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Ferreira-Silva J, Rodrigues-Pinto E, Vilas-Boas F, Macedo G. Biliary stent placement with modified Shim technique in a child with tracheoesophageal fistula and esophageal stricture. Endoscopy 2022; 54:E904-E905. [PMID: 35777371 PMCID: PMC9735400 DOI: 10.1055/a-1860-2031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | | | - Filipe Vilas-Boas
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
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Kumar S, Bahdi F, Emelogu IK, Yu AC, Coronel M, Ge PS, Coronel E, Ajani JA, Weston B, Lynch P, Ross WA, Lee JH. How much progress have we made?: a 20-year experience regarding esophageal stents for the palliation of malignant dysphagia. Dis Esophagus 2022; 35:6479794. [PMID: 34937091 DOI: 10.1093/dote/doab085] [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: 09/06/2021] [Revised: 11/21/2021] [Indexed: 12/11/2022]
Abstract
Esophageal stents are widely used for the palliation of malignant esophageal obstruction. Advances in technology have made esophageal stenting technically feasible and widespread for such obstruction, but complications remain frequent. We present outcomes of a large cohort undergoing esophageal stent placement for malignant esophageal obstruction at a tertiary care cancer center. Patients who underwent placement of esophageal stents for malignancy-related esophageal obstruction between 1 January 2001 and 31 July 2020 were identified. Exclusion criteria included stents placed for benign stricture, fistulae, obstruction of proximal esophagus (proximal to 24 cm from incisors), or post-surgical indications. Patient charts were reviewed for demographics, procedure and stent characteristics, complications, and follow-up. A total of 242 patients underwent stent placement (median age: 64 years, 79.8% male). The majority, 204 (84.3%), had esophageal cancer. During the last two decades, there has been an increasing trend in the number of esophageal stents placed. Though plastic stents were previously used, these are no longer utilized. Complications are frequent and include early complications of pain in 68 (28.1%) and migration in 21 (8.7%) and delayed complications of recurrent symptoms of dysphagia in 46 (19.0%) and migration in 26 (10.7%). Over the study period, there has not been a significant improvement in the rate of complications. During follow-up, 92 (38%) patients required other enteral nutrition modalities after esophageal stent placement. No patient, treatment, or stent characteristics were significantly associated with stent complication or outcome. Esophageal stent placement is an increasingly popular method for palliation of malignant dysphagia. However, complications, particularly pain, migration, and recurrent symptoms of dysphagia are common. Almost 40% of patients may also require other methods of enteral access after esophageal stent placement. Given the high complication rates and suboptimal outcomes, removable stents should be considered as first-line in the case of poor palliative response.
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Affiliation(s)
- Shria Kumar
- Division of Digestive Health and Liver Diseases, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Firas Bahdi
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Ikenna K Emelogu
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Abraham C Yu
- Department of Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Martin Coronel
- Department of Gastroenterology, Hepatology & Nutrition, MD Anderson Cancer Center, Houston, TX, USA
| | - Philip S Ge
- Department of Gastroenterology, Hepatology & Nutrition, MD Anderson Cancer Center, Houston, TX, USA
| | - Emmanuel Coronel
- Department of Gastroenterology, Hepatology & Nutrition, MD Anderson Cancer Center, Houston, TX, USA
| | - Jaffer A Ajani
- Department of Gastroenterology, Hepatology & Nutrition, MD Anderson Cancer Center, Houston, TX, USA
| | - Brian Weston
- Department of Gastroenterology, Hepatology & Nutrition, MD Anderson Cancer Center, Houston, TX, USA
| | - Patrick Lynch
- Department of Gastroenterology, Hepatology & Nutrition, MD Anderson Cancer Center, Houston, TX, USA
| | - William A Ross
- Department of Gastroenterology, Hepatology & Nutrition, MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey H Lee
- Department of Gastroenterology, Hepatology & Nutrition, MD Anderson Cancer Center, Houston, TX, USA
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Ramos LL, Marques RC, Guedes HG. OTSC (Padlock Clip) as a Rescue Endoscopic Method for a Severe Post-Bariatric Complication. Obes Surg 2022; 32:1761-1763. [PMID: 35091904 DOI: 10.1007/s11695-022-05922-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Luiza L Ramos
- Federal University of Santa Catarina, Araranguá, SC, 88906-072, Brazil
| | - Ravi C Marques
- Division of Gastrointestinal Endoscopy, Hospital Santa Luzia, Rede D'or, Brasília, DF, 70390-903, Brazil
| | - Hugo G Guedes
- Division of Gastrointestinal Endoscopy, Hospital Santa Luzia, Rede D'or, Brasília, DF, 70390-903, Brazil.
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de Moura EGH. The best endoscopic method to close refractory esophageal fistula: vacuum? clips? stenting? sheet? glue? ablation? Endosc Int Open 2020; 8:E596-E597. [PMID: 32356851 PMCID: PMC7165014 DOI: 10.1055/a-1135-8921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Stenting the Upper/Cervical Oesophagus with a Proximal Deployment Cervical Oesophageal Stent: Technique and Outcomes. Cardiovasc Intervent Radiol 2019; 42:1024-1028. [PMID: 30891615 DOI: 10.1007/s00270-019-02201-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 03/07/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Proximal oesophageal stent deployment continues to provide challenges due to the proximity of the upper oesophageal sphincter and the associated subsequent complications such as globus sensation and stent migration. Patients with cervical oesophageal cancer have previously had limited stenting options available to them with a paucity of the literature describing the radiological technique for successfully placing these high-risk stents. In this paper, we present our experience using the Taewoong Niti-S CERVICAL Oesophageal Stent. MATERIALS AND METHODS We describe our method for stent deployment highlighting the importance of pre-procedural planning in ensuring an adequate proximal landing zone for the short proximal flare of the stent. Furthermore, we outline how we have adapted our placement technique to incorporate a routine pre-dilatation stage which has optimised retrieval of the proximal to distal deployment system. RESULTS We have placed eight cervical oesophageal stents within our institution. Contrast swallows in all the patients following stent deployment have demonstrated free flow of contrast to the stomach with all patients reporting symptomatic relief and no foreign body/globus sensation. There has been one episode of stent migration but no incidence of oesophageal perforation or haemorrhage. DISCUSSION Evolution of stenting technique and the properties of the stents themselves are improving accuracy of stent placement in relation to the important landmark of the upper oesophageal sphincter. CONCLUSION Stenting of cervical oesophageal malignancy has proved successful in our institution and provided symptom relief for a subset of palliative patients who were previously unable to benefit from oesophageal stenting.
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Kwon CI, Moon JP, Yun H, Jeong S, Koh DH, Lee WJ, Ko KH, Kang DH. Evaluation of valve function in antireflux biliary metal stents. BMC Gastroenterol 2018; 18:150. [PMID: 30340463 PMCID: PMC6194677 DOI: 10.1186/s12876-018-0878-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 10/02/2018] [Indexed: 02/08/2023] Open
Abstract
Background To overcome duodenobiliary reflux induced by biliary stents, antireflux valve (ARV) biliary stents have been developed and showed improvement in stent patency. However, negative study results have also been reported because stent patency may be decreased by the malfunction of ARV itself. Given such mixed results, the true efficacy of ARV remains unknown and the mechanism of its dysfunction needs to be clearly elucidated. The aim of this study was to investigate the exact mechanism of ARV dysfunction using in vitro phantom models. Methods Two experimental models were designed to evaluate two important environmental factors suspected to cause ARV malfunction, i.e. bile flow and pH. Three types of ARV metal stents from different companies were used for the experiments: a funnel type ARV, a windsock type ARV, and a wine glass-shaped ARV. Ten stents of each type were tested (five stents in the bile flow phantom model, and another five stents in the duodenal pH environmental model). To determine ARV malfunction, ARV-induced flow resistance was measured using a custom-made testing device. All stents from the two models were removed every 2 weeks for 12 weeks after stent insertion and were evaluated on morphological and functional changes of the ARV. Results Only ARV of wine glass-shaped ARV was morphologically changed due to silicone bond detachment in the bile flow model. All types of ARV were morphologically changed in the pH model. The morphological changes of ARV influenced the flow resistance. The antegrade pressure gradients were increased over time in the pH model (p < 0.05). Conclusions Morphological change of the ARVs may induce dysfunction of ARV metal stents, which is mainly due to duodenal pH environment. In the future, development of new ARV that is not affected by duodenal environmental factors can be expected to improve stent patency. Electronic supplementary material The online version of this article (10.1186/s12876-018-0878-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chang-Il Kwon
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Jong Pil Moon
- Interventional Research Center, M.I.Tech, Co. Ltd., Pyeongtaek, Republic of Korea
| | - Ho Yun
- Interventional Research Center, M.I.Tech, Co. Ltd., Pyeongtaek, Republic of Korea
| | - Seok Jeong
- Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, Incheon, Republic of Korea
| | - Dong Hee Koh
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University School of Medicine, Hwaseong, Republic of Korea
| | - Woo Jung Lee
- Division of Gastroenterology, Department of Internal Medicine, Temple University Hospital, Philadelphia, PA, USA
| | - Kwang Hyun Ko
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Dae Hwan Kang
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
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Influence of Different Lengths of Rubber Tube on Patients After Esophageal Stent Implantation Using a Silk Thread. Gastroenterol Nurs 2017; 40:484-490. [PMID: 29210817 DOI: 10.1097/sga.0000000000000256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Our objective was to compare the efficacy of different lengths of rubber tube (6 French) on patients with esophageal stent implantation performed using a silk thread. We measured the effects in terms of pain and foreign body sensation felt in the pharynx and esophageal mucosa of the patients. A retrospective analysis was conducted using records of 65 patients who were divided into 3 groups. Group A had 20 cases with the distal end of the tube toward the nasal cavity, Group B had 21 cases with the distal end of the tube reaching the nasopharynx without exceeding the soft palate, and Group C had 24 cases with the distal end of the tube toward the upper end of the stent. Follow-up was performed on 1 day, 2 days, 1 week, 2 weeks, 4 weeks, 6 weeks, and 8 weeks postoperatively. During each period, the pain scores for Groups B and C were lower than those for Group A (p < .05), whereas no difference was observed when Groups B and C were compared. Although no variations were seen between the 3 groups in terms of the proportion of patients with foreign body sensation on the first day (p > .05), Groups A and B had a lower proportion than Group C (p < .05) at those periods. No difference was observed when Groups A and B were compared. In conclusion, the Group B method was successful in alleviating the side effects caused by the silk thread.
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Thrower A, Nasrullah A, Lowe A, Stephenson S, Kay C. The use of self-expanding metal stents in the cervical esophagus. GASTROINTESTINAL INTERVENTION 2016. [DOI: 10.18528/gii160002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Andrew Thrower
- Department of Radiology, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- Department of Radiology, Hampshire NHS Hospital Trust, Winchester, UK
| | - Ayesha Nasrullah
- Department of Radiology, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Andy Lowe
- Department of Radiology, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Sophie Stephenson
- Department of Radiology, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Clive Kay
- Department of Radiology, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
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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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Choi IJ. Upper endoscopy in international digestive endoscopy network 2012: towards upper end of quality. Clin Endosc 2012; 45:217-9. [PMID: 22977805 PMCID: PMC3429739 DOI: 10.5946/ce.2012.45.3.217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 07/27/2012] [Accepted: 07/27/2012] [Indexed: 12/16/2022] Open
Abstract
Upper gastrointestinal (GI) endoscopy is the most basic part of endoscopy field. Although old and basic procedures are still in use, a line of innovative techniques and devices are being introduced to allow much complex and difficult procedures in endoscopy unit. High quality upper endoscopic procedures can replace or obviate surgical treatment. Selected reviews dealing with non-variceal upper GI bleeding, challenging esophageal stenting, endoscopic management of subpeithelial tumor, and endoscopic evaluation for candidate lesions of endoscopic submucosal dissection were selected among the topics from International Digestive Endoscopy Network 2012.
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Affiliation(s)
- Il Ju Choi
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
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