Self-expanding nitinol stent in combined treatment of bleeding from esophageal varices

Abstract

Aim. To assess the capabilities of endoscopic hemostasis using self-expanding nitinol stents as an alternative to balloon tamponade using Sengstaken-Blakemore probe-obturator in the combined treatment program of patients with acute bleeding from esophageal varices.Methods. In 15 of the 266 patients with portal hypertension of various origins and with high risk of rebleeding (or at the height of the latter) endoscopic hemostasis with Danis self-expanding nitinol stents was performed instead of the traditional balloon tamponade using Sengstaken-Blakemore probe-obturator.Results. In all 15 cases, the Danis stent was inserted under intravenous general anesthesia with preservation of spontaneous breathing, using direct laryngoscopy. 5 of the 15 inserted by the manufacturer’s instructions stents (33.3%) migrated into the stomach: 1 did not deploy at all, 4 were in the expanded form. 10 (66.7%) stents were successfully inserted in a standard position in the esophagus without any complications. This was confirmed endoscopically immediately after the delivery device removal. In 2 of 4 patients who was inserted Danis stent at the height of esophageal bleeding, a reliable hemostasis was achieved. In none of the 15 cases, we did not observe any complications associated with the presence of the stent in the esophagus or its removal procedure. 4 of 15 patients (26.7%) died, despite the achieved endoscopic hemostasis, against the background of progressive multiple organ failure.Conclusion. Endoscopic hemostasis in a combined treatment program of patients with bleeding from esophageal varices using Danis self-expanding nitinol stents can be considered as a reasonable alternative to balloon tamponade using Sengstaken-Blakemore probe-obturator.