scholarly journals Individually designed fully covered self-expandable metal stents for pediatric refractory benign esophageal strictures

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Xing Wang ◽  
Haifeng Liu ◽  
Zhihong Hu ◽  
Rufang Zhang ◽  
Zhujun Gu ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Stent Migration ◽  
Metal Stents ◽  
Endoscopic Intervention ◽  
Esophageal Strictures ◽  
Institutional Experience ◽  
Esophageal Perforations ◽  
Refractory Benign Esophageal Strictures ◽  
Grade Iii

AbstractTo share our institutional experience of placing individually designed fully covered self-expandable metal stents (FCSEMSs) for the treatment of refractory benign esophageal strictures (RBESs) in pediatric patients. A 10-year retrospective study between May 2009 and July 2020 that includes 14 children with RBESs who were treated with individually designed FCSEMSs. Patients were followed-up regularly after stent placement to observe the improvement of vomiting and dysphagia, changes in stenosis diameter and complications. A total of 20 stents were successfully placed in 14 patients. During a follow-up period ranging from 5 to 83 months, except for one 4-year-old child who could not endure chest pain, the remaining 13 patients all benefited from stenting. Their Ogilvie & Atkinson scores improved from grade III–IV to grade 0-I, and the diameters of the stenosis’ were enlarged from 2–5 mm to 9–14 mm. Two patients developed restenosis and granulation tissue hyperplasia was found in 2 patients and stent migration and malapposition in 2 patients with esophageal perforations that required further endoscopic intervention. The use of FCSEMS for RBES is safe and effective in selected pediatric patients. Rationally designed stents and timely management of postoperative complications are critical to ensure the success of this new method.

Self-expanding segmental radioactive metal stents for palliation of malignant esophageal strictures

2019 ◽  
Vol 61 (7) ◽  
pp. 921-926 ◽  
Author(s):  
Yonghua Bi ◽  
Jindong Li ◽  
Mengfei Yi ◽  
Zepeng Yu ◽  
Xinwei Han ◽  
...  
Keyword(s):  
Esophageal Stricture ◽  
Stent Migration ◽  
Metal Stents ◽  
Stent Insertion ◽  
Dysphagia Score ◽  
Kaplan Meier ◽  
Esophageal Strictures ◽  
The Mean ◽  
Stenting Procedure

Background Traditional metal stents are not always suitable for patients with circuitous malignant esophageal stricture. Purpose We aimed to report the safety and effectiveness of stent insertion using self-expanding segmental radioactive metal stent in the palliation of malignant esophageal stricture. Material and Methods We conducted a retrospective analysis of 22 consecutive patients who underwent insertion of segmental radioactive metal stents from November 2016 to March 2019. Technical success, dysphagia score, and complications were analyzed. Kaplan–Meier analysis was used to analyze the survival time. Results The stenting procedure was successful in all 22 patients with no procedure-related deaths. Twenty-four segmental radioactive metal stents were successfully implanted. A total of 6 (27.3%) complications were found, mainly 5 (22.7%) stent migrations. The median follow-up period was 3.3 months. Stent removal was required in 4 (12.5%) patients due to complete stent migration. The mean dysphagia score decreased significantly after stent insertion ( P<0.0001). During follow up, 13 patients survived with no obvious clinical symptom and nine patients died. The mean survival was 9.9 months. Conclusion The stenting procedure using self-expanding segmental radioactive metal stents is safe and effective in dysphagia palliation of malignant esophageal stricture.

scholarly journals Outcomes of the Use of Fully Covered Esophageal Self-Expandable Stent in the Management of Colorectal Anastomotic Strictures and Leaks

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Chad J. Cooper ◽  
Angel Morales ◽  
Mohamed O. Othman
Keyword(s):  
Anastomotic Leak ◽  
Clinical Success ◽  
Anastomotic Stricture ◽  
Clinical Success Rate ◽  
Stent Migration ◽  
Metal Stents ◽  
The Novel ◽  
Anastomotic Leaks ◽  
Anastomotic Strictures

Introduction. Colorectal anastomotic leak or stricture is a dreaded complication leading to significant morbidity and mortality. The novel use of self-expandable metal stents (SEMS) in the management of postoperative colorectal anastomotic leaks or strictures can avoid surgical reintervention. Methods. Retrospective study with particular attention to the indications, operative or postoperative complications, and clinical outcomes of SEMS placement for patients with either a colorectal anastomotic stricture or leak. Results. Eight patients had SEMS (WallFlex stent) for the management of postoperative colorectal anastomotic leak or stricture. Five had a colorectal anastomotic stricture and 3 had a colorectal anastomotic leak. Complete resolution of the anastomotic stricture or leak was achieved in all patients. Three had recurrence of the anastomotic stricture on 3-month flexible sigmoidoscopy follow-up after the initial stent was removed. Two of these patients had a stricture that was technically too difficult to place another stent. Stent migration was noted in 2 patients, one at day 3 and the other at day 14 after stent placement that required a larger 23 mm stent to be placed. Conclusions. The use of SEMS in the management of colorectal anastomotic leaks or strictures is feasible and is associated with high technical and clinical success rate.

FA07.04: THE ROLE OF ENDOSCOPIC DILATION AND STENTS IN THE REFRACTORY BENIGN ESOPHAGEAL STRICTURES: A RETROSPECTIVE ANALYSIS

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 14-14
Author(s):  
Qing Lu ◽  
Tiantian Lei ◽  
Hailin Yan ◽  
Jinlin Yang ◽  
Hongsheng Ma
Keyword(s):  
Adverse Events ◽  
Endoscopic Therapy ◽  
Long Term Results ◽  
Secondary Outcome ◽  
Endoscopic Dilation ◽  
Growth Trend ◽  
Esophageal Strictures ◽  
Refractory Benign Esophageal Strictures

Abstract Background The outcomes of patients with refractory benign esophageal strictures (RBES) was unclear and lacking in relative researches on the clinical efficacy of dilation compared with stent placement. Our objective was to explore the role of endoscopic dilation and stents in the management of RBES. Methods This study including patients with RBES (recurrence of dysphagia despite endoscopic therapy more than 3 sessions) by dilation and stents between January 2009 and December 2017. Endoscopic therapy success was defined as: before the end of the follow-up, no need for endoscopic interventions for at least 6 months. The primary outcome was to assess clinical effectiveness and adverse events. Secondary outcome was to identify factors that predicted the dysphagia-free period (the time interval of two subsequent endoscopic interventions). Multivariate analysis was used to estimate the risk factors influencing the treatment success. To explore the trend of dysphagia-free period along with times used hierarchical linear models. Results 75 patients (54 male; median age, 59 years) with RBES, 39 (52%), 20 (26.7%), 3 (4%), 10(13.3%), and 3(4%) were post-surgical, post-ESD, achalasia of cardia, caustic and mixed etiology, respectively. The median times of endoscopic therapy was 5 times (range 3, 21). Self-expandable metal stents (SEMSs) were placed in 20 patients (26.7%), and the success rate of patients treated with dilation (70.9%, 39/55) was higher than with stents (35%, 7/20). Fifteen patients died during follow-up. Nineteen patients had adverse events after endoscopic therapy. In total, the mean dysphagia-free period was 3.4 months (95% CI, 2.5–4.3). The dysphagia-free period of patients treated with dilation was 3.7months (95% CI, 2.7–5), and with stents was 2.3 months (95% CI, 1.5–3). The dysphagia-free period has linear growth trend with times, increased by 12 days per endoscopic therapy. Conclusion The dysphagia-free period increased by 12 days per endoscopic therapy, so the endoscopic dilation and stents tended to be effective in patients with RBES. Before the end of follow-up, nearly half of patients required continuing endoscopic dilation and stents, therefore, the patients with RBES may have negative long-term results. Stents therapy tended to not reduce the times and frequency of dilation. Disclosure All authors have declared no conflicts of interest.

scholarly journals Treatment of refractory post-esophagectomy anastomotic esophageal strictures using temporary fully covered esophageal metal stenting compared to repeated bougie dilation: results of a randomized controlled trial

2019 ◽  
Vol 07 (02) ◽  
pp. E178-E185 ◽  
Author(s):  
W. Kappelle ◽  
J. van Hooft ◽  
M. Spaander ◽  
F. Vleggaar ◽  
M. Bruno ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Controlled Trial ◽  
Current Data ◽  
Metal Stents ◽  
Technical Success Rate ◽  
Kaplan Meier ◽  
Esophageal Strictures ◽  
Significant Difference

Abstract Background and study aims Fully covered self-expanding metal stents (FCSEMS) provide an alternative to bougie dilation (BD) for refractory benign esophageal strictures. Controlled studies comparing temporary placement of FCSES to repeated BD are not available. Patients and methods Patients with refractory anastomotic esophageal strictures, dysphagia scores ≥ 2, and two to five prior BD were randomized to 8 weeks of FCSEMS or to repeated BD. The primary endpoint was the number of BD during the 12 months after baseline treatment. Results Eighteen patients were included (male 67 %, median age 66.5; 9 received metal stents, 9 received BD). Technical success rate of stent placement and stent removal was 100 %. Recurrent dysphagia occurred in 13 patients (72 %) during follow-up. No significant difference was found between the stent and BD groups for mean number of BD during follow-up (5.4 vs. 2.4, P = 0.159), time to recurrent dysphagia (median 36 days vs. 33 days, Kaplan-Meier: P = 0.576) and frequency of reinterventions per month (median 0.3 vs. 0.2, P = 0.283). Improvement in quality of life score was greater in the stent group compared to the BD group at month 12 (median 26 % vs. 4 %, P = 0.011). Conclusions The current data did not provide evidence for a statistically significant difference between the two groups in the number of BD during the 12 months after initial treatment. Metal stenting offers greater improvement in quality of life from baseline at 12 months compared to repeated BD for patients with refractory anastomotic esophageal strictures.

Selective application of fully covered biliary stents and narrow-diameter esophageal stents for proximal esophageal indications

Endoscopy ◽  
2018 ◽  
Vol 51 (02) ◽  
pp. 169-173 ◽  
Author(s):  
Maoyin Pang ◽  
Michael Bartel ◽  
Donnesha Clayton ◽  
Bhaumik Brahmbhatt ◽  
Timothy Woodward
Keyword(s):  
High Risk ◽  
Adverse Events ◽  
Stent Migration ◽  
Metal Stents ◽  
Biliary Stents ◽  
Esophageal Stents ◽  
Dysphagia Score

Abstract Background Proximal esophageal stents are poorly tolerated and have a high risk of complications. We report our experience using fully covered, biliary, self-expandable metal stents (B-SEMS) and narrow-diameter, esophageal, self-expandable metal stents (NDE-SEMS) for this group of patients. Methods 24 patients underwent placement of B-SEMS or NDE-SEMS for proximal esophageal lesions between 1 January 2011 and 31 July 2016. The outcomes included improvement of dysphagia, healing of fistulas, and adverse events. Results 10 patients received B-SEMS and 14 had NDE-SEMS. Median follow-up time was 11.5 months (range 0.5 – 62 months). In both cohorts, stents were left in place for a mean of 6 weeks. The dysphagia score decreased in 7 (70 %) and 10 (71.4 %) patients, and fistulas resolved in 3/5 (60.0 %) and 5/8 (62.5 %) patients with B-SEMS and NDE-SEMS, respectively. Stent migration occurred in three patients (30.0 %) with B-SEMS and five patients (35.7 %) with NDE-SEMS. Conclusions Both stents were well tolerated and resulted in overall improvement of dysphagia in 70.8 % of patients. B-SEMS appeared to be more favorable for cervical esophageal lesions with narrower diameters, while NDE-SEMS may be better for more distal lesions.

scholarly journals Trapped Esophageal Stent in a Child: An Unusual Complication

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Mustafa Okumuş
Keyword(s):  
Surgical Treatment ◽  
Early Detection ◽  
Balloon Dilatation ◽  
Pediatric Patients ◽  
Esophageal Stent ◽  
Metal Stents ◽  
Unusual Complication ◽  
Right Thoracotomy ◽  
Esophageal Strictures ◽  
Proximal Stricture

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.

scholarly journals Safety and efficacy of coaxial lumen-apposing metal stents in the management of refractory gastrointestinal luminal strictures: a multicenter study

2017 ◽  
Vol 05 (09) ◽  
pp. E861-E867 ◽  
Author(s):  
Fateh Bazerbachi ◽  
Jason Heffley ◽  
Barham Abu Dayyeh ◽  
Jose Nieto ◽  
Eric Vargas ◽  
...  
Keyword(s):  
Adverse Events ◽  
Clinical Success ◽  
Stent Migration ◽  
Metal Stents ◽  
Technical Success ◽  
Novel Therapy ◽  
Safety And Efficacy ◽  
Anastomotic Strictures ◽  
The Mean

Abstract Background and aims Benign gastrointestinal (GI) strictures are often refractory to standard endoscopic interventions. Fully covered coaxial lumen-apposing metal stents (LAMS) have emerged as a novel therapy for these strictures. The aim of this study was to evaluate the safety and efficacy of LAMS for refractory GI strictures. Patients and methods A retrospective analysis was performed for patients who underwent LAMS placement for benign luminal strictures in three US centers between January 2014 and December 2016. The primary outcomes were technical success and initial clinical success of LAMS placement. Secondary outcomes were stent migration, rate of re-intervention, and adverse events. Results A total of 49 patients underwent 56 LAMS placement procedures. Previous treatment had failed in 39 patients (79.6 %), and anastomotic strictures were the indication in 77.6 % (38/49), with the most common site being gastrojejunal (34.7 % [17/49]). Technical success was achieved in all procedures and initial clinical success was achieved in 96.4 % of all procedures (54/56). Patient initial clinical success was 95.9 % (47/49). Stent migration occurred in 17.9 % of procedures, and was more likely to occur at sites in the lower GI tract (P = 0.02). The mean stent dwell time was 100.6 days, and the mean follow-up was 169.8 days. Minor adverse events, not requiring hospitalization, occurred in 33.9 % of procedures, including subsequent stricture progression (10.7 %). In cases where LAMS were removed, mean follow-up time was 102.2 days. The re-intervention rate was 75 % at 300 days follow-up after stent removal. Of the LAMS placed at anastomotic strictures, 36.4 % required re-intervention, with approximately two-thirds of these re-interventions requiring placement of a new stent or surgery. Conclusion LAMS placement was successful for the management of refractory GI strictures, with good technical and initial clinical success rates. However, re-intervention rates after LAMS removal were high, and many strictures were not resolved by an extended period of stenting with these coaxial stents. LAMS placement offers additional therapeutic options and in selected cases might be considered a destination therapy for patients with recalcitrant benign strictures.

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