Stent For Decompression Research Articles

23. 3D printed decompression stent for the treatment of extensive odontogenic cysts

23. 3D printed decompression stent for the treatment of extensive odontogenic cysts

Self-Retaining Decompression Stent.

Decompression of odontogenic cysts is valuable in large cysts involving vital structures and cysts in pediatric and geriatric age-groups. The use of red rubber catheters, nasopharyngeal airways, intravenous tubing, nasal cannula tubing, and tuberculin syringes has been reported in catheterization of odontogenic cysts. These methods require some means of securing them to the tissues, like suturing or the use of screws. We propose a new technique of making a self-retaining decompression stent from pediatric endotracheal tube. The technique is simple and effective.

The safety and application of Molloplast-B customised decompression stent for Odontogenic cysts – A single surgeon experience

The safety and application of Molloplast-B customised decompression stent for Odontogenic cysts – A single surgeon experience

Patient-orientated removable space maintainer as a decompression stent

Fig. 1. Panoramic radiograph taken at the first visit showing the dentigerous cyst around the unerupted right mandibular first premolar. The tooth germ of the right mandibular premolars has also been displaced. ecompression is one of conservative ways to treat odonogenic cysts in children.1 This includes opening the cystic avity and preserving the patency between the cyst and the ral environment using a stent. It helps to alleviate cystic presure, and allows the impacted tooth to erupt spontaneously. everal decompression stents or tubes have been introduced nd used successfully.2–4 However, it is inevitable that the hild will have some discomfort from repetitive mechanial trauma during the treatment.3 There may also be a risk f delayed infection because there is no way to prevent mpaction of food or contamination. Here we describe an alternative technique to minimise he possible complications, which consists of a removable pace maintainer and communicating tube with a retractable ap. The removable appliance can preserve the edentulous pace and recover masticatory function simultaneously.4 The assage to the cystic cavity can be opened when it needs to e cleaned, or closed during feeding, by adjusting the cap of he tube (Eppendorf® PCR tube; Sigma-Aldrich, St Louise, O, USA). The use of the capping system may reduce the isk of delayed infection.

Endoscopic ultrasound-guided gastroenterostomy using a lumen-apposing self-expanding metal stent for decompression of afferent loop obstruction.

Acute afferent loop syndrome following pancreaticoduodenostomy is generally caused by mechanical occlusion due to pancreatic cancer recurrence. Historically, it has been treated with palliative surgical bypass [1–5]. A retrograde endoscopic approach with placement of an enteral metal stent across the afferent limb stricture is often not possible [2]. We report the first case series of endoscopic ultrasound (EUS)-guided gastrojejunostomy using a lumen-apposing, self-expanding, metal stent (LASEMS) for therapy of acute afferent loop syndrome. Three patients who had previously undergone a pancreaticoduodenostomy for pancreatic cancer presented with acute abdominal pain and vomiting. Computed tomography revealed dilation of the afferent loop caused by bowel obstruction due to cancer recurrence (● Fig.1). All three patients underwent successful EUS-guided gastroenterostomy using LASEMS. The dilated afferent limb was located endosonographically by an echoendoscope in the stomach. The obstructed afferent limb was then punctured using a 19-gauge EUS needle. Contrast was injected through the 19-gauge needle into the dilated afferent limb to confirm the position, and a 0.035-inch guidewire was introduced through the needle and coiled into the obstructed afferent limb. Needle-knife cautery was used to make an incision into the fistula tract, and then a 6-mm balloon was used to dilate the tract (● Fig.2,● Video 1). A 15mm×10mm LASEMS (Axios; Boston Scientific Corp., Marlborough, Massachusetts, USA) was then deployed under fluoroscopic guidance across the tract, resulting in apposition between the dilated afferent limb and the stomach wall. A 15-mm balloon was then used to dilate the tract within the lumen of the LASEMS to create an endoscopic gastrojejunostomy for drainage of the obstructed afferent limb (● Fig.3,● Video 1). All three patients had resolution of clinical symptoms (● Fig.4) and were discharged. This series demonstrates that EUS-guided gastroenterostomy involving LASEMS placement offers a safe, technically feasible, and clinically successful endoscopic method of management for acute afferent loop obstruction.

The design and construction of a decompression stent for extensive odontogenic cysts

Introduction: Nasopharyngeal tubes have been used to decompress extensive odontogenic cysts following marsupialisation. Some patients report experiencing mucosal soreness and occlusal interference. In order to construct a flexible and durable decompression stent, we present the design and laboratory method of using “Monoplast B”, a heat cure permanent soft liner.

Customised decompression stent for extensive odontogenic cysts

Customised decompression stent for extensive odontogenic cysts

Comparison of a Newly Designed Double-Layered Combination Covered Stent and D-Weave Uncovered Stent for Decompression of Obstructive Colorectal Cancer: A Prospective Multicenter Study

Stent reocclusion and migration are the most important complications after stent insertion. To overcome both problems, a double-layered combination covered stent was developed. Our purpose was to compare the efficacy and safety of the newly designed double-layered combination covered stent (Niti-S enteral colonic stent, Comvi type) and the double-wire woven uncovered stent (Niti-S enteral colonic stent, D-type) in the treatment of malignant colorectal obstructions. Sixty-eight patients with obstructive colorectal cancer underwent stent placement for preoperative decompression (n = 30) or palliative purpose (n = 38) at 6 medical centers. Combination covered stents were used in 31 patients and uncovered stents were used in 37 patients. There were no significant differences between both stents in terms of technical and clinical success rates. Regarding complications after stent insertion, there was no significant difference in early stent occlusion and migration rate between the combination covered stents and the uncovered stents. Despite a trend toward lower rates of late stent occlusion in the combination covered stent group, there was no significant difference in the rate of late stent occlusion by tumor ingrowth between the 2 groups (0% vs 20%, respectively; P = .107), and late stent migration occurred significantly more often with the combination covered stent (22.2% vs 0%, respectively; P = .041). However, we observed no significant difference in the overall late-complication rates and stent patency duration between the 2 groups. In our study, we could not prove that the newly designed double-layered combination covered stents have preventive advantages in stent migration compared with the uncovered stent.

T1595 Cystogastrostomy, Retroperitoneal Drainage and G-J Entereal Alimentation for Complex Pancreatitis-Associated Pseudocyst: 19 Patients with No Recurrence

Introduction: Various techniques have been described to achieve resolution without recurrence of complex acute pancreatitis associated pseudocysts (PAC). Many strategies, inclusive of open, minimally invasive and radiological procedures are hampered by high recurrence or failed resolution, particularly for PAC near the pancreatic head. The present series describes a multimodal strategy combining open anterior gastrostomy for the creation of a stapled posterior cystogastrostomy, placement of an 8 french secured silastic tube for intentional formation of a cystogastric fistula tract in combination with gastric drainage and post duodenal enteral alimentation. Material and Methods: Using a prospectively maintained hepatobiliary database, patients with complex PAC undergoing the above management were identified. PAC location, postoperative length of stay (LOS), time to enteral were identified. PAC were assessed by CT scan prior to operation, one month after drainage and patients with PAC resolution were started on oral diet, with the fistula silastic tube kept in place for an additional month. Results: Over the interval 2003-2008, 19 patients were managed with the stated strategy. PACs were located at the pancreatic body/tail in 12 patients and 7 patients had PAC at the level of the pancreatic head/neck area.17/19 had undergone ERCP with decompression stent placement and 13/19 had a failed percutaneous drainage. There was no perioperative mortality after open surgical drainage. All patients started on jejunal tube feeding 24 hs after surgical procedure. Median postoperative LOS was 7 days (4-13). At one month 16/19 (84%) of patients showed complete resolution of the PAC on CT scan and were started on oral diet, 3/19 required additional month for complete resolution. There were no PAC recurrences in any of these patients demonstrated on follow up. Conclusion: The described strategy is safe, efficient and allows early restoration of enteral feeding with early hospital discharge. High resolution rates and absence of PAC recurrences in this series support s this approach for complex PAC.

Comparison of a Newly Designed Niti-S D-Weave Combination Covered Stent and Niti-S D-Weave Uncovered Stent for Decompression of Obstructive Colorectal Cancer: A Randomized Prospective Controlled Multicenter Study

Background: Uncovered and covered stent have been used for the decompression of gastrointestinal obstruction by cancer with contrary merit and demerit each other. The reobstruction due to tumor ingrowth and migration is the most important problem in stent insertion. To overcome these problems, the Niti-S D-Weave uncovered stent and its double layered covered stent (Taewoong Medical Co., Seoul, Korea) have been developed. The Niti-S D-Weave uncovered stent was designed to have good conformability and less migration, and its double layered covered stent (Niti-S D-Weave combination covered) consists of an interposing PTFE (polytetrafluorethylene) membrane to prevent tumor ingrowth and an outer uncovered nitinol wire to allow the stent to embed itself in the colorectal cancer to prevent migration. Aim: To compare the effectiveness of Niti-S D-Weave combination covered stent and Niti-S D-Weave uncovered stent in the decompression of colon obstruction and the prevention of migration and tumor ingrowth in patients with obstructive colorectal cancer. METHOD: Between June 2004 and May 2005, sixty-seven patients from five medical centers were treated with stent insertion for preoperative decompression or palliative purpose. Patients were randomized to either Niti-S D-Weave combination covered or Niti-S D-Weave uncovered stent group. Results: In sixty-seven patients (40 males; mean age 65.7 ± 14.5 years), twenty nine patients were treated for bridge to surgery and 38 patients for palliation of incurable colorectal cancer. Technical and clinical success rates of both groups were not statistically different (92.9% vs. 100% and 96.4% vs. 97.4% respectively). In surgical finding of colorectal cancer with Niti-S D-Weave combination covered stent, PTFE membrane blocked the tumor ingrowth and the wire of outer layer of stent was embedded into tumor, being expected to prevent migration. As early complications within 7 days after stent insertion, early stent occlusion and migration were not different in both groups. In stent insertion for the palliative purpose, delayed stent occlusion by tumor ingrowth occurred in 5 of 22 patients (22.7%) with Niti-S D-Weave uncovered stent and 1 of 16 (6.3%) with Niti-S D-Weave combination covered stent. Delayed stent migration occurred in only 3 (18.8%) patients with Niti-S D-Weave combination covered stent. However, the rates of delayed stent occlusion and migration were not statistically different in both groups. Conclusion: Newly designed double-layered covered stent (Niti-S D-Weave combination covered stent) could be useful in preventing both the stent migration and the tumor ingrowth after stent insertion.

Decompression and cystectomy of the odontogenic keratocysts of the mandible: a clinical study.

Owing to the aggressive nature of OKC's if one could stop or even reverse the growth of the cyst with a simple procedure like decompression, regardless of the histologic type, it would be an alternative to radical and disfiguring surgery. Eight patients who were diagnosed with Odontogenic keratocyst of the mandible were chosen and the first stage of treatment being, insertion of the decompression stent into the most prominent or dependent part of the cystic cavity. Then based on assessment of regular second monthly OPG radiograph the second stage ie. Enucleation of the cyst and treatment of the cystic cavity with Carnoy's solution was carried out, when the size of the cystic cavity had decreased. The radiographs of all the patients were analyzed at a two month interval and compared with the pre operative radiograph. The percentage of change in radiodensity of the lesion ranged from 35.15% to 66.16% with a mean decrease of 53.85%. This also indicated that the quantum of bone regeneration which occurred simultaneously and as observed during the cystectomy procedure was commendable. Reduction of surgical morbidity while preserving anatomy and function, is the greatest advantage of decompression, however one should not forget the emphasis on the value of long term studies needed to be carried out with regular follow-up, to keep a check on those patients treated with decompression.

Single Operator EUS-Guided Cholangiopancreatography (EUSCP) for Difficult Pancreaticobiliary Access

Background: Intradiverticular papillae, periampullary tumor infiltration, and obstructing downstream pancreatic strictures and stones may lead to therapeutic ERCP failure. When conventional ERCP methods have failed, EUSCP may be an adjunct for difficult pancreaticobiliary access. Limited data exists on a single-operator technique. Methods: Transenteric bile duct (BD) or pancreatic duct (PD) puncture was attempted using a 19G or 22G FNA needle followed by contrast injection and antegrade placement of a 0.035” or 0.018” wire ideally across the papilla for rendezvous ERCP. Results: 9 patients (5F, 4M, mean age 64) underwent attempted EUSCP after failed attempts at ERCP for BD (N = 6) or PD (N = 3) access. Anatomical reasons for failed ERCP included: intradiverticular papillae (N = 4), periampullary tumor infiltration with duodenal compression (N = 2), and downstream PD obstruction from chronic pancreatitis (N = 3). Interventions at time of EUS-guided cholangiogram: sphincterotomy and stone extraction (N = 1), transpapillary stent for malignant obstruction (N = 2), transduodenal stent (N = 1), sphincterotomy for papillary stenosis (N = 1), and failed attempt to puncture the BD due to angulation (N = 1). Antegrade transpapillary wire placement was not possible in the papillary stenosis case but ERCP was facilitated by EUS-cholangiography enhancing visualization of the papilla on the rim of a diverticulum. EUS-cholangiography also served as a fluoroscopic landmark for retrograde cannulation in the case of periampullary tumor infiltration. The patient with transduodenal stent placement had an intradiverticular papilla with obstructing downstream biliary stones that prohibited transpapillary wire placement. She required PTC and rendezvous ERCP for sphincterotomy and stone extraction. Interventions at time of EUS-guided pancreatography: transgastric pancreatic duct stent for decompression (N = 1), rendezvous ERCP via the minor papilla with sphincterotomy, pancreatoscopy with electrohydraulic lithotripsy, and stone extraction (N = 1), retrograde stricture dilation and stent placement for chronic pancreatitis (N = 1). Overall, 6/9 (67%) had successful retrograde ductal access at the same procedure as EUSCP. Conclusions: 1. In this preliminary series, single-operator EUS-guided cholangiopancreatography is successful in gaining retrograde access for difficult ERCP in the majority of patients with obstructed ducts. 2. Obstruction from papillary stenosis or stones may limit successful antegrade placement of the wire across the papilla but EUSCP may enhance endoscopic visualization of the papilla and/or serve as a fluoroscopic landmark to facilitate retrograde cannulation.

Conservative treatment of large cystic lesions of the mandible: a prospective study of the effect of decompression

Our aim was to evaluate prospectively the effects of decompression as the primary treatment of large mandibular cysts, irrespective of their histological type. Twenty patients with large mandibular cysts completed treatment successfully. After a mean duration of decompression of 446 days, cysts had shrunk by a mean of 81%. Mean follow-up was 527 days after removal of the decompression stent and removal of the cyst. There were no recurrences. The advantages of this approach are simplicity, immediate gathering of information on the type of cyst with simultaneous start of treatment, low morbidity and low incidence of complications during treatment. Despite the length of the treatment, we recommend the use of decompression stents in the treatment of large mandibular cysts.

Host, heredity and helicobacter

<h3>Introduction</h3> Extracorporeal shock wave lithotripsy (ESWL) of pancreatic duct stones, followed by endoscopic retrograde cholangio-pancreaticography (ERCP) with mechanical clearance of the pancreatic duct, and subsequent stenting is an established treatment...

A modified stent for decompression of cysts

A modified stent for decompression of cysts

A modified stent for decompression of cysts

Presented is a simple method for decompression of a cyst with the use of a modified stent. The patient is instructed in methods of removal, insertion, and irrigation by means of a blunt No. 16 gauge needle. Periodic follow-up radiographic examinations permit reduction in tube length as the defect “fills in” (Figs. 3 and 4).