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Peng R, Chen J, Lv L, Liu D, Li R. Complex duodenal fistula after cholecystectomy successfully treated with endoscopic suturing. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2024. [PMID: 38235685 DOI: 10.17235/reed.2024.10193/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
We reported a 47-year-old female with a history of laparoscopic cholecystectomy presented with a complex duodenal fistula. The bleeding artery embolization and endoscopic suture of the duodenal fistula were performed successfully. We highlight the endoscopic tissue clip suture as a safe and feasible option when surgery is too risky.
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Affiliation(s)
- Ruyi Peng
- Gastroenterology, The Second Xiangya Hospital of Central South University
| | - Jiefei Chen
- Laboratory Medicine, Xiangya Medical School of Central South University
| | - Liang Lv
- Gastroenterology, The Second Xiangya Hospital of Central South University
| | - Deliang Liu
- Gastroenterology, The Second Xiangya Hospital of Central South University
| | - Rong Li
- Gastroenterology, The Second Xiangya Hospital of Central South University, china
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Diaz-Martinez J, Pérez-Correa N. Postcholecystectomy Duodenal Injuries, Their Management, and Review of the Literature. Euroasian J Hepatogastroenterol 2024; 14:44-50. [PMID: 39022195 PMCID: PMC11249893 DOI: 10.5005/jp-journals-10018-1427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 04/12/2024] [Indexed: 07/20/2024] Open
Abstract
Backgrounds Laparoscopic cholecystectomy (LC) is the gold standard for treating gallstones; however, it is not free of complications. Postcholecystectomy duodenal injuries are rare but challenging complications after cholecystectomy. The objective of this study was to analyze the management of postcholecystectomy duodenal injuries and to review the related literature. Materials and methods An observational and retrospective study was conducted. We included all patients with postcholecystectomy duodenal injuries treated at a reference center, from January 2019 to December 2023. In addition, a review of the literature was carried out. Results Fifteen patients were found, mostly women; with gallbladder wall thickening on ultrasound (mean of 8 mm). The majority were emergency (n = 12, 80%) and LCs (n = 8, 53.33%). Cholecystectomies were reported to be associated with excessive difficulty (n = 10, 66.66%). The most injured duodenal portion was the first portion (n = 9, 60%), and blunt dissection was the most common mechanism of injury (n = 7, 46.66%). Most of these injuries were detected in the operating room (n = 9, 60%), and treated with primary closure (n = 11, 73.33%). Three patients with delayed injuries died (20%). According to the literature reviewed, 93 duodenal injuries were found, mostly detected intraoperatively, in the second portion, and treated with primary closure. A minority of patients were treated with more complex procedures, for a mortality rate of 15.38%. Conclusion Postcholecystectomy duodenal injuries are rare. Most of these injuries are detected and repaired intraoperatively. However, a high percentage of patients have high morbidity and mortality. How to cite this article Diaz-Martinez J, Pérez-Correa N. Postcholecystectomy Duodenal Injuries, Their Management, and Review of the Literature. Euroasian J Hepato-Gastroenterol 2024;14(1):44-50.
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Affiliation(s)
- Jair Diaz-Martinez
- Department of General and HPB Surgery, Hospital de Alta Especialidad Centenario de la Revolución Mexicana ISSSTE, Zapata, Morelos, Mexico
| | - Nayelli Pérez-Correa
- Department of General Surgery, Hospital General Regional c/MF No. 1, IMSS, Cuernavaca, Morelos, Mexico
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Mosenko V, Jurevičius S, Šileikis A. Enterocutaneous Fistula: Open Repair after Unsuccessful Stenting—A Case Report. Medicina (B Aires) 2022; 58:medicina58020223. [PMID: 35208547 PMCID: PMC8876532 DOI: 10.3390/medicina58020223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/21/2022] [Accepted: 01/26/2022] [Indexed: 11/16/2022] Open
Abstract
Enterocutaneous fistula (ECF) is an abnormal connection between the gastrointestinal tract and the skin; by some estimates, it represents 88.2% of all fistulae. It can either develop spontaneously due to underlying malignancy, inflammatory bowel disease, radiation exposure, or, more commonly, as a complication of gastrointestinal surgery. A 75-year-old woman was treated for a small bowel enterocutaneous fistula that developed after laparoscopic cholecystectomy using a HANAROSTENT self-expanding metal stent (SEMS) to cover the fistula. Seven months later, the patient was discharged. For the following 2 years, the patient refused the reconstructive surgery until stent obstruction occurred. After optimizing the patient’s nutritional status, laparotomy and small bowel resection were performed successfully. The use of SEMS in fistulas of the lower gastrointestinal tract is a heavily debated and fairly under-researched topic, especially in the context of enterocutaneous fistulas. No international guidelines officially recommend using SEMS in the small bowel ECF.
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Abstract
Cholecystectomy is one of the most common general surgery procedures performed worldwide. Complications include bile duct injury, strictures, bleeding, infection/abscess, retained gallstones, hernias, and postcholecystectomy syndrome. Obtaining a critical view of safety and following the other tenets of the Safe Cholecystectomy Task Force will aid in the prevention of bile duct injury and other morbidity associated with cholecystectomy.
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Affiliation(s)
- Xiaoxi Chelsea Feng
- Department of Surgery, Cedars Sinai Medical Center, 8635 W Third Street, West Medical Office Tower, Suite 795, Los Angeles, CA 90048, USA
| | - Edward Phillips
- Department of Surgery, Cedars Sinai Medical Center, 8635 W Third Street, West Medical Office Tower, Suite 795, Los Angeles, CA 90048, USA
| | - Daniel Shouhed
- Department of Surgery, Cedars Sinai Medical Center, 459 North Croft Avenue, Los Angeles, CA 90048, USA.
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Beyersdorffer P, Kunert W, Jansen K, Miller J, Wilhelm P, Burgert O, Kirschniak A, Rolinger J. Detection of adverse events leading to inadvertent injury during laparoscopic cholecystectomy using convolutional neural networks. ACTA ACUST UNITED AC 2021; 66:413-421. [PMID: 33655738 DOI: 10.1515/bmt-2020-0106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 02/16/2021] [Indexed: 01/17/2023]
Abstract
Uncontrolled movements of laparoscopic instruments can lead to inadvertent injury of adjacent structures. The risk becomes evident when the dissecting instrument is located outside the field of view of the laparoscopic camera. Technical solutions to ensure patient safety are appreciated. The present work evaluated the feasibility of an automated binary classification of laparoscopic image data using Convolutional Neural Networks (CNN) to determine whether the dissecting instrument is located within the laparoscopic image section. A unique record of images was generated from six laparoscopic cholecystectomies in a surgical training environment to configure and train the CNN. By using a temporary version of the neural network, the annotation of the training image files could be automated and accelerated. A combination of oversampling and selective data augmentation was used to enlarge the fully labeled image data set and prevent loss of accuracy due to imbalanced class volumes. Subsequently the same approach was applied to the comprehensive, fully annotated Cholec80 database. The described process led to the generation of extensive and balanced training image data sets. The performance of the CNN-based binary classifiers was evaluated on separate test records from both databases. On our recorded data, an accuracy of 0.88 with regard to the safety-relevant classification was achieved. The subsequent evaluation on the Cholec80 data set yielded an accuracy of 0.84. The presented results demonstrate the feasibility of a binary classification of laparoscopic image data for the detection of adverse events in a surgical training environment using a specifically configured CNN architecture.
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Affiliation(s)
| | - Wolfgang Kunert
- Department of Surgery and Transplantation, Tübingen University Hospital, Tübingen, Germany
| | - Kai Jansen
- Department of Surgery and Transplantation, Tübingen University Hospital, Tübingen, Germany
| | - Johanna Miller
- Department of Surgery and Transplantation, Tübingen University Hospital, Tübingen, Germany
| | - Peter Wilhelm
- Department of Surgery and Transplantation, Tübingen University Hospital, Tübingen, Germany
| | - Oliver Burgert
- Department of Medical Informatics, Reutlingen University, Reutlingen, Germany
| | - Andreas Kirschniak
- Department of Surgery and Transplantation, Tübingen University Hospital, Tübingen, Germany
| | - Jens Rolinger
- Department of Surgery and Transplantation, Tübingen University Hospital, Tübingen, Germany
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Bojanapu S, Malani RA, Ray S, Mangla V, Mehta N, Nundy S. Duodenal Perforation: Outcomes after Surgical Management at a Tertiary Care Centre-A Retrospective Cross-Sectional Study. Surg Res Pract 2020; 2020:8392716. [PMID: 33195794 PMCID: PMC7641718 DOI: 10.1155/2020/8392716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/04/2020] [Accepted: 10/11/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Duodenal perforation is a common surgical emergency and carries mortality ranging from 4% to 30% reported in Western countries, but there is a paucity of reports from India. We aimed to determine the factors which influence the surgical outcomes in patients with duodenal perforation. METHODS We retrospectively analyzed prospectively collected data from January 2010 to December 2018. RESULTS A total of 55 patients were included in the study of which 69% (38) were males and 31% (17) were females (M : F = 4.5 : 2). The mean age was 52.3 years. The cause for duodenal perforation was duodenal ulcer (n = 25, 45.5%), followed by post-ERCP complications (n = 15, 27.3%), surgery (n = 11, 20%), and blunt trauma (n = 4, 7.2%) with perforations localized at D2 (n = 28, 51%) and at D1 (n = 27, 49%). Patients underwent primary repair with an additional diversion procedure (n = 28, 51%) and repair only in 18 (32.8%). There were 21 (38%) deaths. Patients with ERCP-associated duodenal perforation had longer hospital stay (P ≤ 0.001), ICU stay (P=0.049), duration of drainage (P ≤ 0.001), and higher leak rate (P=0.001) and re-exploration rate (P=0.037). A high mortality rate was seen in patients with preoperative organ failure (n = 18, 78% versus 9.4%, P=0.001), postoperative leak (n = 7, 64% versus 32%, P=0.05), and longer duration from onset of symptoms to surgery (≥4 days) (P=0.045). CONCLUSION Perforation of the duodenum is associated with high morbidity and mortality regardless of its cause and is higher in those who have a longer interval to surgery, preoperative organ failure, and a postoperative leak.
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Affiliation(s)
- Srinivas Bojanapu
- Department of Surgical Gastroenterology and Liver Transplantation Sir Ganga Ram Hospital, New Delhi 110060, India
| | - Ronak Atulbhai Malani
- Department of Surgical Gastroenterology and Liver Transplantation Sir Ganga Ram Hospital, New Delhi 110060, India
| | - Samrat Ray
- Department of Surgical Gastroenterology and Liver Transplantation Sir Ganga Ram Hospital, New Delhi 110060, India
| | - Vivek Mangla
- Department of Surgical Gastroenterology and Liver Transplantation Sir Ganga Ram Hospital, New Delhi 110060, India
| | - Naimish Mehta
- Department of Surgical Gastroenterology and Liver Transplantation Sir Ganga Ram Hospital, New Delhi 110060, India
| | - Samiran Nundy
- Department of Surgical Gastroenterology and Liver Transplantation Sir Ganga Ram Hospital, New Delhi 110060, India
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Soni S, Swami A, Yadav T, KS S, Varshney VK. Postcholecystectomy Duodenal Injury: Role of Conservative Management. Cureus 2020; 12:e11144. [PMID: 33251054 PMCID: PMC7686932 DOI: 10.7759/cureus.11144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Postcholecystectomy duodenal injuries are very rare complications. Early surgical intervention is a common practice due to its fatal consequences. Most of the patients with post laparoscopic cholecystectomy duodenal injury reported in literature have been successfully managed by early surgical repair. We present here a case of a 32-year-old female who underwent open cholecystectomy and had an injury in the second part of the duodenum. She was subsequently managed conservatively.
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Overbey DM, Carmichael H, Wikiel KJ, Hirth DA, Chapman BC, Moore JT, Barnett CC, Jones TS, Robinson TN, Jones EL. Monopolar stray energy in robotic surgery. Surg Endosc 2020; 35:2084-2090. [PMID: 32385708 DOI: 10.1007/s00464-020-07605-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/28/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Stray energy transfer from monopolar radiofrequency energy during laparoscopy can be potentially catastrophic. Robotic surgery is increasing in popularity; however, the risk of stray energy transfer during robotic surgery is unknown. The purpose of this study was to (1) quantify stray energy transfer using robotic instrumentation, (2) determine strategies to minimize the transfer of energy, and (3) compare robotic stray energy transfer to laparoscopy. METHODS In a laparoscopic trainer, a monopolar instrument (L-hook) was activated with DaVinci Si (Intuitive, Sunnyvale, CA) robotic instruments. A camera and assistant grasper were inserted to mimic a minimally invasive cholecystectomy. During activation of the L-hook, the non-electric tips of the camera and grasper were placed adjacent to simulated tissue (saline-soaked sponge). The primary outcome was change in temperature from baseline (°C) measured nearest the tip of the non-electric instrument. RESULTS Simulated tissue nearest the robotic grasper increased an average of 18.3 ± 5.8 °C; p < 0.001 from baseline. Tissue nearest the robotic camera tip increased (9.0 ± 2.1 °C; p < 0.001). Decreasing the power from 30 to 15 W (18.3 ± 5.8 vs. 2.6 ± 2.7 °C, p < 0.001) or using low-voltage cut mode (18.3 ± 5.8 vs. 3.1 ± 2.1 °C, p < 0.001) reduced stray energy transfer to the robotic grasper. Desiccating tissue, in contrast to open air activation, also significantly reduced stray energy transfer for the grasper (18.3 ± 5.8 vs. 0.15 ± 0.21 °C, p < 0.001) and camera (9.0 ± 2.1 vs. 0.24 ± 0.34 °C, p < 0.001). CONCLUSIONS Stray energy transfer occurs during robotic surgery. The assistant grasper carries the highest risk for thermal injury. Similar to laparoscopy, stray energy transfer can be reduced by lowering the power setting, utilizing a low-voltage cut mode instead of coagulation mode and avoiding open air activation. These practical findings can aid surgeons performing robotic surgery to reduce injuries from stray energy.
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Affiliation(s)
| | - Heather Carmichael
- Department of Surgery, the University of Colorado School of Medicine & the Rocky Mountain Regional Denver Veterans Affairs Medical Center, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA
| | - Krzysztof J Wikiel
- Department of Surgery, the University of Colorado School of Medicine & the Rocky Mountain Regional Denver Veterans Affairs Medical Center, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA
| | - Douglas A Hirth
- General Surgeons of Western Colorado, Grand Junction, CO, USA
| | - Brandon C Chapman
- General Surgeons of Western Colorado, Grand Junction, CO, USA
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga, TN, USA
| | - John T Moore
- Department of Surgery, the University of Colorado School of Medicine & the Rocky Mountain Regional Denver Veterans Affairs Medical Center, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA
| | - Carlton C Barnett
- Department of Surgery, the University of Colorado School of Medicine & the Rocky Mountain Regional Denver Veterans Affairs Medical Center, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA
| | - Teresa S Jones
- Department of Surgery, the University of Colorado School of Medicine & the Rocky Mountain Regional Denver Veterans Affairs Medical Center, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA
| | - Thomas N Robinson
- Department of Surgery, the University of Colorado School of Medicine & the Rocky Mountain Regional Denver Veterans Affairs Medical Center, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA
| | - Edward L Jones
- Department of Surgery, the University of Colorado School of Medicine & the Rocky Mountain Regional Denver Veterans Affairs Medical Center, 1700 North Wheeling St, Mail Stop 112, Aurora, CO, 80045, USA.
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Ansari D, Torén W, Lindberg S, Pyrhönen HS, Andersson R. Diagnosis and management of duodenal perforations: a narrative review. Scand J Gastroenterol 2019; 54:939-944. [PMID: 31353983 DOI: 10.1080/00365521.2019.1647456] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Duodenal perforation is a rare, but potentially life-threatening injury. Multiple etiologies are associated with duodenal perforations such as peptic ulcer disease, iatrogenic causes and trauma. Computed tomography with intravenous and oral contrast is the most valuable imaging technique to identify duodenal perforation. In some cases, surgical exploration may be necessary for diagnosis. Specific treatment depends upon the nature of the disease process that caused the perforation, the timing, location and extent of the injury and the clinical condition of the patient. Conservative management seems to be feasible in stable patients with sealed perforations. Immediate surgery is required for patients presenting with peritonitis and/or intra-abdominal sepsis. Minimally invasive techniques are safe and effective alternatives to conventional open surgery in selected patients with duodenal perforations. Here we review the current literature on duodenal perforations and discuss the outcomes of different treatment strategies.
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Affiliation(s)
- Daniel Ansari
- Department of Surgery, Division of Clinical Sciences, Lund University, Skane University Hospital , Lund , Sweden
| | - William Torén
- Department of Surgery, Division of Clinical Sciences, Lund University, Skane University Hospital , Lund , Sweden
| | - Sarah Lindberg
- Department of Surgery, Division of Clinical Sciences, Lund University, Skane University Hospital , Lund , Sweden
| | - Helmi-Sisko Pyrhönen
- Department of Surgery, Division of Clinical Sciences, Lund University, Skane University Hospital , Lund , Sweden
| | - Roland Andersson
- Department of Surgery, Division of Clinical Sciences, Lund University, Skane University Hospital , Lund , Sweden
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Gupta V, Gupta A, Yadav TD, Mittal BR, Kochhar R. Post-cholecystectomy acute injury: What can go wrong? Ann Hepatobiliary Pancreat Surg 2019; 23:138-144. [PMID: 31225415 PMCID: PMC6558122 DOI: 10.14701/ahbps.2019.23.2.138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 02/18/2019] [Accepted: 02/21/2019] [Indexed: 12/14/2022] Open
Abstract
Backgrounds/Aims Most of the emphasis of postcholecystectomy injuries is laid on iatrogenic bilary trauma. However, they can involve a wide spectrum of injuries. Methods We prospectively evaluated 42 patients with postcholecystectomy injuries referred to us from July 2011 to December 2012. Based on spectrum of injuries, we proposed an algorithm of management. Results Injuries occurred following laparoscopy in 20 (2 converted) patients and open in 22 patients. Mean time of detection of injury was 4.32±2.33 days. The nature of drainage was bilious in 36, bile with blood in 2, only blood in 2, and enteric in 2. Nine had organ failure at presentation. Six (14%) needed re-operation. Source of hemorrhage was from right hepatic artery in three and small bowel mesentry in 1. Enteric injuries were one each to duodenum and colon. Six patient (14%) died. Advancing age and organ failure were the predictors of mortality. Persistant biliary fistula was seen in 5 (14%). Ten had lateral leaks that closed at 28.89±2.34 days. Twenty-two formed stricture which was successfully managed with definitive hepaticojejunostomy. Conclusions Post cholecystectomy acute injury does not limit itself to bile duct or vascular injury but it can traumatize adjacent hollow viscus or mesentery. It is important to diagnose and intervene enteric injury early. Presentation and management for such injury should be followed as per the proposed algorithm.
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Affiliation(s)
- Vikas Gupta
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Gupta
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Thakur Deen Yadav
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhagwant Rai Mittal
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Simpson WG. Profound Diarrhea After Cholecystectomy. Gastroenterology 2019; 156:554-555. [PMID: 30205098 DOI: 10.1053/j.gastro.2018.08.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 08/30/2018] [Indexed: 12/02/2022]
Affiliation(s)
- William G Simpson
- Department of Internal Medicine, Northeastern Health System, Tahlequah, and Department of Rural Health - Gastroenterology, Oklahoma State University College of Osteopathic Medicine, Tulsa, Oklahoma
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Greenbaum A, Parasher G, Demarest G, Auyang E. Oesophageal stent placement to treat a massive iatrogenic duodenal defect after laparoscopic cholecystectomy. BMJ Case Rep 2017; 2017:bcr-2016-218895. [PMID: 28476904 DOI: 10.1136/bcr-2016-218895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Iatrogenic duodenal injury occurring during laparoscopic cholecystectomy (LC) is managed surgically, though rarely a large, persistent fistula is refractory to surgical interventions. We present the case of a 40-year-old woman transferred to our centre following elective LC for a reported perforated duodenal ulcer. An uncontained leak was found to originate from a 1.5 cm duodenal defect, with no evidence of ulceration. A duodenostomy tube was placed. One month after abdominal closure, the patient continued to have a persistent, large duodenal fistula. A through-the-scope covered oesophageal stent was placed under endoscopic and fluoroscopic guidance. Five weeks later, it was successfully retrieved and no subsequent extravasation of contrast from the duodenum was noted. Unrecognised iatrogenic duodenal injuries sustained during LC can be catastrophic. In cases of massive duodenal defects and high-output biliary fistula uncontrolled after surgical intervention, endoscopic-guided and fluoroscopic-guided placement of a fully covered oesophageal stent may be lifesaving.
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Affiliation(s)
- Alissa Greenbaum
- Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Gulshan Parasher
- Division of Gastroenterology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Gerald Demarest
- Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Edward Auyang
- Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
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