Self-Expanding Metal Stents for the Treatment of Post-Surgical Esophageal Leaks: A Tertiary Referral Center Experience

2018 ◽  
Vol 36 (4) ◽  
pp. 309-316 ◽  
Author(s):  
Andrea Anderloni ◽  
Chiara Genco ◽  
Marco Massidda ◽  
Milena Di Leo ◽  
Uberto Romario Fumagalli ◽  
...  
Keyword(s):  
Success Rate ◽  
Stent Placement ◽  
Secondary Outcome ◽  
Metal Stents ◽  
Stent Insertion ◽  
Therapeutic Success ◽  
Tertiary Referral Center ◽  
Stent Type ◽  
Self Expanding Metal Stents ◽  
Secondary Closure

Background/Aims: The study aimed to evaluate the effectiveness and safety of self-expanding metal stents (SEMS) in the management of post-surgical esophageal leaks. Methods: Retrospective data of consecutive patients with a post-surgical esophageal leak treated by means of a metal stent between January 2008 and December 2014 at the Humanitas Research Hospital (Milan, Italy) were extracted from a prospectively maintained register of SEMS used for benign indications, such as post-surgical benign esophageal strictures and/or leaks. The primary outcome of the study was to assess the rate of successful leak closure and to identify the variables associated with its achievement. As a secondary outcome, we evaluated the overall safety of SEMS placement and the efficacy and safety for different types of SEMS in this specific setting of patients. Leak resolution was documented with endoscopic and/or imaging studies. In the case of leak persistence, further attempts of esophageal stenting were carried out at the discretion of both endoscopists and surgeons. Results: A total of 49 patients were included in the study (men 41 of 49, 83.7%, mean age 62.4 ± 11.9). One patient was excluded from analysis, because of death 1 day after stent insertion due to worsening of pre-existing mediastinitis. A total number of 82 stents were placed (mean number of stents per patient: 1.7) in 49 patients: 35 patients (71.4%) received a partially covered SEMS (PCSEMS) as the first stent positioned, while the remaining 14 (28.6%) received a fully covered SEMS (FCSEMS); but 1 patient (2%) died following stent insertion; therefore, data regarding therapeutic success were available for 48 patients. Stents were left in place for a mean period of 21.9 ± 15.2 days. Leak closure after the first stent placement was achieved in 22 of 48 (45.8%) patients. Of the 26 patients with failure of index stent placement, 18 patients underwent further stenting attempts (69.2%), and secondary closure of leak was achieved in 7 (38.9%) of these 18 patients. Thus, the overall success rate was 60.5% (29 of 48). On the basis of stent type, the success rate was 57.1% (8 of 14) for FCSEMS and 64.7% (22 of 34) for PCSEMS. Logistic regression analysis did not find any significant association between successful leak closure and analyzed variables. Overall mortality was 13.0%. Complication rate was 38.8% (19 of 49 patients). Conclusion: The use of SEMS is an effective and safe option for post-surgical esophageal leaks, with no evidence of any significant influence of stent type on outcome.

scholarly journals Kako prevenirati tkivno urastanje i inkrustaciju metalnih stentova urinarnog trakta kod bolesnika sa osnovnom malignom bolescu male karlice?

2009 ◽  
Vol 56 (4) ◽  
pp. 171-173
Author(s):  
Z. Markovic ◽  
D. Masulovic ◽  
B. Markovic ◽  
P. Anojcic ◽  
A. Mladenovic
Keyword(s):  
Infection Control ◽  
Clinical Application ◽  
Current Level ◽  
Clinical Aspects ◽  
Metal Stents ◽  
Stent Insertion ◽  
Metal Stent ◽  
Insertion Technique ◽  
Stent Type ◽  
Selection Of

At the current level of stent application in urology each irreversible urostasis contraindicated for surgical therapy implies consideration of indications for metal stent insertion. Stent incrustation which leads directly into a new uroobstruction is a characteristic complication of this method. Available experience in different uroobstructive conditions has shown that very different clinical aspects of stent usage may directly determine the possibility of their incrustation. Stent incrustation may occur in the early postprocedural course or several months later. After that, prevention of stent incrustation starts with postprocedural evaluation, selection of the stent type, and it is subsequently continued by insertion technique and lasts practically permanently after the insertion (infection control, promotion of diuresis and maintenance of normal urodynamics). Authors present own experianse in clinical application of metal stents in uroradiology strictures for period of last 15 years.

scholarly journals Safety, efficacy, and removability of a fully covered multi-hole metal stent in a swine model of hilar biliary stricture: a feasibility study

2019 ◽  
Vol 07 (04) ◽  
pp. E498-E503 ◽  
Author(s):  
Jin-Seok Park ◽  
Seok Jeong ◽  
Makoto Kobayashi ◽  
Don Lee
Keyword(s):  
Success Rate ◽  
Biliary Stricture ◽  
Stent Migration ◽  
Metal Stents ◽  
Stent Insertion ◽  
Swine Model ◽  
Type I ◽  
Stent Patency ◽  
Technical Success Rate ◽  
Hilar Biliary Stricture

Abstract Background and study aims Use of fully covered self-expandable metal stents (FCSEMS) for biliary drainage of malignant hilar biliary strictures is limited because of risk of cholangitis due to side branch obstruction. The aim of this study was to evaluate the safety and efficacy of unilateral placement of a multi-hole FCSEMS (FCSEMS-MH), which had a 2.5-mm hole in the center of the membrane on each cavity, in a swine model of hilar biliary stricture. Materials and methods Six female mini pigs were included in this prospective study. The hilar biliary stricture model was prepared using an endobiliary radiofrequency ablation. FCSEMS-MHs were endoscopically inserted into the peri-hilar bile duct of all the animals. Outcomes were assessed in terms of adverse events (AEs) including cholangitis, stent patency, stent migration, and endoscopic stent removability for 1 month after stenting. Results In terms of hilar biliary stricture types, two animals were of Bismuth type I and four were of type II. Technical success rate for endoscopic metal stenting was 100 % (6/6), and the functional success rate, which was evaluated 7 days after stent insertion, was also 100 % (5/5). The immediate overall AE rate was 0 %. There was no procedure-related mortality and stent migration did not occur in any animal during the 4-week stent indwelling period. Stents were removed from all six animals at 4 weeks post-stenting. Conclusion Unilateral placement of FCSEMS-MH might be safe and effect for swine hilar biliary stricture models. However, long-term follow-up and comparative studies are needed to verify the usefulness of this stent.

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.

Biodegradable oesophageal stents: A potentially useful adjunct in the treatment of dysphagia in patients undergoing radiotherapy for oesophageal carcinoma

2019 ◽  
Vol 18 (4) ◽  
pp. 312-317
Author(s):  
K White ◽  
S Thampy ◽  
H Sheikh ◽  
L Bhatt ◽  
D Mullan ◽  
...  
Keyword(s):  
Clinical Effectiveness ◽  
Oesophageal Carcinoma ◽  
Radiotherapy Planning ◽  
Metal Stents ◽  
Stent Insertion ◽  
Dysphagia Score ◽  
Upper Gastrointestinal Bleed ◽  
Biodegradable Stents ◽  
Self Expanding Metal Stents ◽  
The Mean

AbstractAim:Dysphagia is common in patients presenting with oesophageal malignancy. This study aimed to determine the clinical effectiveness of biodegradable stents to help with malignant dysphagia due to radiotherapy for oesophageal cancer and furthermore to establish the complication and re-intervention rates associated with their use.Methods:This was a retrospective, observational study of 22 patients between 2008 and 2013. Complications within 2 weeks and episodes of re-intervention required within 4 months of stent insertion prior to radiotherapy were recorded.Results:Pre-stent insertion, the mean O’Rourke dysphagia score was 3·5 (median 3, range 2–5). This improved to a mean score of 2·8 (median 3, range 1–4) 1–3 weeks following stent insertion. Complications occurred in seven patients (32%) in an immediate 2-week period, including: pain (2), dysphagia requiring dilatation (1), food obstruction not requiring intervention (1), food obstruction requiring intervention (2) and upper gastrointestinal bleed not requiring intervention (1). Re-intervention was required in 18% within a 4-month period.Findings:We propose that biodegradable oesophageal stents are safe and may have benefit over self-expanding metal stents. We recommend they are placed alongside a radiologically inserted gastrostomy in a combined procedure prior to radiotherapy planning.

Endoscopic Self-Expanding Metal Stents for Acute Colonic Obstruction

2013 ◽  
Vol 79 (1) ◽  
pp. 30-34 ◽  
Author(s):  
Dan Tirosh ◽  
Zvi Perry ◽  
Shlomo Walfisch ◽  
Alex Rozental ◽  
Alex Fich ◽  
...  
Keyword(s):  
Palliative Care ◽  
Simple Procedure ◽  
Bowel Perforation ◽  
Metal Stents ◽  
Stent Insertion ◽  
Bridge To Surgery ◽  
Historical Cohort ◽  
Colorectal Obstruction ◽  
Self Expanding Metal Stents ◽  
Acute Perforation

The current study presents our experience with the introduction of self-expanding metal stents (SEMS) and assesses success rate, clinical outcomes, and complications. We conducted a historical cohort study reviewing endoscopic SEMS insertions between 2000 and 2010. Overall, 51 patients underwent stent insertion: 38 with an emergent procedure and 13 with a semielective procedure. SEMS was inserted in 27 men and 24 women with a mean age of 68.9 years. Colonic malignancy was the cause of obstruction in all patients. The tumors were localized in the rectosigmoid in 33 (64.7%), in the left colon in 16 (31.4%), and in the right colon in two cases (3.9%). Endoscopic SEMS insertion was technically successful in 68.4 per cent of patients in an emergency and in 84.6 per cent of patients in a semielective setting. Successful stent insertion allowed a “bridge to surgery” in 23 and palliative care in 14 patients. Stent migration occurred in three, obstruction in two, and bowel perforation in three cases. Nineteen patients in the emergent group underwent a subsequent successful semielective colonic resection within 8.1 days (range, 2 to 30 days) of stent insertion. There were two cases (11.1%) of major and four cases (22.2%) of minor postoperative complications in this series. No anastomotic leaks were observed. Mean postoperative hospitalization was 10.1 days (range, 5 to 45 days). Endoscopic stent insertion is a relatively simple procedure providing an effective first-line treatment for relief of symptoms of acute malignant colorectal obstruction, preventing acute perforation, and serving either as a preoperative procedure (allowing lower morbidity semielective surgery) or as palliative care.

scholarly journals Long-Term Colon Stent Patency for Obstructing Colorectal Cancer Combined with Bevacizumab

2017 ◽  
Vol 11 (3) ◽  
pp. 711-717 ◽  
Author(s):  
Anouk E.J. Latenstein ◽  
Mathijs P. Hendriks ◽  
Emo E. van Halsema ◽  
Jeanin E. van Hooft ◽  
Anne-Marie van Berkel
Keyword(s):  
Colorectal Cancer ◽  
Stent Placement ◽  
Large Bowel Obstruction ◽  
Metal Stents ◽  
Colon Tumor ◽  
Stent Patency ◽  
Angiogenic Therapy ◽  
Self Expanding Metal Stents ◽  
Palliative Setting

Self-expanding metal stents can be considered as initial treatment for malignant large bowel obstruction in the palliative setting. It is suggested that systemic anti-angiogenic therapy increases the risk of stent perforation. We report a 65-year-old woman with a metastatic, obstructing colon tumor who has been successfully treated with stent placement and chemoimmunotherapy consisting of capecitabine and bevacizumab for 8 years.

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