Self-expanding metal stent insertion for inoperable esophageal carcinoma in Belfast: an audit of outcomes and literature review

Abstract The incidence of esophageal carcinoma (EC) in Singapore is declining since 1970s. However, the age-incidence curve in 2010s shows a steep rise after age 40-50s. The majority of EC patients presented late with locally advanced or metastatic disease. The outcomes of inoperable esophageal carcinoma treated with palliative self-expanding metallic (SEM) stents were reviewed. Methods Consecutive cases of EC including Siewert Type I adenocarcinoma of esophago-gastric junction (AEG) were identified from electronic medical records from August 2015 to February 2021. There were 78 cases of EC and of which 14 were stented. The outcomes of inoperable or metastatic EC cases treated with palliative SEM stents were analyzed. Other palliative treatment included best supportive care and palliative chemotherapy with or without radiotherapy. Results The demographics showed the mean age of 73 ± 11 years with ECOG score 0-1 in 86% and mean BMI 19.1 ± 3.8. All were males with the risks from smoking in 85% and alcohol in 50%. The mean length of EC was 6.2 ± 2.6 cm. There were 10 Wallflex and 4 Ultraflex partially covered stents deployed successfully. The pre-stent dysphagia score was 3 in 72% and 4 in 29% whilst all had post-stent score of 1. The mean duration of survival was 4.4 ± 4.1 months. Post-stent complications included stent migration without obstruction and food bolus obstruction. Conclusion About 18% of patients diagnosed with advanced symptomatic EC were treated with palliative SEM stent insertion in a safe and effective manner. Those at risk were elderly males with smoking history. All stented cases had immediate improvement of dysphagia score and were able to tolerate soft diet. The overall duration of survival was variable up to 1 year likely due to different tumour biology and concurrent palliative systemic therapy.

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Tu1447 – Efficacy of Lumen-Apposing Metal Stent Insertion in Patients with Malignant Pancreatic Fluid Collections: A Tertiary Cancer Center Experience

Gastroenterology ◽

10.1016/s0016-5085(19)39560-5 ◽

2019 ◽

Vol 156 (6) ◽

pp. S-1043

Author(s):

Osman Ahmed ◽

Phonthep Angsuwatcharakon ◽

Brian R. Weston ◽

Phillip Lum ◽

William A. Ross ◽

...

Keyword(s):

Cancer Center ◽

Stent Insertion ◽

Metal Stent ◽

Pancreatic Fluid Collections ◽

Pancreatic Fluid ◽

Fluid Collections ◽

Tertiary Cancer Center

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A unique type of fully covered metal stent for the management of post liver transplant biliary anastomotic strictures

BMC Gastroenterology ◽

10.1186/s12876-020-01479-6 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Ben Warner ◽

Phillip Harrison ◽

Muhammad Farman ◽

John Devlin ◽

David Reffitt ◽

...

Keyword(s):

Liver Transplant ◽

Liver Function Tests ◽

Stent Insertion ◽

Complication Rates ◽

Metal Stent ◽

Unique Type ◽

Anastomotic Strictures ◽

Stricture Recurrence

Abstract Background We report our experience of treating anastomotic strictures using a novel type of fully covered metal stent (FCSEMS). This stent, known as the Kaffes Stent, is short-length with an antimigration waist and is easily removable due to long retrieval wires deployed within the duodenum. Methods Sixty-two patients underwent ERCP and Kaffes stent insertion for post-transplant anastomotic strictures following confirmation of a stricture on MRCP. These patients were retrospectively analysed for immediate and long-term stricture resolution, improvement in symptoms and liver function tests (LFTs), stricture recurrence and complication rates. Results Of the 56 patients who had their stent removed at the time of analysis, 54 (96%) had immediate stricture resolution and 42 continued to have long-term resolution (mean follow-up period was 548 days). Of the 16 patients with symptoms of biliary obstruction, 13 had resolution of their symptoms. Overall, there was a significant improvement in LFTs after stent removal compared to before stent insertion. Complication rates were 15% with only one patient requiring biliary reconstruction. Conclusions The Kaffes stent is effective and safe at resolving post liver transplant biliary anastomotic strictures.

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Weight Predicts Survival Following Self-Expanding Metal Stent Insertion for Palliation of Malignant Oesophageal Obstruction

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2006.03.229 ◽

2006 ◽

Vol 63 (5) ◽

pp. AB135

Author(s):

Melissa L. Haines ◽

Stewart Campbell ◽

Anthony C. Smith ◽

Jim C. Brooker ◽

Bernd Grunewald ◽

...

Keyword(s):

Stent Insertion ◽

Metal Stent ◽

Oesophageal Obstruction

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Iatrogenic Perforation of an Advanced Esophageal Carcinoma Treated with Placement of a Self-Expanding Metal Stent

Video Journal and Encyclopedia of GI Endoscopy ◽

10.1016/s2212-0971(13)70036-0 ◽

2013 ◽

Vol 1 (1) ◽

pp. 81-82

Author(s):

O Pech

Keyword(s):

Esophageal Carcinoma ◽

Metal Stent ◽

Iatrogenic Perforation

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Pancreatic pseudocyst-portal vein fistula with refractory hepatic pseudocyst: Two cases treated with EUS cyst-gastrostomy and review of the literature

Endoscopy International Open ◽

10.1055/a-0754-2247 ◽

2019 ◽

Vol 07 (01) ◽

pp. E83-E86 ◽

Cited By ~ 2

Author(s):

John Eccles ◽

Edward Wiebe ◽

Pernilla D’Souza ◽

Gurpal Sandha

Keyword(s):

Portal Vein ◽

Pancreatic Pseudocyst ◽

Pancreatic Cyst ◽

Treatment Approach ◽

Fistula Formation ◽

Pancreatic Pseudocysts ◽

Stent Insertion ◽

Metal Stent ◽

Pancreatic Fluid ◽

Pseudocyst Formation

Abstract Background and study aims Pseudocysts are the most common pancreatic cystic lesions and they usually develop in association with pancreatitis of at least 4 weeks’ duration. Extra-pancreatic pseudocysts, although reported, are relatively uncommon. Secondary liver pseudocysts are recognized within the literature, and most patients described have required percutaneous or surgical drainage due to infection or symptoms. The mechanism of hepatic pseudocyst formation is not entirely clear but it is postulated that this phenomenon may occur through pseudocyst-portal vein fistulization. We describe two cases of patients presenting with pancreatic pseudocysts invading the portal venous system with embolization of pancreatic fluid to the liver and subsequent hepatic pseudocyst formation. Interestingly, liver pseudocyst resolution was incomplete with antibiotics and percutaneous drainage alone, and only occurred following endoscopic ultrasonography-guided pancreatic cyst-gastrostomy and metal stent insertion. We have reviewed the current literature on the diagnosis and management of pseudocyst-portal vein fistula formation and we believe that our cases represent the first published within the literature to describe this treatment approach.

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