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Lopera JE. Percutaneous Removal of Migrated Gastrointestinal Stents Using Gastrostomy Access. J Vasc Interv Radiol 2024; 35:890-894. [PMID: 38447770 DOI: 10.1016/j.jvir.2024.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/25/2024] [Accepted: 02/23/2024] [Indexed: 03/08/2024] Open
Abstract
This report describes the experience of removing migrated gastrointestinal (GI) stents using a gastrostomy (G) access. Four male patients aged 23-62 years (mean, 42 years) had 6 migrated stents removed using an existing (n = 3) or new (n = 1) G access. Removed stents included 5 covered esophageal stents that migrated into the stomach and 1 distal noncovered duodenal stent that migrated into the proximal duodenum. One patient had 2 stents removed during the same session. All stents were removed successfully without adverse events. Techniques used included the folding technique using a wire in 3 stents and forceps in 2 stents. Eversion technique was used in the duodenal stent. The G or gastrojejunostomy tubes were replaced after stent removal and used for enteral feedings. In conclusion, removing migrated GI stents using an existing or new G access was technically successful and safe.
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Affiliation(s)
- Jorge E Lopera
- Department of Radiology, University of Texas at San Antonio, San Antonio, Texas.
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2
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Sigdel M, Zhou X, Song M, Liu Y, Zhang C, Jiao D. A novel technique to remove migrated esophageal stent under fluoroscopy. Abdom Radiol (NY) 2024; 49:1646-1652. [PMID: 38592493 DOI: 10.1007/s00261-024-04281-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/03/2024] [Accepted: 03/05/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE To evaluate the efficacy and safety of a novel technique for removal of migrated esophageal stent (MES) under fluoroscopy. METHODS From January 2009 to April 2023, 793 patients with a dysphagia score of 3-4 underwent esophageal stenting at our center, and 25 patients (mean age: 70.06 years old; male/female: 15/10) underwent stent removal using "loop method" under fluoroscopy. The primary outcomes were technical success and complications. The secondary outcomes were procedure time, radiation exposure, biochemical indicators [white blood cell (WBC), hemoglobin (Hb), platelet (PLT), albumin (ALB), alanine transaminase (ALT), total bilirubin (TB), urea nitrogen (UN) and C-reactive protein] of pre- and post-treatment at 2 weeks. RESULTS Technical success was 100% without major complications. The mean procedure time was (39.44 ± 9.28) minutes, which showed no statistical significance between benign (n = 5) and malignant (n = 20) group [(42.40 ± 8.85) vs (38.71 ± 9.46) mins, p > 0.05]. The mean radiation exposure was (332.88 ± 261.47) mGy, which showed no statistical significance between benign and malignant group [(360.74 ± 231.43) vs (325.92 ± 273.54) mGy, p > 0.05]. Pre- and post-procedure Hb [(114.46 ± 11.96) vs. (117.57 ± 13.12) g/L] and ALB [(42.26 ± 3.39) vs. (44.12 ± 3.77) g/L] showed significant difference (p < 0.05), while WBC, PLT, CRP, and ALT showed no significance (p > 0.05). CONCLUSION Fluoroscopy-guided "Loop method" for MES removal is an effective and safe alternative technique.
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Affiliation(s)
- Milan Sigdel
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Xueliang Zhou
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Mengyao Song
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Yiming Liu
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Chengzhi Zhang
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Dechao Jiao
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China.
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3
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Harris S, Hall AB, Derr C. Esophageal Stent Migration Diagnosed With Point-of-Care Ultrasound. Cureus 2023; 15:e49418. [PMID: 38149125 PMCID: PMC10750131 DOI: 10.7759/cureus.49418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2023] [Indexed: 12/28/2023] Open
Abstract
This unique case depicts the first published report of a physician using point-of-care ultrasound to diagnose an esophageal stent migration. Discussed in this article are the sonographic findings that clinicians should be familiar with when evaluating patients with abdominal pain or chest pain who have a history of an esophageal stent. When coupled with a high index of suspicion, ultrasound can be one of the most portable, readily available, low-cost, and minimally invasive techniques for making a rapid diagnosis of esophageal stent migration.
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Affiliation(s)
- Samuel Harris
- Emergency Medicine, University of South Florida Morsani College of Medicine, Tampa, USA
| | - A Brad Hall
- Emergency Medicine, Lakeland Regional Health, Lakeland, USA
| | - Charlotte Derr
- Emergency Medicine, University of South Florida Morsani College of Medicine, Tampa, USA
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4
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Mao LQ, Yu HB, Li JJ, Wei GJ, Yao LH. An unexpected complication of prophylactic esophageal stenting: esophageal stent impaction after thread dislocation. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS : ORGANO OFICIAL DE LA SOCIEDAD ESPANOLA DE PATOLOGIA DIGESTIVA 2022; 114:768-769. [PMID: 36093986 DOI: 10.17235/reed.2022.9151/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A 47-year-old woman was referred to our department with opportunistic endoscopic findings of two submucosal esophageal bulges, approximately half the circumference of the esophagus, both nearly 2.0 cm in size, and 24-27 cm from the incisors. Ultrasound endoscopy diagnosed smooth muscle tumors originating from the muscularis propria layer and she next underwent submucosal tunneling endoscopic resection. Intraoperatively, part of the tumor could not be separated from the muscularis propria layer and a U-shaped tumor was finally resected. A fully covered self-expanding esophageal nitinol stent was then inserted, covering the full circumference esophageal mucosa. The stent was fixed by ears with knotted thread and proton pump inhibitors were given for 1 week.
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Affiliation(s)
- Li-Qi Mao
- Gastroenterology, The First People's Hospital of Huzhou, The First Affiliated Hospital of Huzhou University, China
| | - Hong-Bin Yu
- General Surgery, The First People's Hospital of Huzhou, The First Affiliated Hospital of Huzhou University
| | - Jing-Jing Li
- Gastroenterology, The First People's Hospital of Huzhou, The First Affiliated Hospital of Huzhou University
| | - Gui-Jun Wei
- Gastroenterology, The First People's Hospital of Huzhou, The First Affiliated Hospital of Huzhou University
| | - Lin-Hua Yao
- Gastroenterology, The First People's Hospital of Huzhou, The First Affiliated Hospital of Huzhou University
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5
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Trapped Esophageal Stent in a Child: An Unusual Complication. Case Rep Surg 2020; 2020:8851112. [PMID: 32963876 PMCID: PMC7499277 DOI: 10.1155/2020/8851112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/01/2020] [Accepted: 08/28/2020] [Indexed: 01/21/2023] Open
Abstract
Background Migration is the most frequent and well-known complication of self-expandable metal stents (SEMS). Most of the time, migrated stents are still in the esophagus and can be relocated or removed successfully through endoscopy. However, what can be done if the stent is stuck between two esophageal strictures? Herein, we present a child with a trapped esophageal stent. Method A 2-year-old male patient with an esophageal stent which migrated and became stuck between two esophageal strictures was reported. Results Proximal stricture was excised, and the stent was removed via a right thoracotomy. Balloon dilatation was applied to the distal stricture. The patient was discharged on the 17th postoperative day without any problem. Conclusions Pediatric patients with an esophageal stent should be closely followed up during this period. Early detection of complications makes treatment easier. Otherwise, there may be no option other than surgical treatment, as in the patient presented here.
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6
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Mahan ME, Baig I, Trivedi AK, Oxenberg JC, Khan Y, Chu KU. Esophageal stent migration to the transverse colon, entrapped within a hiatal hernia status post esophagectomy. J Surg Case Rep 2020. [DOI: 10.1093/jscr/rjaa221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Self-expandable metal stents are used in both benign and malignant esophageal conditions for the treatment of strictures, leaks and perforations. With this intervention, the most common complication is stent migration. Those in whom migration occurs are subject to additional procedures with significant risk. We present a unique case of stent migration in a 61-year-old male who underwent transhiatal esophagectomy secondary to esophageal adenocarcinoma. Postoperatively, two covered stents were applied to relieve anastomotic stricture and proximal esophageal occluding web. Several months thereafter, the initial stent was found to have migrated to the transverse colon subsequently entrapped in a hiatal hernia defect. Fortunately, the migrated stent was amenable to colonoscopic retrieval. As endoscopic stent use grows, it is important to recognize that covered stents may migrate through anatomic narrowing’s such as pylorus and ileocecal valve, but can also become entrapped in nonanatomic narrowing’s such as a hernia leading to further complications.
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Affiliation(s)
- Mark E Mahan
- Department of Surgical Oncology, Geisinger Wyoming Valley, Wilkes-Barre, PA, USA
| | - Imran Baig
- Department of Surgical Oncology, Geisinger Wyoming Valley, Wilkes-Barre, PA, USA
| | - Apurva K Trivedi
- Department of Surgical Oncology, Geisinger Wyoming Valley, Wilkes-Barre, PA, USA
| | | | - Yakub Khan
- Department of Gastroenterology, Geisinger Wyoming Valley, Wilkes-Barre, PA, USA
| | - Kyo U Chu
- Department of Surgical Oncology, Geisinger Wyoming Valley, Wilkes-Barre, PA, USA
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Sarani B, Paspulati RM, Hambley J, Efron D, Martinez J, Perez A, Bowles-Cintron R, Yi F, Hill S, Meyer D, Maykel J, Attalla S, Kochman M, Steele S. A multidisciplinary approach to diagnosis and management of bowel obstruction. Curr Probl Surg 2018; 55:394-438. [PMID: 30526888 DOI: 10.1067/j.cpsurg.2018.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 09/11/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Babak Sarani
- Center for Trauma and Critical Care, George Washington University School of Medicine, Washington, DC.
| | | | - Jana Hambley
- Department of Trauma and Acute Care Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - David Efron
- Division of Acute Care Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jose Martinez
- Division of Minimally Invasive Surgery, Minimally Invasive Surgery/Flexible Endoscopy Fellowship Program, University of Miami Miller School of Medicine, Miami, FL
| | - Armando Perez
- University of Miami Miller School of Medicine, Miami, FL
| | | | - Fia Yi
- Brooke Army Medical Center, San Antonio, TX
| | - Susanna Hill
- University of Massachusetts Medical Center, Worcester, MA
| | - David Meyer
- Division of Colon and Rectal Surgery, University of Massachusetts Medical Center, Worcester, MA
| | - Justin Maykel
- Division of Colon and Rectal Surgery, University of Massachusetts Medical Center, Worcester, MA
| | - Sara Attalla
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Michael Kochman
- Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Kucera S, Barthel J, Klapman J, Shridhar R, Hoffe S, Harris C, Almhanna K, Meredith K. Small caliber covered self-expanding metal stents in the management of malignant dysphagia. J Gastrointest Oncol 2016; 7:411-9. [PMID: 27284474 DOI: 10.21037/jgo.2015.12.03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Use of large caliber [≥18 mm body diameter (BD)] self-expanding metal stents (SEMS) for management of malignant dysphasia is associated with substantial adverse event (AE) and mortality rates (MRs). We sought to determine dysphagia response, stent migration rates, and AE and MRs, for small caliber covered SEMS (sccSEMS) with BDs between 10-16 mm in malignant dysphagia. METHODS Thirty-one patients underwent direct endoscopic placement of 50 sccSEMS between January 2008 and March 2011. Patients were monitored for change in dysphagia score (DS), stent migration, AEs, and death through May 2011. RESULTS DS improved in 30 of 31 patients (97%). The median DS decreased from 3 to 2 (P<0.0001). The median effective duration of first sccSEMS placement was 116 (95% CI: 75-196) days. Major and minor AE rates were 6.5% and 19.4% respectively. No stent related deaths were encountered. The overall migration rate was 36% (18/50). The anticipated migration rate was 45.7% (16/35) and the unanticipated migration rate was 13.3% (2/15) (P=0.052). Positive effective clinical outcome occurred in 93.5% (29/31) of cases. CONCLUSIONS In malignant dysphagia, direct endoscopic sccSEMS placement provided acceptable dysphagia control and migration rates with substantial reductions in stent related AEs and MRs compared to those reported for large caliber SEMS.
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Affiliation(s)
- Stephen Kucera
- 1 Florida State University, USA ; 2 Florida Digestive Health, USA ; 3 Moffitt Cancer Center, USA ; 4 University of Central Florida, USA
| | - James Barthel
- 1 Florida State University, USA ; 2 Florida Digestive Health, USA ; 3 Moffitt Cancer Center, USA ; 4 University of Central Florida, USA
| | - Jason Klapman
- 1 Florida State University, USA ; 2 Florida Digestive Health, USA ; 3 Moffitt Cancer Center, USA ; 4 University of Central Florida, USA
| | - Ravi Shridhar
- 1 Florida State University, USA ; 2 Florida Digestive Health, USA ; 3 Moffitt Cancer Center, USA ; 4 University of Central Florida, USA
| | - Sarah Hoffe
- 1 Florida State University, USA ; 2 Florida Digestive Health, USA ; 3 Moffitt Cancer Center, USA ; 4 University of Central Florida, USA
| | - Cynthia Harris
- 1 Florida State University, USA ; 2 Florida Digestive Health, USA ; 3 Moffitt Cancer Center, USA ; 4 University of Central Florida, USA
| | - Khaldoun Almhanna
- 1 Florida State University, USA ; 2 Florida Digestive Health, USA ; 3 Moffitt Cancer Center, USA ; 4 University of Central Florida, USA
| | - Kenneth Meredith
- 1 Florida State University, USA ; 2 Florida Digestive Health, USA ; 3 Moffitt Cancer Center, USA ; 4 University of Central Florida, USA
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9
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Martins BDC, Retes FA, Medrado BF, de Lima MS, Pennacchi CMPS, Kawaguti FS, Safatle-Ribeiro AV, Uemura RS, Maluf-Filho F. Endoscopic management and prevention of migrated esophageal stents. World J Gastrointest Endosc 2014. [PMID: 24567792 DOI: 10.4253/wjge.v6.i2.49.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The use of self-expandable metallic stents has increased recently to palliate inoperable esophageal neoplasia and also in the management of benign strictures. Migration is one of the most common complications after stent placement and the endoscopist should be able to recognize and manage this situation. Several techniques for managing migrated stents have been described, as well as new techniques for preventing stent migration. Most stents have a "lasso" at the upper flange which facilitates stent repositioning or removal. An overtube, endoloop and large polypectomy snare may be useful for the retrieval of stents migrated into the stomach. External fixation of the stent with Shim's technique is efficient in preventing stent migration. Suturing the stent to the esophageal wall, new stent designs with larger flanges and double-layered stents are promising techniques to prevent stent migration but they warrant validation in a larger cohort of patients.
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Affiliation(s)
- Bruno da Costa Martins
- Bruno da Costa Martins, Felipe Alves Retes, Bruno Frederico Medrado, Marcelo Simas de Lima, Caterina Maria Pia Simione Pennacchi, Fabio Shiguehissa Kawaguti, Adriana Vaz Safatle-Ribeiro, Ricardo Sato Uemura, Fauze Maluf-Filho, Department of Gastroenterology, Endoscopy Division, Cancer Institute of the University of São Paulo, São Paulo 01246-000, Brazil
| | - Felipe Alves Retes
- Bruno da Costa Martins, Felipe Alves Retes, Bruno Frederico Medrado, Marcelo Simas de Lima, Caterina Maria Pia Simione Pennacchi, Fabio Shiguehissa Kawaguti, Adriana Vaz Safatle-Ribeiro, Ricardo Sato Uemura, Fauze Maluf-Filho, Department of Gastroenterology, Endoscopy Division, Cancer Institute of the University of São Paulo, São Paulo 01246-000, Brazil
| | - Bruno Frederico Medrado
- Bruno da Costa Martins, Felipe Alves Retes, Bruno Frederico Medrado, Marcelo Simas de Lima, Caterina Maria Pia Simione Pennacchi, Fabio Shiguehissa Kawaguti, Adriana Vaz Safatle-Ribeiro, Ricardo Sato Uemura, Fauze Maluf-Filho, Department of Gastroenterology, Endoscopy Division, Cancer Institute of the University of São Paulo, São Paulo 01246-000, Brazil
| | - Marcelo Simas de Lima
- Bruno da Costa Martins, Felipe Alves Retes, Bruno Frederico Medrado, Marcelo Simas de Lima, Caterina Maria Pia Simione Pennacchi, Fabio Shiguehissa Kawaguti, Adriana Vaz Safatle-Ribeiro, Ricardo Sato Uemura, Fauze Maluf-Filho, Department of Gastroenterology, Endoscopy Division, Cancer Institute of the University of São Paulo, São Paulo 01246-000, Brazil
| | - Caterina Maria Pia Simione Pennacchi
- Bruno da Costa Martins, Felipe Alves Retes, Bruno Frederico Medrado, Marcelo Simas de Lima, Caterina Maria Pia Simione Pennacchi, Fabio Shiguehissa Kawaguti, Adriana Vaz Safatle-Ribeiro, Ricardo Sato Uemura, Fauze Maluf-Filho, Department of Gastroenterology, Endoscopy Division, Cancer Institute of the University of São Paulo, São Paulo 01246-000, Brazil
| | - Fabio Shiguehissa Kawaguti
- Bruno da Costa Martins, Felipe Alves Retes, Bruno Frederico Medrado, Marcelo Simas de Lima, Caterina Maria Pia Simione Pennacchi, Fabio Shiguehissa Kawaguti, Adriana Vaz Safatle-Ribeiro, Ricardo Sato Uemura, Fauze Maluf-Filho, Department of Gastroenterology, Endoscopy Division, Cancer Institute of the University of São Paulo, São Paulo 01246-000, Brazil
| | - Adriana Vaz Safatle-Ribeiro
- Bruno da Costa Martins, Felipe Alves Retes, Bruno Frederico Medrado, Marcelo Simas de Lima, Caterina Maria Pia Simione Pennacchi, Fabio Shiguehissa Kawaguti, Adriana Vaz Safatle-Ribeiro, Ricardo Sato Uemura, Fauze Maluf-Filho, Department of Gastroenterology, Endoscopy Division, Cancer Institute of the University of São Paulo, São Paulo 01246-000, Brazil
| | - Ricardo Sato Uemura
- Bruno da Costa Martins, Felipe Alves Retes, Bruno Frederico Medrado, Marcelo Simas de Lima, Caterina Maria Pia Simione Pennacchi, Fabio Shiguehissa Kawaguti, Adriana Vaz Safatle-Ribeiro, Ricardo Sato Uemura, Fauze Maluf-Filho, Department of Gastroenterology, Endoscopy Division, Cancer Institute of the University of São Paulo, São Paulo 01246-000, Brazil
| | - Fauze Maluf-Filho
- Bruno da Costa Martins, Felipe Alves Retes, Bruno Frederico Medrado, Marcelo Simas de Lima, Caterina Maria Pia Simione Pennacchi, Fabio Shiguehissa Kawaguti, Adriana Vaz Safatle-Ribeiro, Ricardo Sato Uemura, Fauze Maluf-Filho, Department of Gastroenterology, Endoscopy Division, Cancer Institute of the University of São Paulo, São Paulo 01246-000, Brazil
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10
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Kujawski K, Stasiak M, Rysz J. The evaluation of esophageal stenting complications in palliative treatment of dysphagia related to esophageal cancer. Med Sci Monit 2012; 18:CR323-9. [PMID: 22534713 PMCID: PMC3560635 DOI: 10.12659/msm.882739] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background Esophageal cancer is the seventh-most frequent cause of cancer-related deaths and it is usually diagnosed at an inoperable stage. In palliative treatment, endoscopic and non-endoscopic methods are applied to reduce dysphagia in patients with neoplastic esophageal obstruction. Because of severe complications, non-endoscopic treatment (surgery, radiotherapy, brachytherapy and chemotherapy) is applied rarely. Within the endoscopic methods, only the use of endoprostheses yields long-term effects. The aim of this study was to evaluate the safety and efficacy of implantation of self-expandable esophageal stents in palliative treatment of dysphagia related to esophageal cancer. Material/Methods A total number of 46 patients (41 males and 5 females) were qualified to palliative implantation of coated self-expandable stent. The mean age of the patients was 67 years (from 51 to 78 years). In all patients, Evolution-type coated self-expandable stents were used. In all cases, 24 hours after the implantation, radiological examination was performed to assess the stent location. Results Severe, possibly life-threatening, complications constituted 28% of all the complications and occurred in 9% of the patients. Less severe complications occurred in 17% of the observed patients and were not life-threatening. Conclusions In patients with neoplastic esophageal stenosis, stenting with coated, self-expandable nitinol prostheses is a safe, effective and fast method of palliative dysphagia treatment.
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Affiliation(s)
- Krzysztof Kujawski
- Gastrointestinal Endoscopy Laboratory, WAM University Hospital, Medical University of Lodz, Lodz, Poland.
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11
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Esophageal strictures, tumors, and fistulae: stents for primary esophageal cancer. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2010. [DOI: 10.1016/j.tgie.2011.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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12
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Harries R, Campbell J, Ghosh S. Fractured migrated oesophageal stent fragment presenting as small bowel obstruction three years after insertion. Ann R Coll Surg Engl 2010; 92:W14-5. [PMID: 20566030 DOI: 10.1308/147870810x12699662981078] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Oesophageal stent migration is a recognised complication; however, few present distal to the stomach causing obstruction. To date, this has never been reported as occurring later than 2 years after insertion. An 84-year-old woman presented with small bowel obstruction secondary to a fractured migrated metallic oesophageal stent fragment; this occurred 3 years after placement for a benign oesophageal stricture, which had failed conservative management. Intra-operatively, the fractured segment of oesophageal stent was found at the ileocaecal junction.
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Affiliation(s)
- R Harries
- Department of General Surgery, Nevill Hall Hospital, Abergavenny, UK.
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13
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Chadha KS, Schiff M, Sitrin MD, Wilding GE, Nava H. Clinical outcomes of using a conservative approach of late esophageal stent placement in palliation of malignant dysphagia. J Gastrointest Cancer 2010; 41:173-8. [PMID: 20178007 DOI: 10.1007/s12029-010-9133-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Esophageal stents have been used as first-line treatment for palliation of malignant dysphagia, but this is associated with significant complications. The present study evaluated clinical outcomes and survival in patients with malignant dysphagia with esophageal stent placement who did not respond to prior chemoradiation or endoscopic modalities. PATIENTS AND METHODS Patients with esophageal cancer, who had esophageal stents, were retrospectively reviewed from the electronic medical records. The patient demographics, type of stent placed, dysphagia scores, stent-related complications, and survival were recorded. RESULTS Thirty-five patients with esophageal cancer received a total of 41 stents. There were 25 males and 10 females with mean age of 69.8 years. Twenty-two patients had esophageal adenocarcinoma, ten patients had squamous cell carcinoma, and three had poorly differentiated tumor. Esophageal malignancy was early stage (I, II) in 10 patients and advanced (III, IV) in 24 patients. Three patients had upper esophageal involvement, eight patients had mid-esophageal involvement; distal esophageal malignancy was present in 24 patients with 10 patients having gastroesophageal junction involvement. Six patients presented with tracheoesophageal fistula. Nine patients had prior esophagectomy. Thirty-three patients had chemoradiation, and 32 patients had other endoscopic therapies previously. Twelve of the 35 (33%) patients developed stent-related complications; nine patients had dysphagia due to various causes; one patient each developed aspiration, intractable hiccups, and intractable vomiting after stent placement, respectively. Nine patients underwent a repeat esophagogastroduodenoscopy. Development of stent-related complications was not significantly associated with poor survival. CONCLUSIONS The clinical outcomes for patients with esophageal stent placement for malignant dysphagia after chemoradiation and other endoscopic treatments is not worse than that reported in patients where esophageal stent placement was used as first-line treatment.
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Affiliation(s)
- Krishdeep Singh Chadha
- Division of Gastroenterology, Hepatology and Nutrition, State University of New York at Buffalo, ECMC, 462 Grider Street, Buffalo, NY 14215, USA
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14
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Complications of Metallic Stent Placement in Malignant Esophageal Stricture and Their Management. Surg Laparosc Endosc Percutan Tech 2010; 20:10-5. [DOI: 10.1097/sle.0b013e3181cdebf4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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15
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An HJ, Lee HY, Kim BW, Park SM, Ji JS, Lee BI, Choi H, Chae HS, Choi KY, Chung IS. Endoscopic removal of a migrated esophageal self-expandable metal stent after compression with detachable snares through an intact esophageal stent. Gastrointest Endosc 2010; 71:205-7. [PMID: 19640522 DOI: 10.1016/j.gie.2009.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Accepted: 06/07/2009] [Indexed: 01/15/2023]
Affiliation(s)
- Ho-Jung An
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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16
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Munoz JC, Khoury JE, Alizadeh M, Pudhota S, Smith-McCutchen A, Corregidor AM, Lambiase LR, Vega KJ. Modified technique to extract malpositioned or migrated self-expanding stents from the esophagus and stomach. J Gastroenterol Hepatol 2009; 24:547-51. [PMID: 19220663 DOI: 10.1111/j.1440-1746.2008.05716.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND AIM Various methods have been used to remove self expandable stents (SES) because of either malposition or migration. The main difficulties encountered in such situations are the anatomic obstacle of the lower and upper esophageal sphincters as well as risk of mucosal injury during removal. METHODS We describe a modified approach using an esophagogastroduodenoscope (EGD) in combination with a foreign body hood protector, rat tooth forceps and snare allowing for successful SES removal from the upper gastrointestinal tract in four cases. RESULTS In all cases, the SES were successfully removed from upper gastrointestinal tract using this technique. No complications were noted after extraction. CONCLUSION The foreign body hood protector combined with rat tooth forceps/snare technique is a safe and effective alternative to previously described methods for extraction of SES from the upper gastrointestinal tract. This method may be applicable for the removal of other such objects within the endoscope's reach.
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Affiliation(s)
- Juan Carlos Munoz
- Division of Gastroenterology, University of Florida Health Science Center/Jacksonville, Jacksonville, Florida 32207, USA
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Homann N, Noftz MR, Klingenberg-Noftz RD, Ludwig D. Delayed complications after placement of self-expanding stents in malignant esophageal obstruction: treatment strategies and survival rate. Dig Dis Sci 2008; 53:334-40. [PMID: 17597412 DOI: 10.1007/s10620-007-9862-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2006] [Accepted: 04/30/2007] [Indexed: 01/12/2023]
Abstract
PURPOSE Placement of self-expanding metal stents is regarded as a safe and effective treatment in patients with incurable malignant esophagogastric obstruction. However, proceeding and possible benefit of re-interventions in patients with recurrent dysphagia due to delayed complications (>4 weeks after stent insertion) is unclear. PATIENTS AND METHODS In 133 patients with malignant stricture of the esophagus or the esophagogastric junction 164 expandable metal stents were placed. About 89 patients were followed up until death. All tumor- or stent-related complications and consequent re-interventions were recorded. RESULTS The overall incidence of delayed complications was 53.4% (71 of 133 pts.), with 34 patients (25.6%) experiencing more than one complication. Recurrent dysphagia due to tumor ingrowth (22%) or overgrowth (15%), bolus obstruction (21%), stent migration (9%), and development of esophagorespiratory fistula (9%) was successfully treated by dilatation (24%), placement of a second/third stent (27%), laser therapy (16%), and/or placement of a feeding tube (PEG, 19%). The median survival of patients with endoscopic therapy was significantly longer (222 +/- 26 days) compared to patients without re-intervention (86 +/- 14 days, P < 0.0001). CONCLUSIONS Delayed complications after metal stent placement for malignant esophageal stricture are common, but can be treated successfully by endoscopic re-intervention in most cases. Regular interventional therapy may also improve survival.
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Affiliation(s)
- Nils Homann
- Department of Gastroenterology, University Clinics of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
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Conio M, Repici A, Battaglia G, De Pretis G, Ghezzo L, Bittinger M, Messmann H, Demarquay JF, Blanchi S, Togni M, Conigliaro R, Filiberti R. A randomized prospective comparison of self-expandable plastic stents and partially covered self-expandable metal stents in the palliation of malignant esophageal dysphagia. Am J Gastroenterol 2007; 102:2667-77. [PMID: 18042102 DOI: 10.1111/j.1572-0241.2007.01565.x] [Citation(s) in RCA: 133] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Self-expanding metal stents (SEMS) provide effective palliation in patients with malignant dysphagia, although severe complications and mortality may result. We performed a prospective controlled trial to compare a new self-expanding polyester mesh stent (Polyflex) with SEMS (Ultraflex). METHODS One hundred one patients with unresectable esophageal carcinoma were randomized to placement of a Polyflex (N=47) or a partially covered Ultraflex (N=54) stent. Patients with esophagogastric junction (EGJ) malignancy were excluded. RESULTS Placement was successful in 46 (98%) patients with the Polyflex and 54 (100%) patients with the Ultraflex stent. In one patient, the Polyflex stent could not be placed. After 1 wk, dysphagia was improved by at least 1 grade in 100% of the Polyflex group and in 94% of the Ultraflex group. Major complications were observed in 48% of the Polyflex group and 33% of the Ultraflex group. Intraprocedural perforation occurred in 1 Polyflex and 1 Ultraflex patient. Two Polyflex patients had postprocedural hemorrhage. Twenty (44%) patients with a Polyflex stent and 18 (33%) with an Ultraflex stent had recurrent dysphagia because of tumor overgrowth, stent migration, hyperplastic granulomatous reaction, or food bolus impaction. Multivariate analysis showed a significantly higher complication rate with Polyflex than with Ultraflex stents (odds ratio 2.3, 95% CI 1.2-4.4). However, median survival was 134 days with Polyflex and 122 days with Ultraflex stents (P=NS). CONCLUSIONS No difference was seen in palliation of dysphagia between the two stents. Significantly more complications, especially late stent migration, were observed in the Polyflex group.
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Affiliation(s)
- Massimo Conio
- Department of Gastroenterology, Sanremo Hospital, Sanremo, Italy
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Kiev J, Amendola M, Bouhaidar D, Sandhu BS, Zhao X, Maher J. A management algorithm for esophageal perforation. Am J Surg 2007; 194:103-6. [PMID: 17560919 DOI: 10.1016/j.amjsurg.2006.07.024] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2006] [Revised: 07/28/2006] [Accepted: 07/28/2006] [Indexed: 12/22/2022]
Abstract
Despite the prolonged morbidity caused by a major surgery and the high occurrence of continued leakage, primary repair has been the standard treatment for esophageal perforations. We believe that management using removable esophageal stents is both simpler and more effective. Over the past 3 years, we have treated 14 patients using esophageal stents, and the procedure was successful in all patients. Because of the shorter bed rest that follows endoscopic Polyflex stent (Rush, Inc; Teleflex Medical, Duluth, GA) placement, it is very likely that the care of patients with esophageal perforation will be changed over time.
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Affiliation(s)
- Jon Kiev
- Division of Cardiothoracic Surgery, Virginia Commonwealth University Medical Center, PO Box 980068, Richmond, VA 23298-0068, USA.
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Conio M, Blanchi S, Filiberti R, Repici A, Barbieri M, Bilardi C, Siersema PD. A modified self-expanding Niti-S stent for the management of benign hypopharyngeal strictures. Gastrointest Endosc 2007; 65:714-20. [PMID: 17383472 DOI: 10.1016/j.gie.2007.02.050] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND The management of patients with refractory hypopharyngeal strictures after surgery in combination with radiation therapy is disappointing, and nutrition through feeding tubes is often required. OBJECTIVE To evaluate the efficacy and safety of a modified self-expanding Niti-S metal stent in the treatment of hypopharyngeal strictures after combined therapy for laryngeal cancer. DESIGN Case series. SETTING A general hospital and a university hospital. PATIENTS Seven consecutive patients were included. One of them did not have laryngectomy. INTERVENTIONS All patients received a modified Niti-S stent. MAIN OUTCOME MEASUREMENTS Improvement of dysphagia, avoiding periodic bougienage, and enteral nutrition through feeding tubes. RESULTS After placement of the first stent, dysphagia improved in all patients. Six of 7 patients developed stent migration and/or granulomatous tissue ingrowth or overgrowth. Additional stents were placed in all patients after a median of 3 months after the previous stent placement. One patient developed an esophagorespiratory fistula caused by a Polyflex stent. Two patients died of causes unrelated to the stent. The remaining 5 patients remained alive and asymptomatic after a median follow-up of 10 months. LIMITATIONS Periodic stent exchange. Stent placement did not resolve the stricture definitively. We had a limited number of patients and have no long-term outcome data yet. CONCLUSIONS The use of this modified Niti-S stent avoids both enteral nutrition through feeding tubes and the need for periodic bougienage in patients with difficult-to-treat benign hypopharyngeal strictures.
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Affiliation(s)
- Massimo Conio
- Department of Gastroenterology, General Hospital, Sanremo, Italy
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Ross WA, Alkassab F, Lynch PM, Ayers GD, Ajani J, Lee JH, Bismar M. Evolving role of self-expanding metal stents in the treatment of malignant dysphagia and fistulas. Gastrointest Endosc 2007; 65:70-6. [PMID: 17185082 DOI: 10.1016/j.gie.2006.04.040] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2005] [Accepted: 04/27/2006] [Indexed: 02/08/2023]
Abstract
BACKGROUND Self-expanding metal stents (SEMS) are touted as the cornerstone of endoscopic palliation of unresectable esophageal cancer. However, usage at MD Anderson has fallen in recent years, despite a greater volume of patients with esophageal cancer. OBJECTIVE To compare our more recent experience with that of earlier reported institutional experience and to assess how esophageal stent use has evolved. DESIGN A retrospective chart review. SETTING A tertiary referral cancer center. PATIENTS Ninety-seven patients with malignant dysphagia who had SEMS placed from 2000 to 2003. INTERVENTIONS Placement of SEMS for malignant disease. MAIN OUTCOMES MEASUREMENTS Dysphagia scores, overall survival, and complication rates. RESULTS Dysphagia scores improved in 86%, and tracheoesophageal fistula symptoms improved in 90%. Complications were seen in a majority of the patients and major complications in 37%. Ten patients had hematemesis, migrations occurred in 5, and early unexpected deaths in 2. Adenocarcinoma and female sex were factors associated with increased odds of a major complication. Prior chemoradiation, age, stricture location, and length were not associated with complications. Median survival was 77 days. LIMITATIONS Noncomparative retrospective single-center study. CONCLUSIONS SEMS fall short of an ideal palliative method, because complications that require additional intervention are frequent. Usage has declined despite higher numbers of patients with esophageal cancer. However, for patients with tracheoesophageal fistulas, SEMS are the treatment of choice. For patients who are not candidates for chemoradiation or who failed to achieve adequate palliation with such therapy, SEMS offer a viable, albeit imperfect, endoscopic approach.
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Affiliation(s)
- William A Ross
- Department of GI Medicine and Nutrition, MD Anderson Cancer Center, Houston, Texas 77030, USA
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Abstract
Almost all endoluminal stents used by gastroenterologists in the United States are self-expandable metal stents, and they are placed most commonly for relief of malignant luminal obstruction. Recently, a plastic self-expandable stent was approved for treating refractory benign esophageal strictures. Endoluminal stent placement is associated with myriad of complications. Some of these complications can be avoided or minimized by the endoscopist, whereas others are beyond the endoscopist's control. This article covers the various complications that can occur following self-expandable stent placement and provides recommendations on how to minimize these complications.
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Affiliation(s)
- Todd H Baron
- Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 First Street Southwest, Charlton 8, Rochester, MN 55905, USA.
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Mosca F, Consoli A, Stracqualursi A, Persi A, Portale TR. Comparative retrospective study on the use of plastic prostheses and self-expanding metal stents in the palliative treatment of malignant strictures of the esophagus and cardia. Dis Esophagus 2003; 16:119-25. [PMID: 12823210 DOI: 10.1046/j.1442-2050.2003.00308.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Palliative treatment of malignant strictures of the esophagus and cardia is usually carried out by the endoscopic placement of a prosthesis. The aim of this retrospective study was to evaluate short- and long-term outcomes of the use of expandable stents, compared with conventional plastic prostheses. One hundred and thirteen endoscopic intubations were carried out in 120 patients affected by malignant stenosis of the esophagus and cardia using plastic prosthesis and self-expanding metal stents. Dysphagia was scored according to Atkinson and Ferguson's classification and the preoperative median score (3.6) was comparable in both groups. The technical success rate was 94.4% with plastic prosthesis and 93.7% with self-expanding metal stent while the functional success rate was, respectively, 85.2% and 88.8%. Three deaths occurred with plastic prostheses (4.4%), while no deaths were observed with metal stents. A comparative analysis of the results of this study suggests that the endoscopic placement of self-expanding metal stents is effective and safe and has to be preferred to the conventional plastic prosthesis for easier implantation and lower morbidity.
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Affiliation(s)
- F Mosca
- Department of Surgery, University of Catania and Unit of General Surgery, via Plebiscito, Catania, Italy
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Abstract
Primary esophageal cancer is the most common cause of malignant esophageal stricture. Prognosis and treatment outcomes vary with the stage of the disease. Endoscopic ultrasound has a high accuracy rate for local and regional staging. Surgery is curative for early cancer. Endoscopic mucosal resection, photodynamic therapy, or brachytherapy can be used with curative intent for early cancer, especially in patients with comorbid conditions precluding surgery. Unfortunately, the majority of patients with esophageal cancer present with advanced disease. The primary aim in these patients is to alleviate symptoms with a minimum of side effects and reinterventions. Palliative surgery or chemoradiotherapy can be associated with high morbidity and mortality rates. Several endoscopic techniques for palliation are available, and all have the potential of significantly improving swallowing. The choice of a particular endoscopic approach is usually determined by local expertise and characteristics of the stricture.
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Affiliation(s)
- Kulwinder S Dua
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Froedtert Memorial Lutheran Hospital, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA.
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Therasse E, Oliva VL, Lafontaine E, Perreault P, Giroux MF, Soulez G. Balloon dilation and stent placement for esophageal lesions: indications, methods, and results. Radiographics 2003; 23:89-105. [PMID: 12533645 DOI: 10.1148/rg.231025051] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Esophageal balloon dilation and expandable stent placement are safe, minimally invasive, effective treatments for esophageal strictures and fistulas. These procedures have brought the management of dysphagia due to esophageal strictures into the field of interventional radiology. Esophageal dilation is usually indicated for benign stenoses and is technically successful in more than 90% of cases. Most patients with esophageal carcinoma are not candidates for resection; thus, the main focus of treatment is palliation of malignant dysphagia and esophagorespiratory fistulas. Esophageal stent placement, which is approved only for malignant strictures, is one of the main therapeutic options in affected patients and relieves dysphagia in approximately 90% of cases. Dedicated commercially available devices continue to evolve, each with its own advantages and limitations. Stent placement is subject to technical pitfalls, and adverse events occur following esophageal procedures in a minority of cases. Although chest pain is common and self-limited, reflux esophagitis, stent migration, tracheal compression, and esophageal perforation and obstruction require specific interventions. In many cases, these complications can be recognized and treated by the interventional radiologist with minimally invasive techniques.
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Affiliation(s)
- Eric Therasse
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, 3840 St Urbain St, Montreal, Quebec, Canada H2W 1T8.
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