P75 CRITICAL APPRAISAL OF THE IMPACT OF OESOPHAGEAL STENTS IN THE MANAGEMENT OF OESOPHAGEAL ANASTOMOTIC LEAKS AND BENIGN OESOPHAGEAL PERFORATIONS: AN UPDATED SYSTEMATIC REVIEW

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
K Kamarajah Sivesh ◽  
Bundred James ◽  
Spence Gary ◽  
Kennedy Andrew ◽  
V M Dasari Bobby ◽  
...  
Keyword(s):  
Systematic Review ◽  
Anastomotic Leakage ◽  
Clinical Success ◽  
Stent Migration ◽  
Metallic Stents ◽  
Plastic Stents ◽  
Oesophageal Perforation ◽  
Anastomotic Leaks ◽  
Technical Success ◽  
The Impact

Abstract Aims This updated systematic review aimed to assess the safety and effectiveness of oesophageal stents in these two scenarios. Background Endoscopic placement of oesophageal stents may be used in benign oesophageal perforation and oesophageal anastomotic leakage to control sepsis and reduce mortality and morbidity by avoiding thoracotomy. Methods A systematic literature search of all published studies reporting use of metallic and plastic stents in the management of postoperative anastomotic leaks, spontaneous and iatrogenic oesophageal perforations were identified. Primary outcomes were technical (deploying ≥1 stent to occlude site of leakage with no evidence of leakage of contrast within 24-48 hours) and clinical success (complete healing of perforation or leakage by placement of single or multiple stents irrespective of whether the stent was left in situ or was removed). Secondary outcomes were stent migration, perforation and erosion and mortality rates. Subgroup analysis were performed for plastic versus metallic stents and anastomotic leaks versus perforations separately. Results A total of 66 studies (n=1752 patients) were included. Technical and clinical success rates were 96% and 87%, respectively. Plastic stents had significantly higher migration rates (24% vs 16%, p=0.001) and repositioning (11% vs 3%, p<0.001) and lower technical success (91% vs 95%, p=0.032) than metallic stents. In patients with anastomotic leaks, plastic stents were associated with higher stent migration (26% vs 15%, p=0.034), perforation (2% vs 0%, p=0.013), repositioning (10% vs 0%, p<0.001) and lower technical success (95% vs 100%, p=0.002). In patients with perforations only, plastic stents were associated with significantly lower technical success (85% vs 99%, p<0.001). Conclusions Covered metallic oesophageal stents appear to be more effective than plastic stents in the management of oesophageal perforation and anastomotic leakage. However, quality of evidence of generally poor and high-quality randomised trial is needed to further evaluate best management option for oesophageal perforation and anastomotic leakage.

scholarly journals EDGE in Roux-en-Y gastric bypass: How does it compare to laparoscopy-assisted and balloon enteroscopy ERCP: a systematic review and meta-analysis

2020 ◽  
Vol 08 (02) ◽  
pp. E163-E171 ◽  
Author(s):  
Banreet Singh Dhindsa ◽  
Amaninder Dhaliwal ◽  
Babu P. Mohan ◽  
Harmeet Singh Mashiana ◽  
Mohit Girotra ◽  
...  
Keyword(s):  
Systematic Review ◽  
Gastric Bypass ◽  
Primary Outcome ◽  
Clinical Success ◽  
Meta Analysis ◽  
Secondary Analysis ◽  
Stent Migration ◽  
Technical Success ◽  
Comprehensive Search ◽  
Better Than

Abstract Background and study aims Endoscopic ultrasound-directed transgastric ERCP (EDGE) is a new endoscopic procedure to perform ERCP in Roux-en-y gastric bypass (RYGB) patients. The aim of this study was to conduct a systematic review and meta-analysis to evaluate technical success, clinical success and adverse effects of EDGE and compare it to laparoscopic ERCP (LA-ERCP) and balloon ERCP (BE-ERCP). Patients and methods We conducted a comprehensive search of several databases and conference proceedings including PubMed, EMBASE, Google-Scholar, LILACS, SCOPUS, and Web of Science databases to identify studies reporting on EDGE, LA-ERCP, and BE-ERCP. The primary outcome was to evaluate technical and clinical success of all three procedures and the secondary analysis focused on calculating the pooled rate of all adverse events (AEs), along with the commonly reported AE subtypes. Results Twenty-four studies on 1268 patients were included in our analysis with the majority of the population being males with mean age 53.72 years. Pooled rates of technical and clinical success with EDGE wer 95.5 % and 95.9 %, with LA-ERCP were 95.3 % and 92.9 % and were BE-ERCP were 71.4 % and 58.7 %, respectively. Pooled rates of all AEs with EDGE were 21.9 %, with LA-ERCP 17.4 % and with BE-ERCP 8.4 %. Stent migration was the most common AE with EDGE with 13.3 % followed by bleeding with 6.6 %. Conclusion Our meta-analysis demonstrated that the technical and clinical success of EDGE procedure is better than BE-ERCP and comparable to that of LA-ERCP in RYGB patients. EDGE also has a similar safety profile as compared to LA-ERCP but has higher AE rate as compared to BE-ERCP.

scholarly journals Anastomotic leak after oesophagectomy and stent implantation: a systematic review

2011 ◽  
Vol 4 (3) ◽  
pp. 159
Author(s):  
A.N. Kanatas ◽  
A. Aldouri ◽  
J. D. Hayden
Keyword(s):  
Systematic Review ◽  
Anastomotic Leak ◽  
Stent Migration ◽  
Oesophageal Perforation ◽  
Covered Stents ◽  
Effective Strategy ◽  
Anastomotic Leaks ◽  
Cancer Resection ◽  
Methodological Rigor

Anastomotic leaks following oesophageal cancer resection have a high mortality. Stents have an established position in the palliation of dysphagia due to malignancy and in treating malignant perforation or fistula. They are increasingly used for benign conditions such as spontaneous oesophageal perforation with encouraging results. In this systematic review we examine the available evidence and attempt to define the role of stents in the management of oesophageal anastomotic leaks after resection for cancer. It is evident from the review that plastic- and metal-covered stents are an effective strategy for the treatment of anastomotic leaks. Vigilance is required as complications such as stent migration and incomplete sealing are not uncommon. Further clinical studies with greater methodological rigor in terms of sample size and study design may confirm that stents have an important contribution to make in the management of oesophageal anastomotic leak.

scholarly journals Y-Shaped Bilateral Self-Expandable Metallic Stent Placement for Malignant Hilar Biliary Obstruction: Data from a Referral Center for Palliative Care

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
R. Di Mitri ◽  
F. Mocciaro
Keyword(s):  
Clinical Success ◽  
Metallic Stents ◽  
Plastic Stents ◽  
Metallic Stent ◽  
Safe Procedure ◽  
Technical Success ◽  
Expandable Metallic Stent ◽  
Hilar Carcinoma ◽  
Malignant Hilar Biliary Obstruction ◽  
Expandable Metallic Stents

Background and Aim. Malignant hilar strictures are a clinical challenge because of the current therapeutic approach and the poor prognosis. In recent years, self-expandable metallic stents have proven more effective than plastic stents for palliation of malignant hilar strictures, with the bilateral stent-in-stent technique registering a high success rate. We report our experience with Y-shaped endoscopic self-expandable metallic stents placement for treatment of advanced malignant hilar strictures.Methods. From April 2009 to August 2012, we prospectively collected data on patients treated with Y-shaped SEMS placement for advanced malignant hilar carcinoma. Data on technical success, clinical success, and complications were collected.Results. Twenty patients (9 males) were treated (mean age 64.2 ± 15.3 years). The grade of malignant hilar strictures according to the Bismuth classification was II in 5 patients (25%), IIIa in 1 (5%), and IV in 14 (70%). The mean bilirubin level was 14.7 ± 4.9 mg/dL. Technical success was achieved in all patients, with a significant reduction in bilirubin levels (2.9 ± 1.7 mg/dL). One patient experienced cholangitis as early complication, while in 2 patients stent ingrowth was observed. No stents migration was recorded. There was no procedure-related mortality. At the end of the follow-up (7.1 ± 3.1 months), 13 of the 20 patients (65%) had died.Conclusions. Our experience confirms endoscopic bilateral self-expandable metallic stents placement with stent-in-stent technique (Y-shaped configuration) as a feasible, effective, and safe procedure for palliation of unresectable malignant hilar strictures.

scholarly journals ENDOSCOPIC TREATMENT OF POST-LIVER TRANSPLANTATION ANASTOMOTIC BILIARY STRICTURE: systematic review andmeta-analysis

2014 ◽  
Vol 51 (3) ◽  
pp. 240-249 ◽  
Author(s):  
Lucas Souto NACIF ◽  
Wanderley Marques BERNARDO ◽  
Luca BERNARDO ◽  
Wellington ANDRAUS ◽  
Lucas TORRES ◽  
...  
Keyword(s):  
Systematic Review ◽  
Liver Transplantation ◽  
Endoscopic Treatment ◽  
Clinical Success ◽  
Controlled Trial ◽  
Balloon Dilation ◽  
Plastic Stents ◽  
Metal Stents ◽  
Complication Rates ◽  
Biliary Strictures

Context Biliary strictures after liver transplantation are recognized as its Achilles’ heel. The strictures are classified in anastomotic and ischemic or non-anastomotic biliary strictures, and they figure among the most common complications after liver transplantation. There are some treatment options including balloon dilation, the placement of multiple plastic stents and the placement of self-expandable metal stents and all of them seem to have good results. Objectives The aim of this study was to systematically review the literature concerning the results of the endoscopic treatment of anastomotic biliary strictures after liver transplantation. Methods A systematic review of the literature was performed on the management of anastomotic biliary strictures post- orthotopic liver transplantation. The Medline-PubMed, EMBASE, Scielo-LILACS, and Cochrane Databases were electronically searched from January 1966 to April 2013. Results No well-designed randomized controlled trial was found. Most studies were retrospective or prospective comparisons in design. One study (86 patients) compared the endoscopic and the percutaneous accesses. The sustained clinical success rates were similar but the treatment duration was longer in the percutaneous group access. Two studies (56 patients) compared balloon dilation with balloon dilation and multiple plastic stents. There were no differences concerning sustained clinical success and complication rates. Conclusions Balloon dilation is as effective as balloon dilation plus multiple plastic stenting for the resolution of the anastomotic biliary strictures. Well-designed randomized trials are still needed to compare balloon dilation versus multiple plastic stenting versus metallic stenting.

Critical Appraisal of the Impact of Oesophageal Stents in the Management of Oesophageal Anastomotic Leaks and Benign Oesophageal Perforations: An Updated Systematic Review

2019 ◽  
Vol 44 (4) ◽  
pp. 1173-1189 ◽  
Author(s):  
Sivesh K. Kamarajah ◽  
James Bundred ◽  
Gary Spence ◽  
Andrew Kennedy ◽  
Bobby V. M. Dasari ◽  
...  
Keyword(s):  
Systematic Review ◽  
Critical Appraisal ◽  
Anastomotic Leaks ◽  
The Impact

scholarly journals Outcomes of a single-step endoscopic ultrasound-guided drainage of pancreatic-fluid collections using an electrocautery-enhanced coaxial lumen-apposing, self-expanding metal stent with and without fluoroscopy

2020 ◽  
Author(s):  
Babatunde Olaiya ◽  
Parit Mekaroonkamol ◽  
Bai-Wen Li ◽  
Julia Massaad ◽  
Cicily T Vachaparambil ◽  
...  
Keyword(s):  
Clinical Success ◽  
Stent Migration ◽  
Single Step ◽  
Success Rates ◽  
Metal Stent ◽  
Technical Success ◽  
Pancreatic Fluid Collections ◽  
Pancreatic Fluid ◽  
The Mean ◽  
Fluid Collections

Abstract Background Fluoroscopy is often used during the endoscopic drainage of pancreatic-fluid collections (PFCs). An electrocautery-enhanced coaxial lumen-apposing, self-expanding metal stent (ELAMS) facilitates a single-step procedure and may avoid the need for fluoroscopy. This study compares the treatment outcomes using ELAMS with and without fluoroscopy. Methods Patients with PFCs who had cystogastrostomy from January 2014 to February 2017 were enrolled. Two groups were studied based on fluoroscopy use. Technical success was defined as uneventful insertion of ELAMS at time of procedure. Clinical success was defined as (i) clinical resolution of symptoms after the procedure and (ii) &gt;75% reduction in cyst size on computed tomography 8 weeks after stent placement. Adverse events including bleeding, stent migration, and infection were recorded. Results A total of 21 patients (13 males) had PFCs drainage with ELAMS in the study period. The mean age was 51.6 ± 14.2 years. Thirteen patients had walled-off necrosis while eight had a pancreatic pseudocyst. The mean size of the PFCs was 11.3 ± 3.3 cm. Fluoroscopy was used in seven cases (33%) and was associated with a longer procedure time compared to non-fluoroscopy (43.1 ± 10.4 vs 33.3 ± 10.5 min, P = 0.025). This association was independent of the size, location, or type of PFCs. Fluoroscopy had no effect on the technical success rates. In fluoroless procedures, the clinical resolution was 91% as compared to 71% in fluoroscopy procedures (P = 0.52) and the radiologic resolution was 57% as compared to 71% in fluoroscopy procedures (P = 0. 65). Three cases of stent migration/displacement occurred in the fluoroless procedures. Conclusions ELAMS may avoid the need for fluoroscopy during cystogastrostomy. Procedures without fluoroscopy were significantly shorter and fluoroscopy use had no impact on the technical or clinical success rates.

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.

Effectiveness of combination endoscopic therapy for colonic anastomotic leaks

Endoscopy ◽  
2020 ◽  
Vol 52 (10) ◽  
pp. 886-890
Author(s):  
Nikhil R. Thiruvengadam ◽  
Christopher Hamerski ◽  
Andrew Nett ◽  
Yasser Bhat ◽  
Janak Shah ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Endoscopic Therapy ◽  
Clinical Success ◽  
Case Series ◽  
Metal Stents ◽  
Anastomotic Leaks ◽  
Endoscopic Suturing ◽  
Adjusted Risk ◽  
Local Closure ◽  
The Impact

Abstract Background Colonic anastomotic leaks are associated with significant morbidity and mortality. Whereas small case series suggest that fully covered self-expandable metal stents (FCSEMS) are effective, no larger studies have examined the impact of combination endoscopic therapy on colonic anastomotic leaks. Methods Our retrospective cohort study reviewed 51 patients undergoing endoscopic therapy for colonic anastomotic leaks between 2011 and 2018. Patients receiving combination therapy involving FCSEMS plus local closure (n = 24) were compared with patients receiving FCSEMS alone (n = 18) or endoscopic suturing alone (n = 9). The primary outcomes were technical and clinical success (resolution of leak, removal of percutaneous drains, avoidance of surgical reoperation, and reversal of temporary diversion). Results Clinical success was achieved in 55 % of patients. Clinical success was achieved in 18/24 patients (75 %) with combination therapy compared with 6/18 patients receiving FCSEMS alone (33 %, adjusted risk ratio [RR] 2.16, 95 % confidence interval [CI] 1.10 – 4.24; P = 0.02) and 4 /9 patients undergoing endoscopic suturing alone (44 %, RR 1.91, 95 %CI 0.84 – 4.31; P = 0.10). Stent migration occurred in 40 % of patients. Conclusions This large series demonstrates that combination therapy was associated with a higher rate of clinical success, and future prospective studies are warranted.

scholarly journals Endoscopic transpapillary gallbladder stenting using a newly designed plastic stent for acute cholecystitis

2019 ◽  
Vol 07 (09) ◽  
pp. E1105-E1114 ◽  
Author(s):  
Kazunari Nakahara ◽  
Yosuke Michikawa ◽  
Ryo Morita ◽  
Keigo Suetani ◽  
Nozomi Morita ◽  
...  
Keyword(s):  
Acute Cholecystitis ◽  
Clinical Success ◽  
Stent Migration ◽  
Sufficient Evidence ◽  
Plastic Stents ◽  
Control Group ◽  
The Novel ◽  
Stent Group ◽  
Biliary Stents ◽  
Plastic Stent

Abstract Background and study aims Biliary plastic stents are generally substituted for gallbladder stents in endoscopic transpapillary gallbladder stenting (EGBS), there is no sufficient evidence about what type of plastic stent is suitable. We examined outcomes of EGBS using standard biliary stents and a novel stent for acute cholecystitis and evaluated the efficacy of the novel stent. Patients and methods Seventy patients with acute cholecystitis in whom EGBS was performed were evaluated retrospectively. We performed EGBS in 23 patients using the novel stent (novel stent group) and 47 patients using standard biliary stents (pigtail: 35, straight: 12) (control group). In the two groups, we examined outcomes of EGBS. Results There were no significant differences in patient backgrounds or rates of technical success, clinical success, or early adverse events (AE) between the novel stent group and the control groups. However, rates of late AEs were 4.3 % in the novel stent group (liver abscess: 1) and 40.4 % in the control group (stent migration: 15, recurrence of cholecystitis: 4), indicating a significantly higher rate in the control group (P = 0.004). The rate of stent migration was significantly higher in the control group (P = 0.006). Multivariate analysis identified a straight type stent as the risk factor for stent migration (odds ratio: 8.81, 95 % confidence interval: 1.66 – 46.83). Conclusions The novel stent had significantly lower rates of late AEs and stent migration. Thus, for long-term stent placement, the novel stent was more effective than traditional biliary stents.

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