scholarly journals Enterocutaneous fistulas due to stent migration. How reliable is its use on duodenal benign pathology? a case report

2020 ◽  
Vol 8 (6) ◽  
pp. 2316
Author(s):  
Aldo Edyair Jimenez Herevia ◽  
Luis Montiel Hinojosa ◽  
Diego Hinojosa Ugarte ◽  
Erick Martin Paez Hernandez ◽  
Enrique Obregon Moreno
Keyword(s):  
Enterocutaneous Fistula ◽  
Duodenal Bulb ◽  
Exploratory Laparotomy ◽  
Stent Migration ◽  
Metal Stents ◽  
Benign Pathology ◽  
Extraction Site ◽  
Self Expanding Metal Stents ◽  
Hepatopancreatobiliary Surgery ◽  
The Right

Duodenal stenting has been widely used on malignant pathology on selected patients with poor prognosis and advanced disease. In these last years, there has been a clear ampliation of the clinical applications of endoscopy procedures and stents. Its use on benign pathology is spreading but there is a lack of literature about the complications in this context. The incidence of stent migration is about 10-25% in self-expandable metal stent (SEMS), and 2-5% on covered self-expanding metal stents (CSEMS). We reported a clinical case of a 48 years old patient who developed a duodenal ulcer. The patient was submitted to exploratory laparotomy, with duodenal primary closure of the ulcer. Later, the patient developed a enterocutaneous fistula because of the duodenal leak. It was referred to our third level hospital to the hepatopancreatobiliary surgery service. A new exploratory laparotomy with duodenal exclusion was planned, but it was impossible to access due to frozen abdomen. CSEMS was placed in the duodenal bulb resulting in the resolution of leaking, but the stent could not be removed because of migration. The stent trajectory was followed by abdominal x ray and tomography. The patient developed multiple intestinal an fecal enterocutaneous fistulas. It was submitted to multiples endoscopies, colonoscopies and enteroscopy without any success to reaching it. It was decided to perform a right lumbotomy to extract the prothesis. The stent was surgically removed, a planned stoma was left on the right flank on the extraction site.

scholarly journals Fully-covered esophageal stent migration rates in benign and malignant disease: a multicenter retrospective study

2019 ◽  
Vol 07 (06) ◽  
pp. E751-E756 ◽  
Author(s):  
Samuel Thomas ◽  
Ali Siddiqui ◽  
Linda Taylor ◽  
Sheeva Parbhu ◽  
Christopher Cao ◽  
...  
Keyword(s):  
Migration Rate ◽  
Malignant Disease ◽  
Stent Migration ◽  
Metal Stents ◽  
Common Complication ◽  
Migration Rates ◽  
Different Types ◽  
Self Expanding Metal Stents ◽  
Insight Into ◽  
Total Migration

Abstract Background and study aims Stent migration is a common complication of fully-covered self-expanding metal stents (FCSEMS), but the rate of clinically relevant migration as defined by stent migration followed by reintervention via endoscopy for stent replacement is unknown. The goal of this study is to gain insight into the total migration rate and clinically relevant migration rate of different types of FCSEMS placed within benign and malignant strictures with specific attention paid to stent manufacturer, diameter, and length. Patients and methods Multicenter retrospective analysis of endoscopic data from patients with FCSEMS placed within benign or malignant strictures. FCSEMS used included a variety of sizes and manufacturers. Results A total of 369 patients were included, 161 of whom had benign strictures and 208 of whom had malignant strictures. The total migration rate and clinically relevant migration rate in benign strictures were 30 % and 17 %, respectively. For benign strictures, Wallflex stents had a clinically relevant migration rate of 15 %, compared to Endomaxx stents with 19 %, and Evolution stents with 25 % (P = 0.52). The total migration rate and clinically relevant migration rates in malignant strictures were 23 % and 14 %, respectively. Evolution stents had a significantly higher clinically relevant migration rate (29 %) than the Wallflex stents (7 %) and the endomaxx stents (12 %), P = 0.003. Conclusion This study is the largest to investigate migration rates for FCSEMS in benign and malignant strictures. Clinically relevant migration is a relatively common occurrence with all stent types studied and better anti-migration features are needed.

Endoscopic suturing of esophageal fully covered self-expanding metal stents reduces rates of stent migration

2017 ◽  
Vol 86 (6) ◽  
pp. 1015-1021 ◽  
Author(s):  
Benjamin L. Bick ◽  
Thomas F. Imperiale ◽  
Cynthia S. Johnson ◽  
John M. DeWitt
Keyword(s):  
Stent Migration ◽  
Metal Stents ◽  
Endoscopic Suturing ◽  
Self Expanding Metal Stents

Small caliber covered self expanding metal stents in the management of malignant dysphagia.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 151-151
Author(s):  
Steven Kucera ◽  
Ravi Shridhar ◽  
Jason Klapman ◽  
Cynthia L. Harris ◽  
Sarah E. Hoffe ◽  
...  
Keyword(s):  
Migration Rate ◽  
Stent Migration ◽  
Distal Esophagus ◽  
Lumen Diameter ◽  
Metal Stents ◽  
Dysphagia Score ◽  
Migration Rates ◽  
Malignant Dysphagia ◽  
Self Expanding Metal Stents ◽  
Stent Lumen

151 Background: Use of large caliber ( ≥ 18 mm body diameter) self expanding metal stents (SEMS) for management of malignant dysphasia is associated with substantial adverse event (AE) and mortality rates (MRs). We sought to determine dysphagia response, stent migration rates, and AE and MRs, for small caliber covered SEMS (sccSEMS) with body diameters (BDs) between 10 - 16 mm in malignant dysphagia. Methods: We identified 31 patients underwent direct endoscopic placement of 50 sccSEMS. Patients were monitored for change in dysphagia score (DS), stent migration, AEs, and death. Results: The cohort consisted of 23 (74%) men and 8 (26%) women with a median age of 64 years (35 - 87 years). Esophageal adenocarcinoma (AC) was present in 19 (61%) patients and squamous cell carcinoma (SCCA) in 12 (39%) patients. Of the patients with SCCA, 2 tumors were located in the proximal esophagus, 7 in the mid-esophagus and 3 in the distal esophagus. All 19 ACs were located in the distal esophagus. The AJCC clinical stages at time of sccSEMS placement were: 1 (3%) Stage II, 8 (26%) Stage III, and 22 (71%) Stage IV. The initial pre-stent lumen diameter was less than 8 mm in 77% (24/31) of patients. The initial pre-stent lumen diameter was equal to 9 mm in 1 patient (3%), equal to 10 mm in 4 patients (13%), and equal to 11 mm in 2 patients (6%). The median pre-stent tumor length was 5.0 cm (interquartile range 4.0 – 7.0 cm). Dysphagia score improved in 30 of 31 patients (97%). The median DS decreased from 3 to 2 (p < 0.0001). The median effective duration of first sccSEMS placement was 116 (95% CI: 75-196) days. Major and minor AE rates were 6.5% and 19.4% respectively. No stent related deaths were encountered. The overall migration rate was 36% (18/50). The anticipated migration rate was 45.7% (16/35) and the unanticipated migration rate was 13.3% (2/15) (p = 0.052). Positive effective clinical outcome occurred in 93.5% (29/31) of cases. Conclusions: In malignant dysphagia, direct endoscopic sccSEMS placement provided acceptable dysphagia control and migration rates with substantial reductions in stent related AEs and MRs compared to those reported for large caliber SEMS.

scholarly journals The Use of Self-Expanding Plastic Stents in the Management of Oesophageal Leaks and Spontaneous Oesophageal Perforations

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
L. H. Moyes ◽  
C. K. MacKay ◽  
M. J. Forshaw
Keyword(s):  
Stent Migration ◽  
Plastic Stents ◽  
Metal Stents ◽  
High Morbidity ◽  
Use Of Self ◽  
Prolonged Hospitalisation ◽  
Self Expanding Metal Stents ◽  
Food Bolus Impaction ◽  
Bolus Impaction ◽  
Polyflex Stent

Leakage after oesophageal anastomosis or perforation remains a challenge for the surgeon. Traditional management has been operative repair or intensive conservative management. Both treatments are associated with prolonged hospitalisation and high morbidity and mortality rates. Self-expanding metallic stents have played an important role in the palliation of malignant oesophageal strictures and the treatment of tracheoesophageal fistulae. However, self-expanding metal stents in benign oesophageal disease are associated with complications such as bleeding, food bolus impaction, stent migration, and difficulty in retrieval. The Polyflex stent is the only commercially available self-expanding plastic stent which has been used in the management of malignant oesophageal strictures with good results. This review will consider the literature concerning the use of self-expanding plastic stents in the treatment of oesophageal anastomotic leakage and spontaneous perforations of the oesophagus.

scholarly journals 1701 A Systematic Review of The Use of Stents in The Treatment of Bariatric Surgery Complications

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
O Barbouti ◽  
J Wei
Keyword(s):  
Bariatric Surgery ◽  
Observational Studies ◽  
Stent Migration ◽  
Success For All ◽  
Metal Stents ◽  
Surgery Complications ◽  
Endoscopic Stents ◽  
Bariatric Surgery Complications ◽  
Bariatric Complications ◽  
Self Expanding Metal Stents

Abstract 41 retrospective observational studies were identified of 792 obese and super obese patients treated with endoscopic stents for bariatric surgery complications including leaks (n = 770) and strictures (n = 22) post-Roux en Y gastric bypass (n = 228) and sleeve gastrectomy (n = 534). The main outcomes of the studies were the percentage success of stent therapy and percentage stent migration. Stents included self-expanding metal stents (SEMS), including partially covered self-expanding metal stents (PcSEMS) and fully covered self-expanding metal stents (FcSEMS). Several SEMS used were specifically designed for bariatric complications, being larger in diameter to reduce migration. The pooled percentage success for all patients (SG and RYGB) was 80.81% with stent migration occurring in 24.67% in all groups. The pooled percentage success for the RYGB group was 80.28% and in the LSG group was 85.86% with percentage migration occurring in 20.65% and 23.82% respectfully.

scholarly journals Propensity score‐matched comparison of stenting as a bridge to surgery and emergency surgery for acute malignant left‐sided colonic obstruction

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yuepeng Cao ◽  
Qing Chen ◽  
Zhizhan Ni ◽  
Feng Wu ◽  
Chenshen Huang ◽  
...  
Keyword(s):  
Overall Survival ◽  
Propensity Score ◽  
Emergency Surgery ◽  
Perineural Invasion ◽  
Cox Regression ◽  
Colonic Obstruction ◽  
Metal Stents ◽  
Bridge To Surgery ◽  
Cox Regression Analysis ◽  
Self Expanding Metal Stents

Abstract Background Bridge to elective surgery (BTS) using self-expanding metal stents (SEMSs) is a common alternative to emergency surgery (ES) for acute malignant left-sided colonic obstruction (AMLCO). However, studies regarding the long-term impact of BTS are limited and have reported unclear results. Methods A multicenter observational study was performed at three hospitals from April 2012 to December 2019. Propensity score matching (PSM) was introduced to minimize selection bias. The primary endpoint was overall survival. The secondary endpoints included surgical approaches, primary resection types, total stent-related adverse effects (AEs), surgical AEs, length of hospital stay, 30-day mortality and tumor recurrence. Results Forty-nine patients in both the BTS and ES groups were matched. Patients in the BTS group more often underwent laparoscopic resection [31 (63.3%) vs. 8 (16.3%), p < 0.001], were less likely to have a primary stoma [13 (26.5%) vs. 26 (53.1%), p = 0.007] and more often had perineural invasion [25 (51.0 %) vs. 13 (26.5 %), p = 0.013]. The median overall survival was significantly lower in patients with stent insertion (41 vs. 65 months, p = 0.041). The 3-year overall survival (53.0 vs. 77.2%, p = 0.039) and 5-year overall survival (30.6 vs. 55.0%, p = 0.025) were significantly less favorable in the BTS group. In multivariate Cox regression analysis, stenting (hazard ratio(HR) = 2.309(1.052–5.066), p = 0.037), surgical AEs (HR = 1.394 (1.053–1.845), p = 0.020) and pTNM stage (HR = 1.706 (1.116–2.607), p = 0.014) were positively correlated with overall survival in matched patients. Conclusions Self-expanding metal stents as “a bridge to surgery” are associated with more perineural invasion, a higher recurrence rate and worse overall survival in patients with acute malignant left-sided colonic obstruction compared with emergency surgery.

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