/09/2023] [Accepted: 06/17/2023] [Indexed: 07/29/2023] Open
Abstract
Malignant dysphagia is a common problem in patients with esophageal cancer. Endoscopic stenting can resolve dysphagia caused by malignant stricture; however, controversy exists regarding the use of esophageal stenting for the treatment of malignant stricture, including whether stenting or radiotherapy is superior, whether stenting before or after radiotherapy is safe, whether stenting before or after chemotherapy is safe, and whether low-radial-force stents are safer than conventional stents. Among treatment options for malignant dysphagia, stenting may have some disadvantages in terms of pain relief and the risk of adverse events compared with radiotherapy and in terms of survival compared with gastrostomy. Additionally, the risk of stent-related adverse events is significantly associated with prior radiotherapy. The risk of perforation is especially high when a radiation dose of >40 Gy is delivered to the esophagus after stenting, whereas perforation is not associated with prior chemotherapy or additional chemotherapy after stenting. Nevertheless, stenting remains an important palliative option, especially for patients with a short life expectancy and a strong desire for oral intake, because stenting can facilitate a more rapid improvement in dysphagia than radiotherapy or gastrostomy. The application of a low-radial-force stent should be considered to reduce the risk of adverse events, especially in patients with prior radiotherapy.
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Affiliation(s)
- Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka 541-8567, Japan
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Pan YL, Wu PS, Ye BW, Li CP, Lee IC, Lee KC, Huang YH, Hou MC. Outcomes of patients with malignant esophagogastric junction obstruction receiving metallic stents: A single-center experience. J Chin Med Assoc 2022; 85:160-166. [PMID: 34670225 DOI: 10.1097/jcma.0000000000000638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Malignancies-related esophagogastric junction (EGJ) obstruction is usually diagnosed in inoperable status with poor clinical outcomes. Metallic stent placement at EGJ could improve dysphagia for these patients. However, studies regarding the outcomes in these patients receiving metallic stents are still limited. This study aimed to investigate the outcomes of metallic stent placement in malignant EGJ obstruction. METHODS Forty-one patients with inoperable malignant EGJ obstruction receiving metallic stent placement were retrospectively enrolled. The clinical outcomes between different stents and deployment techniques were analyzed. RESULTS The overall technical success rate was 97.6% and clinical success rate was 92.1%. The median overall survival time was 77 (4-893) days, and the patency time was 71 (4-893) days, respectively. Poststent radiotherapy significantly prolonged survival and stent patency. Between patients receiving uncovered or partially covered metal stents, there was no difference in procedure-related complications, survival time, and stent patency time. Moreover, the clinical outcomes in patients receiving duodenal stents for malignant EGJ obstruction are not inferior to those receiving esophageal stents. CONCLUSION This study provides crucial information for endoscopists to establish individualized stenting strategies for malignant EGJ obstruction.
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Affiliation(s)
- Yu-Ling Pan
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Pei-Shan Wu
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Bing-Wei Ye
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Gastroenterology, Department of Medicine, Taiwan Adventist Hospital, Taipei, Taiwan, ROC
| | - Chung-Pin Li
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Clinical Skills Training, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - I-Cheng Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Kuei-Chuan Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Ming-Chih Hou
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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Outcomes of self-expandable metal stent placement for malignant oesophageal strictures. Clin Radiol 2019; 75:156.e21-156.e27. [PMID: 31703807 DOI: 10.1016/j.crad.2019.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 10/03/2019] [Indexed: 01/21/2023]
Abstract
AIM To analyse the outcomes of oesophageal stenting for malignant strictures and to study the correlation between the follow-up time and major complications. MATERIALS AND METHODS Patients with oesophageal malignancy who underwent stent placement between 2011 and 2016 for dysphagia were included. The data included age, sex, dysphagia, length and location of stenosis, date of stent placement, complications, follow-up time, and survival. RESULTS Two hundred and ninety-eight patients were included in the study. Minor complications occurred in 113 patients (37.9%) including chest pain (17.1%), foreign body sensation (25.5%), hiccups (1.68%), and reflux symptoms (27.5%). Major adverse events occurred in 93 (31.1%) patients including pneumonia (25.5%), migration (3%), perforation (0.67%), bleeding (1.68%), and restenosis (22.5%). oesophago-airway fistula occurred in 45 (15.1%) patients. The incidence of recurrent dysphagia, pneumonia, and oesophago-airway fistula increased over 3 months and decreased after another 3 months. The incidence of major complications as a percentage of survivors remained high after 3 months (>40%). Spearman analysis revealed a significant positive correlation between the incidence and the follow-up time over this period (rs=0.907, p<0.01). CONCLUSION The major complications of oesophageal stenting increased with time over 3 months and remained high for another 3 months. Therefore, stenting should be considered for palliation in patients with short expected survival (usually <3 months).
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Self-expandable metal stent for palliation of malignant dysphagia & quality of life improvement in advanced cancer esophagus: Upper Egypt experience. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.jescts.2017.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Medeiros VS, Martins BC, Lenz L, Ribeiro MSI, de Paulo GA, Lima MS, Safatle-Ribeiro AV, Kawaguti FS, Pennacchi C, Geiger SN, Bastos VR, Ribeiro-Junior U, Sallum RA, Maluf-Filho F. Adverse events of self-expandable esophageal metallic stents in patients with long-term survival from advanced malignant disease. Gastrointest Endosc 2017; 86:299-306. [PMID: 28024985 DOI: 10.1016/j.gie.2016.12.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 12/15/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Self-expandable metallic stents are considered the best palliative treatment of dysphagia for patients with advanced esophageal cancer. Adverse events (AEs) are a major concern, especially in patients with better prognosis and longer survival. The present study aimed to evaluate the AEs of patients who survived longer than 6 months with esophageal stents in place. METHODS This is a retrospective analysis of a prospectively collected database including all patients submitted to esophageal stent placement for the palliation of malignant diseases during the period from February 2009 to February 2014 at a tertiary care academic center who had stents longer than 6 months. RESULTS Sixty-three patients were included. Mean follow-up was 10.7 months. Clinical success was achieved in all patients, and the median stent patency was 7.1 months. AEs occurred in 40 patients (63.5%), totaling 62 AEs (mean, 1.5 AEs per patient). Endoscopic management of AEs was successful in 84.5% of cases, with a mean of 1.6 reinterventions per patient. The univariate analysis revealed that performance status, age, and post-stent radiotherapy presented a trend to higher risk of AEs. The multivariate analysis revealed that only performance status was associated with AEs (P = .025; hazard ratio, 4.1). CONCLUSIONS AEs are common in patients with long-term esophageal stenting for malignancy. However, AEs were not related to higher mortality rate, and most AEs could be successfully managed by endoscopy. Only performance status was a risk factor for AEs. Our data suggest that metallic stenting is a valid option for the treatment of malignant esophageal conditions, even when survival longer than 6 months is expected.
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Affiliation(s)
- Vitor Sousa Medeiros
- Department of Gastroenterology, Endoscopy Division, Cancer Institute of the University of São Paulo, São Paulo, Brazil
| | - Bruno Costa Martins
- Department of Gastroenterology, Endoscopy Division, Cancer Institute of the University of São Paulo, São Paulo, Brazil
| | - Luciano Lenz
- Department of Gastroenterology, Endoscopy Division, Cancer Institute of the University of São Paulo, São Paulo, Brazil
| | - Maria Sylvia Ierardi Ribeiro
- Department of Gastroenterology, Endoscopy Division, Cancer Institute of the University of São Paulo, São Paulo, Brazil
| | - Gustavo Andrade de Paulo
- Department of Gastroenterology, Endoscopy Division, Cancer Institute of the University of São Paulo, São Paulo, Brazil
| | - Marcelo Simas Lima
- Department of Gastroenterology, Endoscopy Division, Cancer Institute of the University of São Paulo, São Paulo, Brazil
| | - Adriana Vaz Safatle-Ribeiro
- Department of Gastroenterology, Endoscopy Division, Cancer Institute of the University of São Paulo, São Paulo, Brazil
| | - Fabio Shighuehissa Kawaguti
- Department of Gastroenterology, Endoscopy Division, Cancer Institute of the University of São Paulo, São Paulo, Brazil
| | - Caterina Pennacchi
- Department of Gastroenterology, Endoscopy Division, Cancer Institute of the University of São Paulo, São Paulo, Brazil
| | - Sebastian N Geiger
- Department of Gastroenterology, Endoscopy Division, Cancer Institute of the University of São Paulo, São Paulo, Brazil
| | - Victor R Bastos
- Department of Gastroenterology, Endoscopy Division, Cancer Institute of the University of São Paulo, São Paulo, Brazil
| | - Ulysses Ribeiro-Junior
- Department of Gastroenterology, Surgery Division, Cancer Institute of the University of São Paulo, São Paulo, Brazil
| | - Rubens A Sallum
- Department of Gastroenterology, Surgery Division, Cancer Institute of the University of São Paulo, São Paulo, Brazil
| | - Fauze Maluf-Filho
- Department of Gastroenterology, Endoscopy Division, Cancer Institute of the University of São Paulo, São Paulo, Brazil
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Outcomes of endoscopically inserted self-expandable metal stents in malignancy according to the type of stent and the site of obstruction. Surg Endosc 2015. [PMID: 26715018 DOI: 10.1007/s00464-015-4712-x.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
BACKGROUND/AIMS Self-expandable metal stents (SEMSs) can be used for the palliation of malignant obstruction in the upper gastrointestinal tract. This study assessed the feasibility and efficacy of endoscopically inserted SEMSs for the palliation of malignant obstruction in the stomach and duodenum. METHODS Between January 2011 and April 2014, 220 patients with gastric or duodenal obstruction due to malignancy underwent endoscopic SEMS insertion at Asan Medical Center. The associations of technical/clinical outcomes and complications with the type of stent and site of obstruction were analyzed. RESULTS The 220 patients included 125 men (56.8 %) and 95 women (43.2 %); median patient age was 63 years. Fully covered, partially covered, and uncovered SEMSs were inserted into 16, 77, and 120 patients, respectively. Obstructions were located in the gastric outlet, including the duodenal bulb, in 106 patients, and in the duodenal second and third portions in 114 patients. Technical success was achieved in 213 of 220 patients (96.8 %) and clinical success in 184 of 213 (86.4 %). Clinical success rates were similar to the type of stent, but were significantly greater for gastric outlet (95/104, 91.3 %) than for duodenal (89/109, 81.7 %) obstructions (p = 0.039). Stent migration was observed in 20 patients (9.1 %) and stent obstruction in 51 (23.2 %). Rates of stent migration were significantly higher for fully covered (6/16, 37.5 %) than for partially covered (7/77, 9.1 %) and uncovered (7/120, 5.8 %) SEMSs (p < 0.001) and were significantly higher for gastric outlet (16/104, 15.4 %) than for duodenal (4/109, 1.2 %) obstructions (p = 0.003). Rates of stent obstruction were similar for fully covered (2/16, 12.5 %), partially covered (17/77, 22.1 %), and uncovered (32/120, 26.7 %) SEMSs (p = 0.409) and in patients with gastric outlet (26/104, 25.0 %) and duodenal (25/109, 22.9 %) obstruction (p = 0.724). CONCLUSIONS SEMS selection for malignant obstruction of the upper gastrointestinal tract depends on the site of obstruction.
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Jung K, Ahn JY, Jung HY, Cho CJ, Na HK, Jung KW, Lee JH, Kim DH, Choi KD, Song HJ, Lee GH, Kim JH. Outcomes of endoscopically inserted self-expandable metal stents in malignancy according to the type of stent and the site of obstruction. Surg Endosc 2015; 30:4001-10. [DOI: 10.1007/s00464-015-4712-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 11/27/2015] [Indexed: 12/14/2022]
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Kim JY, Kim SG, Lim JH, Im JP, Kim JS, Jung HC. Clinical outcomes of esophageal stents in patients with malignant esophageal obstruction according to palliative additional treatment. J Dig Dis 2015; 16:575-84. [PMID: 26316005 DOI: 10.1111/1751-2980.12280] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 07/04/2015] [Accepted: 08/03/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the efficacy and feasibility of esophageal self-expanding metal stents (SEMS) insertion for malignant esophageal obstruction (MEO) in patients with or without additional palliative treatment. METHODS We retrospectively reviewed the medical records of the patients with SEMS for MEO. Baseline characteristics, changes in Mellow-Pinkas dysphagia score, and adverse events were collected and compared according to the presence and absence of additional palliative treatment. RESULTS Altogether 192 patients underwent 236 SEMS insertion procedures. Esophageal, gastric cardiac and lung cancers were seen in 46.4%, 33.3% and 15.1% of the patients, respectively. Their Mellow-Pinkas score significantly decreased within one week and one month after the SEMS insertion (1.66 ± 0.79 and 1.71 ± 0.87 vs 3.09 ± 0.79, respectively, P = 0.000). Complications occurred in 54 (22.9%) of 236 SEMS insertion; there were 28 (11.9%) stent obstruction, 5 (2.1%) perforation (2.1%), 10 (4.2%) stent migration, 5 (2.1%) tracheoesophageal fistula, but no procedure-related death. Most complications were managed by inserting additional SEMS. The risk of stent obstruction was significantly higher in uncovered stents than in covered SEMS (OR 3.56, 95% CI 1.39-9.12, P = 0.006). Mean duration to the development of complications was 74.8 ± 111.1 days. Overall survival (169.0 ± 127.8 days vs 96.4 ± 90.6 days, P = 0.000) and stent patency (143.3 ± 123.9 days vs 67.6 ± 71.3 days, P = 0.000) were significantly favorable in patients with SEMS and additional palliative treatments compared with those with SEMS alone. CONCLUSION SEMS insertion is effective and safe for treating MEO, and additional palliative treatment might lengthen stent patency by prolonging the patient's survival.
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Affiliation(s)
- Ji Yeon Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine
| | - Sang Gyun Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine
| | - Joo Hyun Lim
- Department of Intestinal Medicine, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Jong Pil Im
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine
| | - Joo Sung Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine
| | - Hyun Chae Jung
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine
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Migration of retrievable expandable metallic stents inserted for malignant esophageal strictures: incidence, management, and prognostic factors in 332 patients. AJR Am J Roentgenol 2015; 204:1109-14. [PMID: 25905949 DOI: 10.2214/ajr.14.13172] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the incidence, prognostic factors, and secondary management of stent migration in patients with malignant esophageal strictures. MATERIALS AND METHODS A retrospective study was performed in a single tertiary referral university hospital to identify the incidence, management, and prognostic factors for stent migration in 332 consecutive patients with placement of a retrievable expandable metallic stent. Stent migration was classified into four patterns as locations of a migrated stent: pattern I, partially migrated in the proximal direction; pattern II, partially migrated in the distal direction; pattern III, completely migrated into the stomach; and pattern IV, completely migrated into the bowel. RESULTS Stent migration occurred in 42 (12.6%) of 332 patients. Migration was partial (n = 21) or complete (n = 21), and nine (21%), 12 (29%), 11 (26%), and 10 (24%) patients had patterns I, II, III, and IV, respectively. Multivariate analysis identified the following prognostic factors: esophagogastric junction strictures caused by cancer of the gastric cardia (odds ratio 1.330; p = 0.004), patients who underwent anticancer treatment after stent placement (17.514; p < 0.001), and patients with a longer survival time (1.994; p < 0.001). Secondary management was needed for 33 of 42 patients. The strictures in the remaining nine patients improved throughout follow-up. CONCLUSION Stent migration occurs most commonly in patients with cancer of the gastric cardia, patients with longer survival time, and those who underwent anticancer treatment after stent placement. Stent migration is successfully managed by further intervention. Accurate knowledge of the pattern of stent migration is important for successful management.
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Abstract
Upper gastrointestinal (GI) stents are increasingly being used to manage upper GI obstructions. Initially developed for palliative treatment of esophageal cancer, upper GI stents now play an emerging role in benign strictures of the upper GI tract. Because recurrent obstruction and stent-related complications are common, new modifications of stents have been implemented. Self-expandable metal stents (SEMS) have replaced older plastic stents. In addition, newly designed SEMS have been developed to prevent complications. This review provides an overview of the various types, indications, methods, complications, and clinical outcomes of upper GI stents in a number of malignant and benign disorders dividing the esophagus and gastroduodenum.
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Affiliation(s)
- Hyoun Woo Kang
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Sang Gyun Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Kang HW, Kim SG. Upper Gastrointestinal Stent Insertion in Malignant and Benign Disorders. Clin Endosc 2015; 48:187-93. [PMID: 26064817 PMCID: PMC4461661 DOI: 10.5946/ce.2015.48.3.187] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 04/22/2015] [Indexed: 02/06/2023] Open
Abstract
Upper gastrointestinal (GI) stents are increasingly being used to manage upper GI obstructions. Initially developed for palliative treatment of esophageal cancer, upper GI stents now play an emerging role in benign strictures of the upper GI tract. Because recurrent obstruction and stent-related complications are common, new modifications of stents have been implemented. Self-expandable metal stents (SEMS) have replaced older plastic stents. In addition, newly designed SEMS have been developed to prevent complications. This review provides an overview of the various types, indications, methods, complications, and clinical outcomes of upper GI stents in a number of malignant and benign disorders dividing the esophagus and gastroduodenum.
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Affiliation(s)
- Hyoun Woo Kang
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Sang Gyun Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Kim MD, Park SB, Kang DH, Lee JH, Choi CW, Kim HW, Chung CU, Jeong YI. Double layered self-expanding metal stents for malignant esophageal obstruction, especially across the gastroesophageal junction. World J Gastroenterol 2012; 18:3732-7. [PMID: 22851867 PMCID: PMC3406427 DOI: 10.3748/wjg.v18.i28.3732] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 02/01/2012] [Accepted: 04/13/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the clinical outcomes of double-layered self-expanding metal stents (SEMS) for treatment of malignant esophageal obstruction according to whether SEMS crosses the gastroesophageal junction (GEJ).
METHODS: Forty eight patients who underwent the SEMS insertion for malignant esophageal obstruction were enrolled. Patients were classified as GEJ group (SEMS across GEJ, 18 patients) and non-GEJ group (SEMS above GEJ, 30 patients) according to SEMS position. Double layered (outer uncovered and inner covered stent) esophageal stents were placed.
RESULTS: The SEMS insertion and the clinical improvement were achieved in all patients in both groups. Stent malfunction occurred in seven patients in the GEJ group and nine patients in the non-GEJ group. Tumor overgrowth occurred in five and eight patients, respectively, food impaction occurred in one patient in each group, and stent migration occurred in one and no patient, respectively. There were no significant differences between the two groups. Reflux esophagitis occurred more frequently in the GEJ group (eight vs five patients, P = 0.036) and was controlled by proton pump inhibitor. Aspiration pneumonia occurred in zero and five patients, respectively, and tracheoesophageal fistula occurred in zero and two patients, respectively.
CONCLUSION: Double-layered SEMS are a feasible and effective treatment when placed across the GEJ for malignant esophageal obstruction. Double-layered SEMS provide acceptable complications, especially migration, although reflux esophagitis is more common in the GEJ group.
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Brimhall B, Adler DG. Enteral stents for malignant gastric outlet obstruction. Gastrointest Endosc Clin N Am 2011; 21:389-403, vii-viii. [PMID: 21684461 DOI: 10.1016/j.giec.2011.04.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Malignant gastric outlet obstruction (GOO) is a commonly encountered entity, defined as the inability of the stomach to empty because of mechanical obstruction at the level of either the stomach or the proximal small bowel. In this article, current literature on GOO is reviewed with a focus on enteral stents to include symptoms and diagnosis, stent and nonstent treatment, types of enteral stents, indications and contraindications to stent placement, and technical and clinical success rates. In comparison with gastrojejunostomy, enteral stent placement is better suited for patients with a shorter life expectancy and/or those who are poor surgical candidates.
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Affiliation(s)
- Bryan Brimhall
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
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Abstract
The incidence of esophageal adenocarcinoma is increasing in Western countries with a tendency to exceed that of squamous-cell carcinoma. Prognosis is unfavorable with 5-year survival less than 15%, irrespective of treatment and the stage. At the time of diagnosis, more than two thirds of patients have a non-operable cancer because of extension or associated co-morbidities. Most studies have included different tumoral locations (esophagus and stomach) and different histological types (adenocarcinoma and squamous-cell carcinoma), making it difficult to interpret results. Surgery is currently the standard treatment for small tumors. Surgery should be preceded by neo-adjuvant treatment for patients with locally advanced resectable tumors, either preoperative chemotherapy or preoperative chemoradiation therapy. The therapeutic choice should be decided during multidisciplinary meetings according to patient and tumor characteristics and the expertise of the center. For patients with contraindications to surgery, exclusive chemoradiation therapy is recommended. Herein we reviewed and synthesized the different therapeutic strategies for esophageal adenocarcinoma.
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16
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Current world literature. Curr Opin Support Palliat Care 2011; 5:65-8. [PMID: 21321522 DOI: 10.1097/spc.0b013e3283440ea5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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