scholarly journals How much progress have we made?: a 20-year experience regarding esophageal stents for the palliation of malignant dysphagia

2021 ◽  
Author(s):  
Shria Kumar ◽  
Firas Bahdi ◽  
Ikenna K Emelogu ◽  
Abraham C Yu ◽  
Martin Coronel ◽  
...  
Keyword(s):  
Stent Placement ◽  
Tertiary Care ◽  
Esophageal Stent ◽  
Plastic Stents ◽  
Complication Rates ◽  
Esophageal Obstruction ◽  
Esophageal Stents ◽  
Malignant Dysphagia ◽  
And Migration

Summary 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.

Evaluation of nitinol stent placement complications for palliation of malignant dysphagia

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 14120-14120
Author(s):  
E. Alach ◽  
E. Troncoso ◽  
A. Barbero ◽  
A. Mainella ◽  
M. Lavezzaro ◽  
...  
Keyword(s):  
Stent Placement ◽  
Palliative Treatment ◽  
Clinical Effectiveness ◽  
Histological Diagnosis ◽  
Esophageal Obstruction ◽  
Nitinol Stent ◽  
Esophagus Carcinoma ◽  
Control Pain

14120 Background: Over 50% of patients (pts) with obstructive carcinoma are inoperable at the time of the diagnosis and only 18% of them survive beyond a year. Palliative treatment must be quickly effective, safe, well tolerated and focused to relieve symptoms, improving the nutritional state and quality of life. The objective of the study was to investigate the clinical effectiveness and complications of palliative treatment with esophageal stent placement. Methods: Descriptive and prospective study about functionality of nitinol autoexpandible stent was carried out. Evaluable pts included those with confirmed histological diagnosis of inoperable or unresectable esophageal cancer, with some clinical contraindication due to risk or personal rejection. An immediate post placement follow-up was performed after 24hours, 7 and 30 days, to evaluate the stent proper location, its permeability as well as its degree of expansion, presence of epigastric or precordial pain, reflux and degree of dysphagia. Results: From August/02 to September/05 stent was placed in 20 people, 9 women and 11 men, mean age 67.8 (range: 42–85). The autoexpandible stent placement was achieved in 100% of pts (3 = gastric carcinoma and 17 = esophagus carcinoma). Histological diagnosis was epidermoid (11 pts) and adenocarcinoma (9 pts). Inoperable malignant stricture was as follows: lower third: 11 pts (55%), middle third: 9 pts (45%). A second stent was required in 2 pts. Median time of hospitalization was 48 hours.Immediate complications appeared in 12 pts: pain 3 (15%), vomiting 3 (15%), pneumonia 2 (10%), cough 1 (5%), pyrosis 1 (5%). After 24 hour control: pain 2(10%), respiratory complications 2 (10%). The delayed ones were as follows: level 4 dysphagia 2 (10%), pain 8 (40%), reflux 5 (25%). No mortality related to stent placement was observed. Dysphagia was perceptibly reduced, from 3.0 to 1, (p < 0,005). Conclusion: The nitinol stent is easy to place, it provides effective palliation of malignant esophageal obstruction with short hospitalization time and low risk of serious complications. No significant financial relationships to disclose.

The use of small-caliber, covered, self-expandable metal stents for palliation of severe malignant dysphagia.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 134-134
Author(s):  
S. Kucera ◽  
C. L. Harris ◽  
S. Vignesh ◽  
J. Klapman ◽  
J. S. Barthel
Keyword(s):  
Stent Placement ◽  
Migration Rate ◽  
Large Diameter ◽  
Stent Migration ◽  
Metal Stents ◽  
Internal Diameter ◽  
Complication Rates ◽  
Malignant Dysphagia ◽  
Major Complications ◽  
Repeat Endoscopy

134 Background: Self-expandable covered metal stents are an important component of palliative care for malignant dysphagia; however significant complication rates have been associated with large diameter stents. We hypothesized that small-caliber, fully covered, self-expandable metal stents (sccSEMS) would prove adequate palliation of dysphagia in the absence of major complications. Methods: Prospective observational study of 17 patients presenting with severe malignant dysphagia between 12/1/08 and 7/30/10. 31 sccSEMS with internal diameters ranging from 8 mm to 16 mm were placed in 17 patients with pre-stent luminal diameters of < 8 mm (n = 13) or 8-10 mm (n = 4). 7 tracheobronchial stents (internal diameter 14–16 mm), 2 biliary stents (internal diameter 8–10 mm), and 22 specially constructed esophageal stents (internal diameter 12–16 mm) were placed. All stents were placed under direct endoscopic vision without fluoroscopic support. Dysphagia scores, migration rates, and complications were identified through review of endoscopy reports, outpatient clinical encounters, and 24-hour post-procedure phone surveys. Anticipated stent migration was defined as events which occurred during chemoradiation. Unanticipated stent migration was defined as events which occurred in the absence of treatment. Results: The post-stent median dysphagia score improved (decreased) from 3 to 2 (p = 0.0003). The overall median duration of first stent placement was 64 days, IQR 32 – 110 days. The overall migration rate was 35.5% (11/31). The anticipated migration rate was 60% (9/15); the unanticipated migration rate was 18.2% (2/11) (p = 0.051). All 11 of the migrated stents were retrieved endoscopically without complication. 9.7% (3/31) of patients reported self-limited sore throat or chest pain within 24-hours of stent placement. All 3 patients were managed conservatively without need for narcotic analgesics, hospitalization, or repeat endoscopy. No other complications occurred. Conclusions: The direct endoscopic placement of sccSEMS in patients presenting with severe malignant dysphagia significantly improved dysphagia scores, provided excellent durability, and resulted in no major complications. No significant financial relationships to disclose.

Analysis of Clinical Outcomes of Esophageal Stent Placement for Palliation of Malignant Dysphagia

2008 ◽  
Vol 67 (5) ◽  
pp. AB188
Author(s):  
Krishdeep S. Chadha ◽  
Michael D. Schiff ◽  
Michael D. Sitrin ◽  
Gregory E. Wilding ◽  
Hector R. Nava
Keyword(s):  
Clinical Outcomes ◽  
Stent Placement ◽  
Esophageal Stent ◽  
Malignant Dysphagia

Clinical Outcomes and Complications of Midfoot Charcot Reconstruction With Intramedullary Beaming

2018 ◽  
Vol 40 (1) ◽  
pp. 18-23 ◽  
Author(s):  
Samuel E. Ford ◽  
Bruce E. Cohen ◽  
W. Hodges Davis ◽  
Carroll P. Jones
Keyword(s):  
Clinical Outcomes ◽  
Corrective Osteotomy ◽  
Tertiary Care ◽  
Case Series ◽  
Deep Infection ◽  
Complication Rates ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Patient Reported

Background: The purpose of this study was to examine the clinical outcomes and complications of patients with midfoot Charcot managed with midfoot osteotomy, realignment arthrodesis, and stabilization using intramedullary beams. Methods: Consecutive patients with midfoot Charcot treated at a tertiary-care foot and ankle center from January 2013 to July 2016 who underwent corrective osteotomy with internal beam fixation were identified; 25 patients were included in the final analysis. Patients with a minimum 1-year follow-up were evaluated with physical examination, weightbearing radiographs, and patient-reported outcome measures. The primary outcome measure was defined as restoration of a stable, plantigrade, ulcer-free foot. Median age was 58 years, median BMI was 32, and 80% were diabetic (75% insulin-dependent). Results: An ulcer-free, stable, plantigrade foot was obtained in 84% of patients. The radiographic lateral and anteroposterior Meary angle medians improved 9° and 15°, respectively, from preoperative to final postoperative weightbearing measurements ( P < .001 and P = .02). Overall, 46% of midfoot osteotomies were united on final radiographs at a median 18-month radiographic follow-up. Deep infection developed in 6 (24%) patients. The presence of a preoperative ulcer was found to be predictive of postoperative infection (P = .04); all 6 deep infections occurred in patients with preoperative ulceration. Four (16%) patients progressed to amputation at a mean 15 postoperative months, all for deep infection. Conclusion: Midfoot Charcot reconstruction with intramedullary beaming allowed for restoration of an ulcer-free, plantigrade foot in most patients, but the complication rates were high, especially in patients with preoperative ulceration. Level of Evidence: Level IV, retrospective case series.

scholarly journals Esophageal metal stent for malignant obstruction after prior radiotherapy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hiroyoshi Iwagami ◽  
Ryu Ishihara ◽  
Sachiko Yamamoto ◽  
Noriko Matsuura ◽  
Ayaka Shoji ◽  
...  
Keyword(s):  
Stent Placement ◽  
Radial Force ◽  
Exclusion Criteria ◽  
Exact Test ◽  
Stent Type ◽  
Group 2 ◽  
And Migration ◽  
Esophageal Stenting ◽  
Median Interval

AbstractThe association between severe adverse events (SAEs) and prior radiotherapy or stent type remains controversial. Patients with esophageal or esophagogastric junctional cancer who underwent stent placement (2005–2019) were enrolled in this retrospective study conducted at a tertiary cancer institute in Japan. The exclusion criteria were follow-up period of < 1 month and insufficient data on stent type or cancer characteristics. We used Mann–Whitney’s U test for quantitative data and Fisher’s exact test for categorical data. Multivariate analysis was performed using a logistic regression model. 107 stents were placed. Low radial-force stents (L group) were used in 51 procedures and high radial-force stents (H group) in 56 procedures. SAEs developed after nine procedures, the median interval from stent placement being 6 days (range, 1–141 days). SAEs occurred more frequently in the H (14%: 8/56) than in the L group (2%: 1/51) (P = 0.03). In patients who had undergone prior radiotherapy, SAEs were more frequent in the H (36%: 4/11) than in the L group (0%: 0/13) (P = 0.03). Re-obstruction and migration occurred after 16 and three procedures, respectively; these rates did not differ significantly between groups (P = 0.59, P = 1, respectively). Low radial-force stents may reduce the risk of SAEs after esophageal stenting.

scholarly journals Immediate Postpartum Intrauterine Contraceptive Device Insertions in Caesarean and Vaginal Deliveries: A Comparative Study of Follow-Up Outcomes

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Reetu Hooda ◽  
Sonika Mann ◽  
Smiti Nanda ◽  
Anjali Gupta ◽  
Hemant More ◽  
...  
Keyword(s):  
Family Planning ◽  
Tertiary Care ◽  
Intrauterine Contraceptive Device ◽  
Categorical Variables ◽  
Contraceptive Device ◽  
Complication Rates ◽  
Vaginal Deliveries ◽  
Significant Difference ◽  
Intrauterine Contraceptive

Background. Immediate postpartum intrauterine contraceptive device (IPPIUCD) is a lucrative postpartum family planning method which provides effective reversible contraception to women in the delivery setting. Our aim was to study the clinical outcomes of IPPIUCD insertions and compare them as a factor of route of insertion (vaginal versus caesarean).Methods. This is a retrospective analytical study done in a tertiary care teaching institute. A Cohort of 593 vaginal and caesarean deliveries with IPPIUCD insertions, over a two-year period, was studied and compared for follow-up results. Outcome measures were safety (perforation, irregular bleeding, unusual vaginal discharge, and infection), efficacy (pregnancy, expulsions, and discontinuations), and incidence of undescended IUCD strings. Descriptives were calculated for various outcomes and chi square tests were used for comparison in between categorical variables.Results. Overall complication rates were low. No case of perforation or pregnancy was reported. Spontaneous expulsions were present in 5.3% cases and were significantly higher in vaginal insertions (p=0.042). The incidence of undescended strings was high (38%), with highly significant difference between both groups (p=0.000).Conclusion. IPPIUCD is a strong weapon in the family planning armoury and should be encouraged in both vaginal and caesarean deliveries. Early follow-up should be encouraged to detect expulsions and tackle common problems.

Clinical Outcomes of Using a Conservative Approach of Late Esophageal Stent Placement in Palliation of Malignant Dysphagia

2010 ◽  
Vol 41 (3) ◽  
pp. 173-178 ◽  
Author(s):  
Krishdeep Singh Chadha ◽  
Michael Schiff ◽  
Michael D. Sitrin ◽  
Gregory E. Wilding ◽  
Hector Nava
Keyword(s):  
Clinical Outcomes ◽  
Stent Placement ◽  
Esophageal Stent ◽  
Conservative Approach ◽  
Malignant Dysphagia

Office-Based Stapes Surgery

2019 ◽  
Vol 161 (6) ◽  
pp. 1018-1026 ◽  
Author(s):  
Béatrice Voizard ◽  
Anastasios Maniakas ◽  
Issam Saliba
Keyword(s):  
Operating Room ◽  
Pure Tone ◽  
Care Center ◽  
Tertiary Care ◽  
Bone Conduction ◽  
Stapes Surgery ◽  
Complication Rates ◽  
Pure Tone Average ◽  
Air Conduction

Objective The objective of this study was to provide a proof of concept and to assess the success and safety of stapes surgery for otosclerosis under local anesthesia in an office-based setting (OBS) as compared with a hospital operating room setting (ORS). Study Design Retrospective cohort study. Setting We reviewed all patients who underwent stapes surgery by the same surgeon from October 2014 to January 2017 at our tertiary care center (ORS, n = 36, 52%) and in an OBS (n = 33, 48%). Subjects and Methods The surgical technique was identical in both groups. All patients had a temporal bone computed tomography scan and audiogram within the 6 months prior to surgery. Air-bone gaps (ABGs), bone conduction, and air conduction pure tone average values were calculated. Preoperative results for pure tone average, bone conduction, ABG, and word recognition scores were compared with early (4 months) and late (12 months) follow-up audiograms. Intra- and postoperative complications were compared. Results Both groups were comparable in terms of demographic characteristics and severity of disease. The mean 1-year postoperative ABG was 5.66 dB (95% CI = 4.42-6.90) in the ORS group and 6.30 dB (95% CI = 4.50-8.10) in the OBS group ( P = .55). ABG improved by 24.27 dB (95% CI = 21.40-27.13) in the ORS group and 23.15 dB (95% CI = 18.45-27.85) in the OBS group ( P = .68). Complication rates did not differ, although this study remains underpowered. Conclusions In this small group of patients, the success of stapes surgery performed in an OBS and its complications were comparable to those of an ORS, thus providing an alternative to patients on long operating room waiting lists.

scholarly journals Fully covered self-expanding metal stents for refractory pancreatic duct strictures in symptomatic chronic pancreatitis, US experience

2019 ◽  
Vol 07 (11) ◽  
pp. E1419-E1423 ◽  
Author(s):  
Reem Z. Sharaiha ◽  
Aleksey Novikov ◽  
Kristen Weaver ◽  
Pawan Marfatia ◽  
Jonathan M. Buscaglia ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Success Rate ◽  
Pancreatic Duct ◽  
Clinical Success ◽  
Tertiary Care ◽  
Plastic Stents ◽  
Metal Stents ◽  
Technical Success ◽  
Self Expanding Metal Stents

Abstract Background and study aims Fully covered self-expanding metal stents (FCSEMS) have been used to treat refractory pancreatic duct strictures. We aimed to evaluate the feasibility, safety, and efficacy of FCSEMS in chronic pancreatitis with refractory pancreatic duct strictures. Patients and methods This was a retrospective multicenter cases series of patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) with FCSEMS placement in the main pancreatic duct (MPD) at five tertiary care centers between February 2010 and June 2016. Primary endpoints were technical success, clinical success, and procedure-related morbidity. Secondary endpoints were pain relief at the end of follow-up and resolution of the pancreatic stricture on ERCP. Results Thirty-three patients with previously drained stents, 76 % of whom were male, underwent ERCP with FCSEMS placement. Mean duration of follow-up was 14 months. All of the patients had prior therapy. The technical success rate for FCSEMS placement was 100 % (n = 33) and the clinical success rate was 93 % (was n = 31). Stents were removed after a median duration of 14.4 weeks. After stent removal, the diameter of the narrowest MPD stricture had increased significantly from 1 mm to 4.5 mm (P < 0.001). There was a statistically significant improvement on the Visual Analogue Scale (VAS) from a median of 8.5 to 2.5. At the end of the study, (n = 27) 87.1 % of patients reported significant pain reduction with reduced narcotic use. Conclusion FCSEMS appeared to be a feasible, safe, and potentially effective Intervention in patients who had not responded to endoscopic therapy with plastic stents.

scholarly journals Exclusive endoscopic transcanal transpromontorial approach: a new perspective for internal auditory canal vestibular schwannoma treatment

2017 ◽  
Vol 126 (1) ◽  
pp. 98-105 ◽  
Author(s):  
Daniele Marchioni ◽  
Matteo Alicandri-Ciufelli ◽  
Alessia Rubini ◽  
Babara Masotto ◽  
Giacomo Pavesi ◽  
...  
Keyword(s):  
Skull Base ◽  
Tertiary Care ◽  
Internal Auditory Canal ◽  
Case Series ◽  
University Hospital ◽  
Cerebrospinal Fluid Leakage ◽  
Complication Rates ◽  
First Case ◽  
The University

OBJECTIVE The aim of this study was to describe the first case series in which an exclusive endoscopic transcanal transpromontorial approach (EETTA) was used to treat small vestibular schwannomas (VSs) and meningiomas of the internal auditory canal (IAC). METHODS The authors performed a retrospective review of patients who had undergone surgery using an EETTA to the IAC at 2 university tertiary care referral centers during the period from November 2011 to January 2015. RESULTS Ten patients underwent surgery via an EETTA for the treatment of VS in the IAC at the University Hospital of Modena or the University Hospital of Verona. The patients had Koos Grade I or II tumors and American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) Class D hearing status preoperatively. Gross-total resection was achieved in all patients. No major complications such as cerebrospinal fluid leakage or hemorrhage were reported. In 7 of 10 (70%) patients, facial nerve function was normal immediately after surgery (Rough Grading System [RGS] Grade I). Two patients presented with a transitory facial palsy immediately after surgery (RGS Grade II–III) but experienced complete recovery during the follow-up period. The mean follow-up was 10 months. CONCLUSIONS The EETTA proved to be successful for the removal of VS or meningioma involving the cochlea, fundus, and IAC, with possible lower complication rates and less invasive procedures than those for traditional microscopic approaches. The potential for the extensive and routine use of this approach in lateral and posterior skull base surgery will depend on the development of technology and surgical refinements and on the diffusion of skull base endoscopic skills among the otolaryngological and neurosurgical communities.

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