Recanalization using diathermic dilator for stent obstruction due to tumor ingrowth

Background. Radiofrequency ablation (RFA) is a palliative method known for its application in the endoscopic treatment of malignant bile duct obstruction. It may be a useful rescue method for metal stent malfunction caused by tumor ingrowth. This study aimed to examine the feasibility and safety of endoluminal RFA for occluded bilateral hilar metal stents due to tumor ingrowth in patients with malignant hilar bile duct obstruction. Methods: From March 2016 to June 2018, 11 patients with unresectable malignant hilar bile duct stricture with occluded bilateral hilar metal stents due to tumor ingrowth were enrolled. Endoluminal RFA was performed through a novel temperature-controlled catheter at a setting of 7 W power for 120 s with a target temperature of 80 °C via endoscopic retrograde cholangiopancreatography (ERCP). The patients’ demographics, clinical outcomes, and adverse events were investigated. Results: The median age was 64 (interquartile range, 54–72) years. All RFA procedures were successful. Clinical success was achieved in eight patients (72.7%). During the follow-up, eight patients (72.7%) showed stent dysfunction, and the median patency after RFA was 50 days (95% confidence interval (CI): 34–not available (NA)). All stent dysfunctions were successfully managed with ERCP. Ten patients died, and the median overall survival was 289 days (95% CI, 107–NA) from RFA to death. There was one case of mild abdominal pain after the procedure without serious adverse events. Conclusions: As a rescue therapy for occluded bilateral hilar metal stents due to tumor ingrowth, endoluminal RFA seemed to be safe and useful in selected patients.

Download Full-text

A Case Report of Tumor Ingrowth in Metalic Stent of Bile Duct; The Usage of Argon Plasma Coagulation Therapy.

The Japanese Journal of Gastroenterological Surgery ◽

10.5833/jjgs.35.1512 ◽

2002 ◽

Vol 35 (9) ◽

pp. 1512-1515

Author(s):

Tadashi Matsuhisa ◽

Lee Wee Khor ◽

Akihiko Kataoka ◽

Shunji Yamada ◽

Masahiko Koike ◽

...

Keyword(s):

Case Report ◽

Bile Duct ◽

Argon Plasma Coagulation ◽

Argon Plasma ◽

Plasma Coagulation ◽

Tumor Ingrowth ◽

Coagulation Therapy

Download Full-text

Successful palliative re-decompression for metastatic obstructive colon cancer with self-expandable metal stent (SEMS) through existing SEMS obstructed by tumor ingrowth despite its unusual depoyment position

The American Journal of Gastroenterology ◽

10.1016/s0002-9270(01)03409-8 ◽

2001 ◽

Vol 96 (9) ◽

pp. S198-S199

Author(s):

N FUKAMI1

Keyword(s):

Colon Cancer ◽

Metal Stent ◽

Tumor Ingrowth ◽

Self Expandable Metal Stent

Download Full-text

Etiopathogenesis of Trismus in Patients With Head and Neck Cancer: An Exploratory Literature Review

Craniomaxillofacial Trauma & Reconstruction ◽

10.1177/1943387520917518 ◽

2020 ◽

Vol 13 (3) ◽

pp. 219-225

Author(s):

Radhu Raj ◽

Krishnakumar Thankappan ◽

Chandrasekhar Janakiram ◽

Subramania Iyer ◽

Anil Mathew

Keyword(s):

Head And Neck Cancer ◽

Cohort Studies ◽

Head And Neck ◽

Neck Cancer ◽

Infratemporal Fossa ◽

Tumor Ingrowth ◽

Retrospective Cohort Studies ◽

Radiation Induced ◽

Randomized Control ◽

Oral Complication

Trismus refers to a person’s inability to normally open his or her mouth. Trismus can occur as a symptom due to tumor ingrowth or it can occur postsurgical following the treatment for head and neck cancer. Radiation-induced trismus is also a relatively common oral complication. This review aimed at reviewing the etiopathogenesis of trismus in patients with head and neck cancer. Of the 16 publications included after final screening, of which one was a nonrandomized control trial, one a randomized control trial, 6 prospective cohort studies, and 8 retrospective cohort studies. Among them, 6 articles addressed the possible mechanism for trismus related to tumor ingrowth, 8 articles suggested the likely reason for trismus in patients who had undergone radiation therapy and 2 articles addressed the postsurgical cause for trismus. This review highlights the possible involvement of infratemporal fossa as a predetermining factor for developing trismus related to tumor extension. The molecular mechanism of radiation-induced fibrosis is well studied in the literature.

Download Full-text

Side-by-side partially covered self-expandable metal stent placement for malignant hilar biliary obstruction

Endoscopy International Open ◽

10.1055/s-0043-117955 ◽

2017 ◽

Vol 05 (12) ◽

pp. E1211-E1217 ◽

Cited By ~ 11

Author(s):

Katsuya Kitamura ◽

Akira Yamamiya ◽

Yu Ishii ◽

Yuta Mitsui ◽

Tomohiro Nomoto ◽

...

Keyword(s):

Stent Placement ◽

Biliary Obstruction ◽

Success Rates ◽

Metal Stent ◽

Stent Removal ◽

Tumor Ingrowth ◽

Hilar Biliary Obstruction ◽

Malignant Hilar Biliary Obstruction ◽

Self Expandable Metal Stent

Abstract Background and study aims This study investigated the feasibility of side-by-side (SBS) partially covered self-expandable metal stent (PCSEMS) placement for unresectable malignant hilar biliary obstruction (MHBO). Patients and methods We retrospectively analyzed 33 patients from a single center who underwent endoscopic biliary drainage for unresectable MHBO from July 2013 to June 2015. In all patients with bilateral obstruction during complete bilateral intrahepatic cholangiograms, we performed endoscopic SBS placement of a 6-mm diameter PCSEMS using an 8-French delivery system. All patients underwent endoscopic sphincterotomy. Generally, patients with recurrent biliary obstruction (RBO) after stent placement underwent endoscopic reintervention. Our study outcomes included the technical and functional success rates, RBO rate, time to RBO (TRBO), reintervention rate, and incidence of adverse events. Results Seventeen patients with unresectable MHBO during complete bilateral intrahepatic cholangiograms underwent endoscopic SBS PCSEMS placement (median age, 78 years; men, 9). Lesions were Bismuth types II (n = 10), III (n = 1), and IV (n = 6), including 10 cholangiocarcinomas, 3 gallbladder cancers, and 4 metastatic cancers. In all patients, the PCSEMS was placed across the duodenal papilla. The technical and functional success rates were 100 % and 82 %, respectively. The median procedure time was 43 minutes (interquartile range [IQR]: 36 – 52 minutes). Twelve patients had RBO (71 %), including 9 stent occlusions due to sludge and 3 stent migrations. The median TRBO was 79 days (IQR: 58 – 156 days) during the follow-up period (median 192 days [IQR: 88 – 551 days]). The median TRBO of patients with Bismuth type II lesions was significantly longer than that of patients with Bismuth types III and IV lesions (87 days [IQR: 70 – 244 days] vs. 54 days [IQR: 35 – 100 days]; P = 0.030). Thirteen patients (76 %) required endoscopic reintervention. Endoscopic stent removal was possible in 6 patients without tumor ingrowth into the uncovered distal part of the stent. One late adverse event (≥ 31 days) occurred (cholangitis). Conclusions Endoscopic SBS placement of a PCSEMS was feasible in patients with unresectable MHBO. Additionally, reinterventional stent removal was possible in the absence of tumor ingrowth.

Download Full-text