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Josino IR, Martins BC, Machado AA, de A. Lima GR, Cordero MAC, Pombo AAM, Sallum RAA, Ribeiro Jr U, Baron TH, Maluf-Filho F. Self-expandable metallic stent-induced esophagorespiratory fistulas in patients with advanced esophageal cancer. Clin Endosc 2023; 56:761-768. [PMID: 37491991 PMCID: PMC10665617 DOI: 10.5946/ce.2022.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND/AIMS Self-expandable metallic stents (SEMSs) are widely adopted for the palliation of dysphagia in patients with malignant esophageal strictures. An important adverse event is the development of SEMS-induced esophagorespiratory fistulas (SEMS-ERFs). This study aimed to assess the risk factors related to the development of SEMS-ERF after SEMS placement in patients with esophageal cancer. METHODS This retrospective study was performed at the Instituto do Cancer do Estado de São Paulo. All patients with malignant esophageal strictures who underwent esophageal SEMS placement between 2009 and 2019 were included in the study. RESULTS Of the 335 patients, 37 (11.0%) developed SEMS-ERF, with a median time of 129 days after SEMS placement. Stent flare of 28 mm (hazard ratio [HR], 2.05; 95% confidence interval [CI], 1.15-5.51; p=0.02) and post-stent chemotherapy (HR, 2.0; 95% CI, 1.01-4.00; p=0.05) were associated with an increased risk of developing SEMS-ERF, while lower-third tumors were a protective factor (HR, 0.5; 95% CI, 0.26-0.85; p=0.01). No difference was observed in overall survival. CONCLUSION The incidence of SEMS-ERFs was 11%, with a median time of 129 days after SEMS placement. Post-stent chemotherapy and a 28 mm stent flare were associated with a higher risk of SEMS-ERF.
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Affiliation(s)
- Iatagan R. Josino
- Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Bruno C. Martins
- Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Andressa A. Machado
- Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Gustavo R. de A. Lima
- Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Martin A. C. Cordero
- Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Amanda A. M. Pombo
- Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Rubens A. A. Sallum
- Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Ulysses Ribeiro Jr
- Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Todd H. Baron
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
| | - Fauze Maluf-Filho
- Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
- Laboratório de Investigações Médicas 37, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
- National Council for Scientific and Technological Development, Brasília, Brazil
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Mwachiro M, Parker R, Lando J, Simel I, Chol N, Ranketi S, Chepkwony R, Pyego L, Chepkirui C, Chepkemoi W, Fleischer D, Dawsey S, Topazian M, Burgert S, White R. Predictors of adverse events and early mortality after esophageal stent placement in a low resource setting: a series of 3823 patients in Kenya. Endosc Int Open 2022; 10:E479-E487. [PMID: 35433219 PMCID: PMC9010091 DOI: 10.1055/a-1783-9829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 01/11/2022] [Indexed: 12/24/2022] Open
Abstract
Background and study aims Dysphagia from esophageal cancer may be palliated with self-expanding metallic stents (SEMS). Controversy exists about the use of dilation before SEMS deployment. Patients and methods We performed a retrospective cohort study of patients who had SEMS placement without fluoroscopy for palliation at Tenwek Hospital in Bomet, Kenya between January 1999 and April 2019. The primary outcome was any serious adverse event (AE) (chest pain, stent migration, perforation, bleeding, or all-cause mortality) within 30 days of the procedure. Various demographic and clinical characteristics, and procedural details, were examined as risk factors. Technical success, defined as correct SEMS placement, and clinical success, defined as dysphagia score improvement without 30-day mortality, were examined. Results A total of 3823 patients underwent SEMS placement, with 2844 (74.4 %) placed in the second decade of the study. Technical and clinical success were achieved in 97.2 % and 95.5 %, respectively, with mean dysphagia scores improving from 3.4 (SD 0.6) to 0.9 (SD 1.3) post-stent placement. AEs occurred in 169 patients (4.4 %). AEs, specifically perforations, were associated with dilation to greater than 36F in the first decade. Perforation rates decreased from the first (4.1 %) to the second decade (0.2 %). Only 30% had complete 30-day follow-up data. Conclusions SEMS placement is a safe, effective method of palliating malignant dysphagia, with low rates of AEs and 30-day mortality and high rates of clinical and technical success. Dilation can facilitate placement of SEMS without fluoroscopy but should not be performed above 36F due to the risk of perforation.
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Affiliation(s)
- Michael Mwachiro
- Department of Endoscopy and Surgery, Tenwek Hospital, Bomet, Kenya
| | - Robert Parker
- Department of Endoscopy and Surgery, Tenwek Hospital, Bomet, Kenya,Department of Surgery; Alpert Medical School of Brown University; Providence, Rhode Island, United States
| | - Justus Lando
- Department of Endoscopy and Surgery, Tenwek Hospital, Bomet, Kenya
| | - Ian Simel
- Department of Endoscopy and Surgery, Tenwek Hospital, Bomet, Kenya
| | - Nyail Chol
- Department of Endoscopy and Surgery, Tenwek Hospital, Bomet, Kenya
| | - Sinkeet Ranketi
- Department of Endoscopy and Surgery, Tenwek Hospital, Bomet, Kenya
| | - Robert Chepkwony
- Department of Endoscopy and Surgery, Tenwek Hospital, Bomet, Kenya
| | - Linus Pyego
- Department of Endoscopy and Surgery, Tenwek Hospital, Bomet, Kenya
| | - Caren Chepkirui
- Department of Endoscopy and Surgery, Tenwek Hospital, Bomet, Kenya
| | - Winnie Chepkemoi
- Department of Endoscopy and Surgery, Tenwek Hospital, Bomet, Kenya
| | - David Fleischer
- Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, Arizona, United States
| | - Sanford Dawsey
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Mark Topazian
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
| | - Steve Burgert
- Department of Endoscopy and Surgery, Tenwek Hospital, Bomet, Kenya
| | - Russell White
- Department of Endoscopy and Surgery, Tenwek Hospital, Bomet, Kenya,Department of Surgery; Alpert Medical School of Brown University; Providence, Rhode Island, United States
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Asombang AW, Chishinga N, Nkhoma A, Chipaila J, Nsokolo B, Manda-Mapalo M, Montiero JFG, Banda L, Dua KS. Systematic review and meta-analysis of esophageal cancer in Africa: Epidemiology, risk factors, management and outcomes. World J Gastroenterol 2019; 25:4512-4533. [PMID: 31496629 PMCID: PMC6710188 DOI: 10.3748/wjg.v25.i31.4512] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/05/2019] [Accepted: 07/19/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Esophageal cancer (EC) is associated with a poor prognosis, particularly so in Africa where an alarmingly high mortality to incidence ratio prevails for this disease. AIM To provide further understanding of EC in the context of the unique cultural and genetic diversity, and socio-economic challenges faced on the African continent. METHODS We performed a systematic review of studies from Africa to obtain data on epidemiology, risk factors, management and outcomes of EC. A non-systematic review was used to obtain incidence data from the International Agency for Research on Cancer, and the Cancer in Sub-Saharan reports. We searched EMBASE, PubMed, Web of Science, and Cochrane Central from inception to March 2019 and reviewed the list of articles retrieved. Random effects meta-analyses were used to assess heterogeneity between studies and to obtain odds ratio (OR) of the associations between EC and risk factors; and incidence rate ratios for EC between sexes with their respective 95% confidence intervals (CI). RESULTS The incidence of EC is higher in males than females, except in North Africa where it is similar for both sexes. The highest age-standardized rate is from Malawi (30.3 and 19.4 cases/year/100000 population for males and females, respectively) followed by Kenya (28.7 cases/year/100000 population for both sexes). The incidence of EC rises sharply after the age of 40 years and reaches a peak at 75 years old. Meta-analysis shows a strong association with tobacco (OR 3.15, 95%CI: 2.83-3.50). There was significant heterogeneity between studies on alcohol consumption (OR 2.28, 95%CI: 1.94-2.65) and on low socioeconomic status (OR 139, 95%CI: 1.25-1.54) as risk factors, but these could also contribute to increasing the incidence of EC. The best treatment outcomes were with esophagectomy with survival rates of 76.6% at 3 years, and chemo-radiotherapy with an overall combined survival time of 267.50 d. CONCLUSION Africa has high incidence and mortality rates of EC, with preventable and non-modifiable risk factors. Men in this setting are at increased risk due to their higher prevalence of tobacco and alcohol consumption. Management requires a multidisciplinary approach, and survival is significantly improved in the setting of esophagectomy and chemoradiation therapy.
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Affiliation(s)
- Akwi W Asombang
- Division of Gastroenterology/Hepatology, Warren Alpert Medical School of Brown University, Providence, RI 02903, United States
| | - Nathaniel Chishinga
- Department for HIV Elimination, Fulton County Government, Atlanta, GA 30303, United States
| | - Alick Nkhoma
- Department of Gastroenterology, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Staffordshire ST4 6QG, United Kingdom
| | - Jackson Chipaila
- Department of Surgery, University Teaching Hospital-Adult Hospital, Lusaka 10101, Zambia
| | - Bright Nsokolo
- Department of Medicine, Levy Mwanawasa University Teaching Hospital, Tropical Gastroenterology and Nutrition Group (TROPGAN), Lusaka 10101, Zambia
| | - Martha Manda-Mapalo
- Department of Medicine, The University of New Mexico, Albuquerque, NM 87106, United States
| | | | - Lewis Banda
- Hematology/Oncology, Cancer Disease Hospital, Lusaka 10101, Zambia
| | - Kulwinder S Dua
- Department of Medicine and Pediatrics, Medical College of Wisconsin, Milwaukee, WI 53226, United States
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Arena M, Eusebi LH, Palamara MA, Iabichino G, Consolo P, Opocher E, Giovenzana M, Barabino M, Luigiano C. The endoscopic overtube is a safe device for removing a fistulizing esophageal metal stent: a literature review. MINERVA BIOTECNOL 2018. [DOI: 10.23736/s1120-4826.18.02406-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Middleton DRS, Bouaoun L, Hanisch R, Bray F, Dzamalala C, Chasimpha S, Menya D, Mbalawa CG, N'Da G, Woldegeorgis MA, Njie R, Koulibaly M, Buziba N, Ferro J, Nouhou H, Ogunbiyi F, Wabinga HR, Chokunonga E, Borok MZ, Korir AR, Mwasamwaja AO, Mmbaga BT, Schüz J, McCormack VA. Esophageal cancer male to female incidence ratios in Africa: A systematic review and meta-analysis of geographic, time and age trends. Cancer Epidemiol 2018; 53:119-128. [PMID: 29414631 PMCID: PMC5871654 DOI: 10.1016/j.canep.2018.01.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/25/2018] [Accepted: 01/31/2018] [Indexed: 12/12/2022]
Abstract
Esophageal squamous cell carcinoma (ESCC) remains the predominant histological subtype of esophageal cancer (EC) in many transitioning countries, with an enigmatic and geographically distinct etiology, and consistently elevated incidence rates in many Eastern and Southern African countries. To gain epidemiological insights into ESCC patterns across the continent, we conducted a systematic review and meta-analysis of male-to-female (M:F) sex ratios of EC age-standardised (world) incidence rates in Africa according to geography, time and age at diagnosis. Data from 197 populations in 36 countries were included in the analysis, based on data from cancer registries included in IARC's Cancer Incidence in Five Continents, Cancer in Africa and Cancer in Sub-Saharan Africa reports, alongside a systematic search of peer-reviewed literature. A consistent male excess in incidence rates overall (1.7; 95% CI: 1.4, 2.0), and in the high-risk Eastern (1.6; 95% CI: 1.4, 1.8) and Southern (1.8; 95% CI: 1.5, 2.0) African regions was observed. Within the latter two regions, there was a male excess evident in 30-39 year olds that was not observed in low-risk regions. Despite possible referral biases affecting the interpretability of the M:F ratios in place and time, the high degree of heterogeneity in ESCC incidence implies a large fraction of the disease is preventable, and directs research enquiries to elucidate early-age exposures among young men in Africa.
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Affiliation(s)
- Daniel R S Middleton
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France.
| | - Liacine Bouaoun
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France
| | - Rachel Hanisch
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer (IARC), Lyon, France
| | - Charles Dzamalala
- Malawi Cancer Registry, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Steady Chasimpha
- Malawi Cancer Registry, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Diana Menya
- School of Public Health, Moi University, Eldoret, Kenya
| | - Charles Gombé Mbalawa
- Registre des Cancers de Brazzaville, Sce de Carcinologie et Radiothérapie, CHU de Brazzaville, Brazzaville, Congo
| | - Guy N'Da
- Registre de Cancer d'Abidjan, Centre Hospitalier Universitaire de Treichville, Abidjan, Cote d'Ivoire
| | - Mathewos A Woldegeorgis
- Addis Ababa City Cancer Registry, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ramou Njie
- GNCR, The Gambia Hepatitis Intervention Study, International Agency for Research on Cancer, c/o MRC unit, Gambia
| | - Moussa Koulibaly
- Registre de Cancer de Guinée, Université de Conakry, Conakry, Guinea
| | - Nathan Buziba
- Eldoret Cancer Registry, Moi University School of Medicine, Eldoret, Kenya
| | - Josefo Ferro
- Beira Cancer Registry, Hospital Central da Beira, Beira, Mozambique
| | - Hassan Nouhou
- Registre des Cancers du Niger, Laboratoire d'Anatomie et Cytologie Pathologiques, Faculté des Sciences de la Santé, Niamey, Niger
| | - Femi Ogunbiyi
- Ibadan Cancer Registry, Department of Pathology, University College Hospital, Ibadan, Nigeria
| | - Henry R Wabinga
- Kampala Cancer Registry, Department of Pathology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Eric Chokunonga
- Zimbabwe National Cancer Registry, Parirenyatwa Hospital, Harare, Zimbabwe
| | - Margaret Z Borok
- Zimbabwe National Cancer Registry, Parirenyatwa Hospital, Harare, Zimbabwe
| | - Anne R Korir
- Nairobi Cancer Registry, Kenya Medical Research Institute, Centre for Clinical Research, Nairobi, Kenya
| | | | | | - Joachim Schüz
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France
| | - Valerie A McCormack
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France
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McCormack VA, Menya D, Munishi MO, Dzamalala C, Gasmelseed N, Leon Roux M, Assefa M, Osano O, Watts M, Mwasamwaja AO, Mmbaga BT, Murphy G, Abnet CC, Dawsey SM, Schüz J. Informing etiologic research priorities for squamous cell esophageal cancer in Africa: A review of setting-specific exposures to known and putative risk factors. Int J Cancer 2017; 140:259-271. [PMID: 27466161 PMCID: PMC5763498 DOI: 10.1002/ijc.30292] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 07/08/2016] [Indexed: 12/30/2022]
Abstract
Esophageal squamous cell carcinoma (ESCC) is one of the most common cancers in most Eastern and Southern African countries, but its etiology has been understudied to date. To inform its research agenda, we undertook a review to identify, of the ESCC risk factors which have been established or strongly suggested worldwide, those with a high prevalence or high exposure levels in any ESCC-affected African setting and the sources thereof. We found that for almost all ESCC risk factors known to date, including tobacco, alcohol, hot beverage consumption, nitrosamines and both inhaled and ingested PAHs, there is evidence of population groups with raised exposures, the sources of which vary greatly between cultures across the ESCC corridor. Research encompassing these risk factors is warranted and is likely to identify primary prevention strategies.
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Affiliation(s)
- V A McCormack
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France
| | - D Menya
- School of Public Health, Moi University, Eldoret, Kenya
| | - M O Munishi
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - C Dzamalala
- College of Medicine, University of Malawi, Blantyre, Malawi
- Malawi Cancer Registry, Malawi
| | - N Gasmelseed
- National Cancer Institute, University of Gezira, Sudan
- Faculty of Science, University of Hafr Al Batin, Saudi Arabia
| | - M Leon Roux
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France
| | - M Assefa
- Radiotherapy Center, Addis-Ababa-University, Addis Ababa, Ethiopia
| | - O Osano
- School of Environmental Studies, University of Eldoret, Kenya
| | - M Watts
- Inorganic Chemistry, Centre for Environmental Geochemistry, British Geological Survey, Nottingham, United Kingdom
| | - A O Mwasamwaja
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - B T Mmbaga
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - G Murphy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - C C Abnet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - S M Dawsey
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - J Schüz
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France
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Ramakrishnaiah VPN, Malage S, Sreenath GS, Kotlapati S, Cyriac S. Palliation of Dysphagia in Carcinoma Esophagus. CLINICAL MEDICINE INSIGHTS. GASTROENTEROLOGY 2016; 9:11-23. [PMID: 27279758 PMCID: PMC4896534 DOI: 10.4137/cgast.s30303] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 04/25/2016] [Accepted: 04/27/2016] [Indexed: 01/10/2023]
Abstract
Esophageal carcinoma has a special place in gastrointestinal carcinomas because it contains two main types, namely, squamous cell carcinoma and adenocarcinoma. Carcinoma esophagus patients require some form of palliation because of locally advanced stage or distant metastasis, where it cannot be subjected to curable treatment with surgery and chemoradiation. Many modalities of palliation of dysphagia are available, but the procedure with least morbidity, mortality, and long-term palliation of dysphagia needs to be chosen for the patient. This study aims to discuss the recent trends in palliation of dysphagia with promising results and the most suitable therapy for palliation of dysphagia in a given patient. A total of 64 articles that were published between years 2005 and 2015 on various modes of palliation of dysphagia in carcinoma esophagus were studied, which were mainly randomized and prospective studies. Through this study, we conclude that stents are the first choice of therapy for palliation, which is safe and cost-effective, and they can be combined with either radiotherapy or chemotherapy for long-term palliation of dysphagia with good quality of life. Radiotherapy can be used as a second-line treatment modality.
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Affiliation(s)
| | - Somanath Malage
- Senior Resident, Department of Surgery, Jawaharlal Institute of Postgraduation Medical Education & Research (JIPMER), Puducherry, India
| | - G S Sreenath
- Associate Professor, Department of Surgery, Jawaharlal Institute of Postgraduation Medical Education & Research (JIPMER), Puducherry, India
| | - Sudhakar Kotlapati
- Senior Resident, Department of Radiotherapy, Jawaharlal Institute of Postgraduation Medical Education & Research (JIPMER), Puducherry, India
| | - Sunu Cyriac
- Assistant Professor, Department of Medical Oncology, Jawaharlal Institute of Postgraduation Medical Education & Research (JIPMER), Puducherry, India
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8
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The Clinical Outcome in Patients Treated With a Newly Designed SEMS in Cervical Esophageal Strictures and Fistulas. J Clin Gastroenterol 2016; 50:379-87. [PMID: 26927492 DOI: 10.1097/mcg.0000000000000501] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND GOALS Using a self-expandable metallic stent (SEMS) in the cervical esophagus is controversial due to an increased risk of complications. Here we assessed a new type of SEMS purpose-designed for the cervical esophagus area. STUDY Patients with malignant or benign stenosis within 4 cm distance of the upper esophageal sphincter who underwent placement of a SEMS with a shorter proximal head (Niti-S Esophageal Covered Stent-Cervical-type, NSECSC), were included. Main outcome measures were the functional outcome, tolerance, complications, recurrent dysphagia, and survival. RESULTS About 37 patients had an NSECSC placed between April 2008 and June 2013 for esophageal stenosis (malignant=20, benign=17), 5 with associated tracheoesophageal fistula. The mean stenosis-upper esophageal sphincter distance was 1.86±1.27 cm. The median follow-up was 150 days. Dysphagia improved in 27/37 cases (73%). Short-term and long-term tolerance without needing stent removal was 92% and 82%, respectively. The complication rate was 59% (22/37): 32% (n=14) major complications [fistula (3), perforation (3), aspiration pneumonia (5), laryngeal dyspnea (2), and bleeding (1)], and 27% (n=10) minor complications [pain (7) or dysphonia (3)]. A multivariate analysis confirmed a higher risk of major complications in cases of benign stenosis (odds ratio=5.2; 95% confidence interval, 1.05-25.90; P=0.04). Recurrent dysphagia occurred in 15 patients (obstruction=7, migration=8). CONCLUSIONS The NSECSC does not appear less morbid than standard SEMS in the cervical esophageal area, but could be useful in malignant indications as it is well-tolerated and offers effective palliation of the dysphagia. However, this device should not be used in benign cervical esophageal strictures or fistulas.
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9
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Bassi M, Luigiano C, Fabbri C, Ferrara F, Ghersi S, Alibrandi A, Fuccio L, Virgilio C, Patelli M, Zanello M, Cennamo V. Large diameter fully covered self-expanding metal stent placement for palliation of proximal malignant esophageal strictures. Dis Esophagus 2014; 28:579-84. [PMID: 24827641 DOI: 10.1111/dote.12236] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In patients with malignant esophageal strictures within 6 cm from the upper esophageal sphincter, self-expanding metal stents placement represents a challenge because there is an increased risk of complications. The aim of this study was to assess the safety and effectiveness of large-diameter WallFlex(®) fully covered self-expanding metal stents for palliation of patients with proximal malignant esophageal strictures. From March 2010 to December 2012, 12 patients with proximal strictures (4-6 cm from the upper esophageal sphincter) and six with very proximal strictures (<4 cm from the upper esophageal sphincter) were palliated with this fully covered self-expanding metal stent and included in the study. Technical success was 100% and clinical success was 94%. The mean baseline dysphagia score was 3.2, and 1 week after stenting it improved significantly to 1.3 (P < 0.001). Early complications occurred in four patients, more frequently in patients with very proximal strictures as compared with patients with proximal strictures (P = 0.02). Late complications occurred in five patients, and there were no differences between patients with very proximal strictures or proximal strictures (P = 0.245). The mean survival after stent placement was 119 days, and no differences between patients with very proximal strictures versus proximal strictures were found (P = 0.851). There was no stent-related mortality or 30-day mortality. Our results suggested that a large-diameter fully covered self-expanding metal stent is an effective and secure device for palliation of patients with proximal malignant esophageal strictures.
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Affiliation(s)
- M Bassi
- Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna, Bologna, Italy
| | - C Luigiano
- Unit of Gastroenterology and Digestive Endoscopy, ARNAS Garibaldi, Catania, Italy
| | - C Fabbri
- Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna, Bologna, Italy
| | - F Ferrara
- Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna, Bologna, Italy
| | - S Ghersi
- Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna, Bologna, Italy
| | - A Alibrandi
- Department of Statistics, University of Messina, Messina, Italy
| | - L Fuccio
- Department of Clinical Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - C Virgilio
- Unit of Gastroenterology and Digestive Endoscopy, ARNAS Garibaldi, Catania, Italy
| | - M Patelli
- Thoracic Endoscopy and Pulmonology Unit, Maggiore Hospital, Bologna, Italy
| | - M Zanello
- Anesthesia and Intensive Care, IRCCS Istituto delle Scienze Neurologiche Bellaria Hospital, Bologna, Italy
| | - V Cennamo
- Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna, Bologna, Italy
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Bick BL, Song LMWK, Buttar NS, Baron TH, Nichols FC, Maldonado F, Katzka DA, Enders FT, Topazian MD. Stent-associated esophagorespiratory fistulas: incidence and risk factors. Gastrointest Endosc 2013; 77:181-9. [PMID: 23245798 DOI: 10.1016/j.gie.2012.10.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 10/03/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND Esophageal self-expandable stents (SESs) effectively treat strictures and leaks but may be complicated by a stent-associated esophagorespiratory fistula (SERF). Little is known about SERFs. OBJECTIVE To determine the incidence, morbidity, mortality, and risk factors for SERF. DESIGN Retrospective case-control study. SETTING Single referral center. PATIENTS All adults undergoing esophageal SES placement during a 10-year period. INTERVENTION Stent placement. MAIN OUTCOME MEASUREMENTS Occurrence of SERF, morbidity, and mortality. RESULTS A total of 16 of 397 (4.0%) patients developed SERF at a median of 5 months after stent placement (range 0.4-53 months) including 6 of 94 (6%), 10 of 71 (14%), and 0 of 232 (0%) of those with lesions in the proximal, middle, and distal esophagus, respectively (overall P < .001). SERF occurred in 10% of those with proximal and mid-esophageal lesions, including 14% with benign strictures, 9% with malignant strictures, and none with other indications for SES placement (P = .27). The risk was highest (18%) in patients with benign anastomotic strictures. Risk factors for development of SERF included a higher Charlson comorbidity index score (odds ratio [OR] 1.47 for every 1-point increase; P = .04) and history of radiation therapy (OR 9.41; P = .03). Morbidity associated with SERF included need for lifelong feeding tubes in 11 of 22 (50%) and/or tracheostomy or mechanical ventilation in 5 of 22 (23%). Median survival after diagnosis was 4.5 months (range 0.35-67), and 7 patients survived less than 30 days. LIMITATIONS Retrospective design, limited statistical power. CONCLUSION SERF is a morbid complication of SES placement for strictures of the proximal and mid-esophagus. The dominant risk factors for development of SERF are prior radiation therapy and comorbidity score.
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Affiliation(s)
- Benjamin L Bick
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA
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Calland JF, Petroze RT, Abelson J, Kraus E. Engaging academic surgery in global health: challenges and opportunities in the development of an academic track in global surgery. Surgery 2012; 153:316-20. [PMID: 23218883 DOI: 10.1016/j.surg.2012.08.070] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 08/10/2012] [Indexed: 11/13/2022]
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Abstract
This article reviews the principal aspects related to sedation in endoscopy and to the prevention of adverse events in some of the most frequently performed therapeutic upper gastrointestinal (GI) endoscopic procedures (esophageal dilation and stenting, endoscopic resection of upper GI early neoplasia, hemostasis of upper GI bleeding and percutaneous endoscopic gastrostomy insertion). These procedures have an inherent risk of negative outcomes that cannot be entirely avoided. Endoscopic procedures are best performed by well-trained, competent and thoughtful endoscopists in facilities suited to provide for patient safety. Attention to clinical risk management may effectively reduce the frequency and intensity of adverse events, enhance recognition and early detection, and improve responsiveness.
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Affiliation(s)
- Gianluca Rotondano
- Division of Gastroenterology and Digestive Endoscopy, Hospital Maresca, Torre del Greco, Italy.
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Current World Literature. Curr Opin Support Palliat Care 2012; 6:109-25. [DOI: 10.1097/spc.0b013e328350f70c] [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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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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Weston AP. Stents in the proximal esophagus: tailoring the stent to the patient to achieve success. Gastrointest Endosc 2011; 73:1106-8. [PMID: 21628011 DOI: 10.1016/j.gie.2011.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 02/16/2011] [Indexed: 02/08/2023]
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