Stent Applications for Palliative Treatment in Advanced Stage Esophageal Cancers

Background and Aim. Endoscopic stenting is a generally safe and effective palliative treatment for esophageal malignancies. In this study, we aimed to present endoscopic stent applications, adverse events, and relative advantages of covered versus uncovered stents in our center. Methods. We examined cases of endoscopic stenting for palliative treatment of advanced stage esophageal cancers between January 2014 and July 2019. Age, gender, location of mass, adverse events, survival time, and stent type were evaluated. Outcomes of fully covered and uncovered self-expanding stents were compared with regard to adverse events, including stent migration and occlusion. Results. The mean age of the patients was 66.4 ± 1 , 52 were male, and 8 were female. Patients were followed up for a mean of 133 days. The most common complication due to stenting was migration. 13 patients developed adverse events. Migration was the most common adverse event, occurring in 8 (13%) patients. Although the migration rate of fully covered stents was higher than uncovered stents, there was no statistically significant difference ( p = 0.47 ). Stent occlusion was observed in 4 patients. In three cases, it was due to the tumor; an uncovered stent was placed again in these cases. Food-related occlusion developed in one patient. There was no statistical difference in terms of overall adverse event rate when comparing fully covered stents to uncovered stents ( p = 0.68 ). Conclusion. Endoscopic stenting is a viable palliative method with low morbidity and mortality in experienced centers. Though there are relative advantages with covered versus uncovered stents in individual cases, the overall adverse event rate is low and relatively similar.

Clinical evaluation the success rate and complications of fluoroscopically guided removal of tracheal tube metallic stents

Background Long-term placement of airway stents has a high probability of restenosis of the airway due to granulation tissue hyperplasia, and it is difficult to remove the stent. Our aim is to evaluate the success rate and complications of removal of tracheal tube metallic stents under fluoroscopic guidance, and to compare the difference between uncovered stent and covered stent. Methods We retrospectively reviewed 45 cases (31 males and 14 females; age, 12–71 years) of tracheal metallic stent removal performed at our center between January 2014 and December 2019. Covered stents were applied in 36 cases, and uncovered stents were applied in 9 cases. In the covered stent group, 15 patients presented with granulation tissue at both ends; 3 cases, with stent fracture; and 2, with stent intolerance due to severe airway foreign body sensation. In the uncovered stents group, all patients presented with granulation tissue formation; 2 patients, with stent fracture; and 1 patient, with stent intolerance. Results A total of 41 (91.1%) stents were successfully removed (34 [94.4%] in the covered stent group and 7 [77.8%] in the uncovered stent group). The average duration of stent placement was 3.2 ± 0.7 and 2.5 ± 1.2 months in the covered stent group and uncovered stent group, respectively. With regard to the complications, hemoptysis occurred in 4 cases (average blood volume lost, 100 ml), tracheal mucosa tear occurred in 5 cases, tracheal collapse requiring emergency airway stent placement occurred in 1 case, and tracheal rupture requiring emergency surgical suture occurred in 1 case. No procedure-related deaths occurred in either group. Conclusions It is safe to remove the metal stent of the tracheal tube under the guidance of fluoroscopy, with low complications, and can avoid the long-term placement of the airway stent.

Clinical Evaluation of Fluoroscopically Guided Removal of Tracheal Tube Metallic Stents

Background: The risk of complications associated with stent placement is high in patients with long-term airway stent placement. Our aim is to evaluate the removal of tracheal tube metallic stents under fluoroscopic guidance.Methods: We retrospectively reviewed 45 cases (31 males and 14 females; age, 12–71 years) of tracheal metallic stent removal performed at our center between January 2014 and December 2018. Covered stents were applied in 36 cases, and uncovered stents were applied in 9 cases. In the covered stent group, 15 patients presented with granulation tissue at both ends; 3 cases, with stent fracture; and 2, with stent intolerance. In the uncovered stents group, all patients presented with granulation tissue formation; 2 patients, with stent fracture; and 1 patient, with stent intolerance. Results: A total of 41 (91.1%) stents were successfully removed (34 [94.4%] in the covered stent group and 7 [77.8%] in the uncovered stent group). The average duration of stent placement was 3.2 ± 0.7 and 2.5 ± 1.2 months in the covered stent group and uncovered stent group, respectively. With regard to the complications, hemoptysis occurred in 4 cases (average blood volume lost, 100 ml), tracheal mucosa tear occurred in 5 cases, tracheal collapse requiring emergency airway stent placement occurred in 1 case, and tracheal rupture requiring emergency surgical suture occurred in 1 case. No procedure-related deaths occurred in either group. Conclusions: Fluoroscopically guided removal of tracheal tube metallic stents is safe, and may reduce the complications associated with long-term stent placement.

Endoscopic placement of covered versus uncovered self-expandable metal stents for palliation of malignant gastric outlet obstruction

ObjectiveStenting is an established endoscopic therapy for malignant gastric outlet obstruction (mGOO). The choice of stent (covered vs uncovered) has been examined in prior randomised studies without clear results.DesignIn a multicentre randomised prospective study, we compared covered (CSEMS) with uncovered self-expandable metal stents (UCSEMS) in patients with mGOO; main outcomes were stent dysfunction and patient survival, with subgroup analyses of patients with extrinsic and intrinsic tumours.ResultsOverall survival was poor with no difference between groups (probability at 3 months 49.7% for covered vs 48.4% for uncovered stents; log-rank for overall survival p=0.26). Within that setting of short survival, the proportion of stent dysfunction was significantly higher for uncovered stents (35.2% vs 23.4%, p=0.01) with significantly shorter time to stent dysfunction. This was mainly relevant for patients with extrinsic tumours (stent dysfunction rates for uncovered stents 35.6% vs 17.5%, p<0.01). Subgrouping was also relevant with respect to tumour ingrowth (lower with covered stents for intrinsic tumours; 1.6% vs 27.7%, p<0.01) and stent migration (higher with covered stents for extrinsic tumours: 15.3% vs 2.5%, p<0.01).ConclusionsDue to poor patient survival, minor differences between covered and uncovered stents may be less relevant even if statistically significant; however, subgroup analysis would suggest to use covered stents for intrinsic and uncovered stents for extrinsic malignancies.

Stent performance in palliative transhepatic treatment of malignant biliary obstruction: a randomized study comparing covered versus uncovered stents

Background Considering the limitations in both uncovered self-expandable metallic stents (USEMS) and covered self-expandable metallic stents (CSEMS), it is difficult to make a general recommendation for their application in percutaneous decompression of malignant biliary obstruction (MBO). Purpose To compare percutaneous transhepatic CSEMSs versus USEMSs for the palliative treatment of MBO in terms of technical success, clinical success, stent patency, patient survival, complications, and stent dysfunction. Material and Methods This prospective randomized study included 66 patients with unresectable MBO. CSEMSs were inserted in 31 patients (26 men, 5 women; mean age = 63.8 ± 7.96 years) and USEMSs were inserted in 35 patients (26 men, 9 women; mean age = 62.3 ± 11.7 years). Results Mean primary stent patency duration was 138 ± 92.7 days in CSEMSs versus 150 ± 77.9 days in USEMSs ( P = 0.578). Tumor overgrowth occurred exclusively in one patient with CSEMS ( P = 0.470) and tumor ingrowth exclusively in two patients with USEMS ( P = 0.494). Stent migration occurred in two patients with CSEMSs versus one patient with USEMSs ( P = 0.579). Hemobilia occurred in five patients with CSEMSs versus three patients with USEMSs while bile leakage occurred in one patient in each group despite the larger introducer sheath caliber with CSEMSs (9 F vs. 6–7 F). There was no significant difference regarding patient survival ( P = 0.969). Conclusion In our cohort of patients with rather poor life expectancy, there was no significant difference between covered and uncovered stents for the palliative treatment of MBO. However, considering the higher cost of CSEMs and the larger introducer diameter necessary for their placement, USEMSs can be preferred.

COMPARATIVE EVALUATION OF THE USE OF COATED AND UNCOATED SELF-EXPANDABLE METALLIC STENTS IN MALIGNANT COLORECTAL OBSTRUCTION

THE OBJECTIVE was to compare the efficacy and rate of complications in patients of groups with uncovered and covered colorectal stents.METHODS AND MATERIALS. The study included 102 patients who were admitted for emergency with symptoms of malignant colon obstruction, who were randomly installed covered and uncovered SEMS from December 2012 to September 2017.RESULTS. Clinical success was achieved with uncovered stents in 98 % of cases and 96 % with covered stents (relative risk (RR) 1.02). 95 % confidence interval (CI) 0.954–1.092). The incidence of complications in the group of uncovered stents was 9.8 %, in the group of covered stents – 3.9 % (RR 0.938, CI 0.841–1.046); the frequency of recurrences of obstruction did not significantly different between groups. The median duration of cumulative stent patency was 181 days in the group of uncovered stents and 218 days in the group of covered stents (p=0.427), the difference was statistically insignificant.CONCLUSION. The use of double covered and double uncovered stents is equally effectively and safely for patients with malignant colorectal obstruction. The frequency of reobstructions did not exceed 4 % and did not differ in the groups of covered and uncovered stents. The choice of the type of stent should be determined individually depending on the clinical situation.

ePTFE/FEP stents for malignant biliary obstruction

BackgroundBiliary obstruction due to malignant disease causes debilitating symptoms and palliation of the disease involves placement of biliary stents. Covered self-expanding metal biliary stents may provide a longer patency and a lower risk of complications and dysfunction compared to uncovered stents, making them better for patients’ quality of life and cost effectiveness. This study aims to evaluate the indications and outcomes for a group of cases where expanded polytetrafluoroethylene/fluorinated ethylene propylene (ePTFE/FEP) covered metal stents were used to palliate malignant biliary obstruction.MethodsAll cases of ePTFE/FEP-covered Viabil stent implantation in a 4-year period in a single hospital were identified and details of indications and outcomes for stent placement were recorded. Kaplan-Meier estimator analysis was used to create plots for stent patency and survival time.ResultsThe median stent patency was 173 days (standard error of the mean, SE = 54) and the median survival time was 247 days (SE = 88). No complications of stent implantation were recorded and in seven cases no dysfunction was noted. In one case, tumour ingrowth was observed, and in one other case the stent was no longer found in situ on subsequent imaging.ConclusionThe use of the ePTFE/FEP-covered Viabil stent in the palliation of malignant obstruction where indicated is promising, providing a low rate of stent dysfunction and complications. More data need to be collected to conclusively ascertain whether covered stents have a longer patency and lower complication rate compared to uncovered stents.