scholarly journals Clear cap-assisted luminal stenting may improve technical success in gastroduodenal and colonic obstruction

2020 ◽  
Vol 08 (10) ◽  
pp. E1429-E1434
Author(s):  
Brian M. Fung ◽  
Formosa C. Chen ◽  
James H. Tabibian
Keyword(s):  
Gastrointestinal Tract ◽  
Stent Placement ◽  
Surgical Intervention ◽  
Colonic Obstruction ◽  
Endoscopic Stenting ◽  
Technical Failure ◽  
Technical Success ◽  
Malignant Obstruction ◽  
Gastrointestinal Obstruction ◽  
Standard Techniques

Abstract Background Luminal stenting is safe, effective, and at times the preferred method for relieving gastrointestinal obstruction. However, stent placement is not technically feasible when lesions cannot be traversed with a guidewire, resulting in the need for more invasive methods of palliation and urgent/emergent surgical intervention. In this series, we report our experience with cap-assisted stenting to improve lumen visualization in obstructed segments of the gastrointestinal tract and salvage cases that may have otherwise resulted in technical failure. Methods A clear cap (i. e. distal attachment) was affixed to the scope tip to facilitate visualization and stenting in two cases of gastroduodenal obstruction and three cases of colonic obstruction. Indications for stent placement included malignant obstruction, diverticulitis-associated obstruction, and Crohn’s disease-associated stricture. Results In this report, we demonstrate that use of a clear cap facilitated endoscopic stenting in challenging cases of malignant and benign gastroduodenal and colonic obstruction. Conclusions A clear cap for endoscopic stenting can be used in cases in which standard techniques are unsuccessful or those anticipated to be technically difficult at the outset. Cases with tortuous anatomy or particularly tight, friable, or exophytic obstructive lesions may benefit most from this novel technical modification.

Safety and efficacy of Mynx vascular closure device for the closure of common femoral artery access after ipsilateral stent placement

2020 ◽  
pp. 112972982096694
Author(s):  
Jin Ho Hwang ◽  
Sang Woo Park ◽  
Woo Young Yang ◽  
Yong Wonn Kwon ◽  
Jeeyoung Min ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Stent Placement ◽  
Common Femoral Artery ◽  
Bleeding Complications ◽  
Closure Device ◽  
Technical Failure ◽  
Technical Success ◽  
Vascular Closure Device ◽  
Access Site ◽  
Low Bmi

Introduction: To evaluate the feasibility and safety of the Mynx vascular closure device (VCD) for arteriotomy closure after stent placement near the common femoral artery (CFA) access site. Methods: A total of 88 patients (73 men; mean age, 72 ± 9.2 years; 136 procedures) who underwent closure of CFA arteriotomy using the Mynx VCD after stent placement in proximal superficial femoral artery (SFA) with antegrade approach, or in common or external iliac artery with retrograde approach were retrospectively studied. Technical success and access site complication were evaluated. Body mass index (BMI), platelet count, international normalized ratio, prior history of ipsilateral CFA access, access direction, degree of CFA calcification, stent location and diameter, total procedure time, and sheath size were analyzed to evaluate their relationship with technical failure and development of bleeding complications. Results: Technical success was achieved in 94.9% (129/136) patients. The mean time to hemostasis was 0.7 ± 1.8 min. Technical failure was significantly associated with low BMI ( p = 0.001). Other variables presented no significant relationship with technical failure and development of complications. Ultrasonography on the day after the procedure revealed that 8 (5.9%) patients had hematoma. Conclusions: Mynx VCD for arteriotomy closure is feasible and provides hemostatic safety after stent placement near antegrade or retrograde CFA access. However, Mynx VCD may have a poor technical success rate among patients with low BMI.

Long-Term Outcome of Endoscopic Colorectal Stenting for Malignant and Benign Disease

2009 ◽  
Vol 75 (10) ◽  
pp. 897-900 ◽  
Author(s):  
Jessica Rayhanabad ◽  
Maher A. Abbas
Keyword(s):  
Success Rate ◽  
Benign Disease ◽  
Long Term Results ◽  
Colorectal Disease ◽  
Endoscopic Stenting ◽  
Technical Failure ◽  
Technical Success ◽  
Technical Success Rate ◽  
Colorectal Stenting

Although the technical success rate of endoscopic stenting has been defined, there is a paucity of outcome data. The purpose of this study was to evaluate the long-term results of colorectal stenting for both malignant and benign disease. A retrospective review was conducted of patients who underwent stenting at a tertiary center over 4 years. One surgeon performed all stents under endoscopic and fluoroscopic guidance. A total of 49 stent procedures were performed in 36 patients (19 females, mean age 65 years). Mean follow-up was 15 months. Twenty-eight patients (78%) underwent stenting for malignant disease and eight patients (22%) for benign conditions. The most common reason for intervention was obstruction (81%). Technical success rate was 72 per cent. Carcinomatosis was associated with a higher technical failure rate. Procedural related complications occurred in two patients (6%). Long-term stent migration rate was 24 per cent and was more common in patients with benign disease and patients who received nonmetal stents or stents with diameter < 25 mm. Endoscopic reintervention was required in 33 per cent of patients with initial technical success. Long-term need for subsequent operative intervention was 14 per cent. Endoscopic stenting is a viable option for a select group of patients with colorectal disease. Patient's selection and stent choice influence outcome.

scholarly journals Endovascular Stenting for Malignant Obstruction of Superior Vena Cava: A Single-Center Experience Using the Body Floss Technique

2021 ◽  
Author(s):  
Dayananda Lingegowda ◽  
Bharat Gupta ◽  
Anisha Gehani ◽  
Priya Ghosh ◽  
Sumit Mukhopadhyay
Keyword(s):  
Superior Vena Cava ◽  
Stent Placement ◽  
Clinical Success ◽  
Superior Vena ◽  
Symptom Relief ◽  
Vena Cava ◽  
The Body ◽  
Technical Success ◽  
Endovascular Stenting ◽  
Malignant Obstruction

Abstract Purpose Endovascular stenting is the treatment of choice for malignant obstruction of the superior vena cava (SVC) when rapid symptomatic relief is desired. Body floss technique is not routinely used during SVC stenting but has few advantages over single-access technique. We report our experience with stenting for malignant obstruction of the SVC using the body floss technique. Materials and Methods Between March 2015 and March 2020, 25 patients (20 men, 5 women; median age, 65 years) with malignant SVC obstruction underwent endovascular stenting of the SVC. We retrospectively evaluated these patients for clinical and technical success rates, complications, recurrence-free survival, and overall survival. Results Stent placement was successful in 24/25 patients (technical success: 96%). Clinical success was achieved in 23/25 (92%) patients. A mortality rate of 4% (1/25) was noted due to SVC rupture. Partial stent migration was noted in two patients (8%) and was treated by placing an additional overlapping stent. Incidental early stent thrombosis was seen in two patients within 8 hours of stent placement, but these patients showed symptom relief with anticoagulation. Follow-up imaging confirmed stent patency in all patients. Late stent occlusion due to tumor progression was seen in one patient. The primary patency rate was 88% (22/25). Overall median survival of 133 days was observed (range: 1–847 days). Conclusion Endovascular stenting of the SVC for malignant obstruction using the body floss technique is associated with high technical and clinical success, and low rate of complications.

scholarly journals A Prospective Multicenter Study of “Inside Stents” for Biliary Stricture: Multicenter Evolving Inside Stent Registry (MEISteR)

2021 ◽  
Vol 10 (13) ◽  
pp. 2936
Author(s):  
Hirofumi Kogure ◽  
Hironari Kato ◽  
Kazumichi Kawakubo ◽  
Hirotoshi Ishiwatari ◽  
Akio Katanuma ◽  
...  
Keyword(s):  
Multicenter Study ◽  
Stent Placement ◽  
Controlled Trial ◽  
Adverse Event Rate ◽  
Success Rates ◽  
Technical Success ◽  
Biliary Strictures ◽  
Prospective Multicenter Study ◽  
Stent Occlusion ◽  
Benign Biliary Strictures

Background: Endoscopic biliary stent placement is the standard of care for biliary strictures, but stents across the papilla are prone to duodenobiliary reflux, which can cause stent occlusion. Preliminary studies of “inside stents” placed above the papilla showed encouraging outcomes, but prospective data with a large cohort were not reported. Methods: This was a prospective multicenter registry of commercially available inside stents for benign and malignant biliary strictures. Primary endpoint was recurrent biliary obstruction (RBO). Secondary endpoints were technical success of stent placement and removal, adverse events, and stricture resolution. Results: A total of 209 inside stents were placed in 132 (51 benign and 81 malignant) cases with biliary strictures in 10 Japanese centers. During the follow-up period of 8.4 months, RBO was observed in 19% of benign strictures. The RBO rate was 49% in malignant strictures, with the median time to RBO of 4.7 months. Technical success rates of stent placement and removal were both 100%. The adverse event rate was 8%. Conclusion: This prospective multicenter study demonstrated that inside stents above the papilla were feasible in malignant and benign biliary strictures, but a randomized controlled trial is warranted to confirm its superiority to conventional stents across the papilla.

scholarly journals Isolated Duodenal Crohn's Disease: A Case Report and a Review of the Surgical Management

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Faruk Karateke ◽  
Ebru Menekşe ◽  
Koray Das ◽  
Sefa Ozyazici ◽  
Pelin Demirtürk
Keyword(s):  
Crohn’S Disease ◽  
Case Report ◽  
Gastrointestinal Tract ◽  
Crohn's Disease ◽  
Medical Treatment ◽  
Immunosuppressive Therapy ◽  
Surgical Management ◽  
Surgical Intervention ◽  
Surgical Options ◽  
Crohn’S Diseases

Crohn's disease may affect any segment of the gastrointestinal tract; however, isolated duodenal involvement is rather rare. It still remains a complex clinical entity with a controversial management of the disease. Initially, patients with duodenal Crohn' s disease (DCD) are managed with a combination of antiacid and immunosuppressive therapy. However, medical treatment fails in the majority of DCD patients, and surgical intervention is required in case of complicated disease. Options for surgical management of complicated DCD include bypass, resection, or stricturoplasty procedures. In this paper, we reported a 33-year-old male patient, who was diagnosed with isolated duodenal Crohn’s diseases, and reviewed the surgical options in the literature.

Minimally Invasive Interventional Management of Gastric Outlet Obstructions

2018 ◽  
Vol 02 (01) ◽  
pp. 025-032
Author(s):  
Wei-Zhong Zhou ◽  
Zheng-Qiang Yang
Keyword(s):  
Stent Placement ◽  
Balloon Dilatation ◽  
Outlet Obstruction ◽  
Covered Stent ◽  
Clinical Consequence ◽  
Endoscopic Stenting ◽  
Stent Patency ◽  
Ulcer Disease ◽  
Recommended Treatment ◽  
Uncovered Stent

AbstractGastric outlet obstruction (GOO) is a clinical consequence of any disease that produces intrinsic or extrinsic obstruction of the pyloric channel or duodenum. The most common symptoms of GOO include nausea, vomiting, abdominal pain, and weight loss. Traditionally, surgery is regarded as the standard treatment modality. However, with the development of mini-invasive technologies, fluoroscopic or endoscopic stenting and balloon dilatation have become the mainstream of the therapies. The initial recommended treatment for malignant GOO is self-expanding metal stent placement. The stent can be classified into covered and uncovered stent according to whether it is coated with a membrane. Covered stent seems to have longer stent patency, while uncovered stent has the advantage of a lower migration rate. Regarding the etiology of benign GOO, peptic ulcer disease and corrosive injury are the two main reasons. Balloon dilatation is a simple and convenient way to treat the benign GOO. Stent placement has recently been reported for the treatment of benign GOO; however, it needs further more studies to verify its effect. This article presents a concise review of current fluoroscopic or endoscopic stenting practice for malignant GOO and balloon dilatation or stenting for benign GOO.

Current state of heart surgery in relation to some views on modern surgical science

1927 ◽  
Vol 23 (3) ◽  
pp. 340-347
Author(s):  
V. L. Bogolyubov
Keyword(s):  
Internal Medicine ◽  
Gastrointestinal Tract ◽  
Biliary Tract ◽  
Heart Surgery ◽  
Surgical Intervention ◽  
Progressive Movement ◽  
Current State ◽  
Long Time ◽  
Sphere Of Influence

Modern surgery is taking over more and more organs, recapturing more and more areas of internal medicine. We see that in its great progressive movement surgery gradually involves within its sphere of influence a whole range of diseases that previously belonged exclusively to the sphere of internal medicine, such as some diseases of the gastrointestinal tract, biliary tract, lungs, etc. We see that even those organs, which until so recently were considered inaccessible to the art of the surgeon, are beginning to be subject to surgical intervention. Such last inviolable organ, on which the hand of the surgeon has not encroached for a long time, is the heart.

Long-term outcomes after endoscopic retrograde pancreatic drainage for symptomatic pancreaticojejunal anastomotic stenosis

2020 ◽  
Author(s):  
Akihiko Kida ◽  
Taro Kawane ◽  
Hitoshi Omura ◽  
Tatsuo Kumai ◽  
Masaaki Yano ◽  
...  
Keyword(s):  
Adverse Events ◽  
Stent Placement ◽  
Stent Migration ◽  
Anastomotic Stenosis ◽  
Technical Success ◽  
Long Term Outcomes ◽  
Endoscopic Retrograde ◽  
Technical Success Rate

Abstract 【Background】 There is limited evidence demonstrating the usefulness of endoscopic retrograde pancreatic drainage (ERPD) for symptomatic pancreaticojejunal anastomotic stenosis (sPJS). We examined the usefulness of ERPD for sPJS. 【Methods】 We conducted a retrospective analysis of 10 benign sPJS patients. Following items were evaluated: technical success, adverse events and clinical outcome of ERPD. 【Results】 Technical success rate was 100% (10/10); 9 patients had a pancreatic stent (no-internal-flap: n=4, internal-flap: n=5). Median follow-up was 920 days. Four patients developed recurrence. Among them, 3 patients had a stent with no-internal-flap in initial ERPD and the stent migrated in 3 patients at recurrence, and a stent was not placed in 1 patient in initial ERPD. Four follow-up ERPD were performed. No recurrence was observed in 6 patients. Among them, none of the stents migrated (no-internal-flap: n=1, internal-flap: n=5), and none were replaced stents due to stent failure. A stent placement with no-internal-flap was associated with recurrence (p=0.042). Mild adverse events developed in 14.3% (2/14). 【Conclusions】 ERPD was performed safely with high technical success. Recurrence was common in a stent placement with no-internal-flap, which was associated with stent migration. Long-term stent placement didn’t result in stent failure.

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