Esophageal Self-expandable Metal Stents Research Articles

Hemostatic powder for the management of hemorrhage from esophageal self-expanding metal stents: A case report.

Hemostatic powder for the management of hemorrhage from esophageal self-expanding metal stents: A case report.

Endoscopic self-expandable metal stent versus endoscopy vacuum therapy for traumatic esophageal perforations: a retrospective cohort study

BackgroundTraumatic esophageal perforations (TEP) are a grave medical condition and require immediate intervention. Techniques such as Esophageal Self-Expandable Metal Stent (E-SEMS) and Endoscopic Vacuum Therapy (EVT) show promise in reducing tissue damage and controlling esophageal leakage. The present study aims to compare the application of EVT to E-SEMS placement in TEP.MethodsRetrospective cohort study valuated 30 patients with TEP. The E-SEMS and EVT groups were assessed for time of hospitalization, treatment duration, costs, and clinical outcome.ResultsPatients treated with EVT (24.4 ± 13.2) demonstrated significantly shorter treatment duration (p < 0.005) compared to the group treated with E-SEMS (45.8 ± 12.9) and patients submitted to E-SEMS demonstrated a significant reduction (p = 0.02) in the time of hospitalization compared to the EVT (34 ± 2 vs 82 ± 5 days). Both groups demonstrated a satisfactory discharge rate (E-SEMS 93.7% vs EVT 71.4%) but did not show statistically significant difference (p = 0.3155). E-SEMS treatment had a lower mean cost than EVT (p < 0.05). Descriptive statistics were utilized, arranged in table form, where frequencies, percentages, mean, median, and standard deviation of the study variables were calculated and counted. The Fisher's Exact Test was used to evaluate the relationship between two categorical variables. To evaluate differences between means and central points, the parametric t-test was utilized. Comparisons with p value up to 0.05 were considered significant.ConclusionE-SEMS showed a shorter time of hospitalization, but a longer duration of treatment compared to EVT. The placement of E-SEMS and EVT had the same clinical outcome. Treatment with E-SEMS had a lower cost compared with EVT.

Prevention of Migration of Esophageal Self-Expandable Metallic Stents Using Endoscopic Clips.

Background and Objectives: Esophageal stenting with self-expandable metallic stents (SEMS), for both benign and malignant reasons, has been widely practiced for decades, but migration still remains the most common complication of the procedure. In this report we aim to review our experience and results in stent fixation with clips. Materials and Methods: We present 18 patients who underwent esophageal stenting for both benign and malignant reasons. The SEMSs used were partially covered and were fixated with two to four through the scope hemostatic clips in the proximal end of the prothesis. The procedure was performed only on patients with a high risk of migration of the stent. Results: Migration occurred in only one of the above-mentioned patients and was treated with stent repositioning. The other adverse events that occurred were related to tumor growth in patients with malignant diseases. Conclusions: Clip fixation of an esophageal self-expandable metallic stent in cases considered high-risk for migration is a safe procedure. It reduces the migration rate significantly for both benign and malignant indications.

[Safety and efficacy analysis of the removal of refractory esophageal self-expandable metal stents by stent-in-stent technique].

To evaluate the safety and efficacy of esophageal stent-in-stent (SIS) in patients with refractory esophageal self-expandable metal stents (SEMS). Case series study. Retrospective analysis was made on the patients with refractory esophageal SEMS treated with SIS technology in Zhongda Hospital Affiliated to Southeast University from June 2015 to June 2021. The success rate of stent removal and the incidence of adverse events were analyzed. A total of 12 patients were included, including 7 males and 5 females, aged 50-73 (62.7±8.5) years. The clinical success rate of the internal stents was 12/12, with the median retention time of [M(Q1, Q3), 64.5 (52.0, 90.8)] days. The postoperative displacement rate and severe stenosis incidence were 1/12 and 3/12, respectively. The esophageal stents were successfully removed in one endoscopic session in all patients. A small amount of mucous membrane extravasation occurred in all patients after SIS, and no patients died after 90 days of follow-up.

Fluoroscopic Removal of Embedded Esophageal Self-Expanding Metal Stents: Stent-in-Stent Combined with Guidewire Lasso Technique.

We report the use of the guidewire lasso technique for the removal of an embedded esophageal self-expanding metal stent (SEMS), following a failure of distal to proximal invagination by removal hook caused by stent incorporation. During a removal procedure of an embedded SEMS using the hook retrieval device, the strut fractured and the stent retained. Attempts to pull up the retained stent using hook were not effective. Thus, the lasso technique with a guidewire over the retained stent was performed and successfully removed with no procedure-related complications. The patient is alive without dysphagia after 3 months follow-up.

Spinal cord compression related to an esophageal self-expandable metal stent

Spinal cord compression related to an esophageal self-expandable metal stent

Endoscopic removal of a retained esophageal stent using the stent-in-stent technique

Video 1Stent-in-stent technique for removal of retained esophageal self-expanding metal stent.

Endoscopic extraction of a gastric foreign body by means of an esophageal self-expanding metal stent.

Endoscopic extraction of a gastric foreign body by means of an esophageal self-expanding metal stent.

Percutaneous Endoscopic Necrosectomy-A Review of the Literature.

In this article, an attempt was made to clarify the role of percutaneous endoscopic necrosectomy (PEN) in the interventional treatment of pancreatic necrosis. A comprehensive review of the current literature was performed to identify publications on the role of PEN in patients with consequences of acute necrotizng pancreatitis. The aim of the study was to review the literature on minimal invasive necrosectomy, with emphasis on PEN using esophageal self-expanding metal stents (SEMS). The described results come from 15 studies after a review of the current literature. The study group comprised 52 patients (36 men and 16 women; mean age, 50.87 (13–75) years) with walled-off pancreatic necrosis, in whom PEN using a self-expandable esophageal stent had been performed. PEN was successfully completed in all 52 patients (100%). PEN complications were observed in 18/52 (34.62%) patients. Clinical success was achieved in 42/52 (80.77%) patients, with follow-up continuing for an average of 136 (14–557) days. In conclusion, the PEN technique is potentially effective, with an acceptable rate of complications and may be implemented with good clinical results in patients with pancreatic necrosis.

Inversion technique under fluoroscopy for removal of self-expanding nitinol esophageal stent after long-term placement: review of 107 consecutive cases.

Removal of self-expanding esophageal metal stents that have been implanted for a long time can be difficult and risky. In this paper, we describe the use of the "inversion technique" under fluoroscopy for removal of self-expandable nitinol esophageal stents that have been placed for long periods and evaluate the effectiveness and safety of the method. Retrospective analysis of patients who underwent removal of self-expanding nitinol esophageal stents by the inversion technique under fluoroscopy at our center. Demographic characteristics, type of esophageal stents, stent retention time, reasons for stent removal, and related complications were collected from the case records and analyzed. A total of 112 metal esophageal stents (62 fully covered esophageal stents and 50 partially covered esophageal stents) were extracted from the 107 patients included in the study. Indications for stent implantation were malignant esophageal stenosis (27 patients), benign esophageal stenosis (42 patients), and esophageal fistula (38 patients). Median duration of stent retention was 77days (29-727days). All stents were removed successfully without major complications such as esophageal rupture, massive hemorrhage, asphyxia, or cardiorespiratory arrest. Inversion technique under fluoroscopy appears to be a safe, effective, and quick procedure for removal of self-expanding nitinol esophageal stent after long-term placement.

Use of a self-expanding metal stent to treat acute esophageal perforation in a 4-year-old child

Esophageal perforations are associated with a high morbidity and mortality in the pediatric population. Most cases are managed conservatively with antibiotics, nutritional supplementation, and percutaneous drainage of fluid collections. Direct surgical repair is reserved for patients with hemodynamic instability or evidence of clinical worsening due to the high risk of postoperative complications. Utilization of stents in the treatment of acute esophageal perforation has become well-established in adults, but evidence remains lacking in the pediatric population. We present the case of a 4-year old male with an acute esophageal perforation who was successfully treated with an esophageal self-expanding metal stent (SEMS) in lieu of direct surgical repair. He failed extubation on postoperative day (POD) 6 due to tracheal compression by the oversized stent but exhibited good healing with successful extubation on POD 13. This case report demonstrates that esophageal stents may be a promising alternative to surgical repair in the pediatric population. Further studies and trials should be performed to compare the effectiveness of esophageal stenting to direct surgical repair. Modification and downsizing of the adult SEMS design for pediatric anatomy is recommended to prevent complications such as tracheal compression and prolonged intubation.

Fluoroscopic removal of fractured, retained, embedded Z self-expanding metal stent using a guidewire lasso technique: A case report

BACKGROUNDThere are few reports of a fractured esophageal self-expanding metallic stent (SEMS) and the lasso retrieval technique, forming a guidewire loop by directing the guidewire back up the external stent for retrieval. CASE SUMMARYA 74-year-old man complained of dysphagia approximately 6 mo after radical resection of esophageal cancer. Benign anastomotic stenosis was diagnosed, and a 20 mm in diameter and 60 mm in length esophageal covered SEMS was inserted after repeated balloon dilatation. About 13.5 mo after stenting, dysphagia recurred and esophagography showed severe stenosis above the proximal stent and stent removal was performed. One-third of the stent was removed and the fractured stent remained in the proximal esophagus. A suction tube was introduced through the guidewire and then the guidewire was grabbed, acting like a “lasso” on tightening. The remaining fractured stent was successfully removed by slowly pulling back the guidewire, with no fragments of stent wires retained.CONCLUSIONThe guidewire lasso technique is a simple, effective method of removing esophageal SEMS in rare cases of stent fracture.

Сравнительный анализ стентирования и гастростомии у больных со злокачественной патологией пищевода и пищеводно-желудочного перехода

Objective — to analyze the results of esophageal stenting in comparison with gastrostomy in patients with malignant dysphagia. Material and methods. The first group consists of 100 men and 42 women with malignant dysphagia, who underwent stenting of the esophagus and cardia with self-expanding metal stents. The group consists of 142 people aged 43 to 90 years. Stenting of the esophagus in this group was performed with the aim of resolving malignant stenosis of the esophagus in 71 patients: malignant stenosis of the esophageal-gastric junction in 59 patients and extraorgan compression of the esophagus from the outside in 12 patients. The second group consisted of 164 people in the age group from 33 to 89 years — 140 men and 24 women who underwent gastrostomy by the laparotor method according to Topprover in order to resolve malignant dysphagia. Gastrostomy was imposed on 110 patients due to malignant stenosis of the esophagus: with malignant stenosis of the esophageal-gastric junction in 44 patients and as a result of external compression in 10 patients. Results. Complications in patients after stenting in the remote period occurred in 17 cases. In the group of patients who underwent gastrostomy, complications requiring gastrostomy replacement occurred in 23 patients. Death occurred in one patient as a result of specific complications after gastrostomy. Life expectancy as a percentage, regardless of the pathology of the disease, does not have a large spread in the comparison groups and is approximately the same. The results of studies on life expectancy depending on the type of treatment (stenting-gastrostomy) and the location of the tumor lesion did not reveal statistically significant differences. Conclusions. Comparison of the results of implantation of self-expanding metal esophageal stents and gastrostomy by the laparotomic method in malignant dysphagia of the esophagus and esophagogastric junction was performed for the first time. In the course of the study, it was revealed that in the studied groups of patients, life expectancy in percentage terms, regardless of the pathology of the disease, does not have a wide spread and is approximately the same. There are no statistically significant differences in life expectancy depending on the type of treatment (stenting-gastrostomy) and the location of the tumor lesion in the analysis of variance according to the criterion of the least significant difference. Esophageal stenting with self-expanding metal stents is the least traumatic and effective method of choosing the resolution of malignant dysphagia of the esophagus and gastroesophageal junction with low complication rates, which allows to restore adequate nutrition, thereby improving the quality of life in incurable patients.

EUS-guided drainage using lumen apposing metal stent and percutaneous endoscopic necrosectomy as dual approach for the management of complex walled-off necrosis: a case report and a review of the literature

BackgroundEndoscopic ultrasound-guided drainage is suggested as the first approach in the management of symptomatic and complex walled-off pancreatic necrosis. Dual approach with percutaneous drainage could be the best choice when the necrosis is deep extended till the pelvic paracolic gutter; however, the available catheter could not be large enough to drain solid necrosis neither to perform necrosectomy, entailing a higher need for surgery. Therefore, percutaneous endoscopic necrosectomy through a large bore percutaneous self-expandable metal stent has been proposed.Case presentationIn this study, we present the case of a 61-year-old man admitted to our hospital with a history of sepsis and persistent multiorgan failure secondary to walled-off pancreatic necrosis due to acute necrotizing pancreatitis. Firstly, the patient underwent transgastric endoscopic ultrasound-guided drainage using a lumen-apposing metal stent and three sessions of direct endoscopic necrosectomy. Because of recurrence of multiorgan failure and the presence of the necrosis deeper to the pelvic paracolic gutter at computed tomography scan, we decided to perform percutaneous endoscopic necrosectomy using an esophageal self-expandable metal stent. After four sessions of necrosectomy, the collection was resolved without complications. Therefore, we perform a revision of the literature, in order to provide the state-of-art on this technique. The available data are, to date, derived by case reports and case series, which showed high rates both of technical and clinical success. However, a not negligible rate of adverse events has been reported, mainly represented by fistulas and abdominal pain.ConclusionDual approach, using lumen apposing metal stent and percutaneous self-expandable metal stent, is a compelling option of treatment for patients affected by symptomatic, complex walled-off pancreatic necrosis, allowing to directly remove large amounts of necrosis avoiding surgery. Percutaneous endoscopic necrosectomy seems a promising technique that could be part of the step-up-approach, before emergency surgery. However, to date, it should be reserved in referral centers, where a multidisciplinary team is disposable.

ID: 3520803 SELF-EXPANDABLE METAL STENTING FOR ESOPHAGEAL FISTULA CLOSURE: INCREASING THE ODDS OF SUCCESS.

Esophageal self-expanding metal stent (SEMS) can be considered for treatment of anastomotic leaks and fistulas. We aim to assess predictors for SEMS success in the closure of fistulas and anastomotic leaks.

Double hitch stitch is a novel technique for fixation of tracheal stent in a case of tracheoesophageal fistula: a case report

BackgroundCaudal tracheal stent migration can be potentially life threatening by causing distal luminal obstruction. We present a rare double hitch stitch procedure (for prevention of migration of tracheal stent), which is an external fixation technique in a case of tracheoesophageal fistula with tracheal and esophageal self-expandable metallic stent (SEMS).Case presentationA 50-year-old male patient who presented with cough and dyspnea was a known case of carcinoma of the esophagus with esophageal stent in situ. Computed tomography (CT) scan showed tracheoesophageal fistula with esophageal stent (esophageal SEMS) migrating into the trachea. Tracheal stenting was done with SEMS. Patient was followed up after 1 month with recurrent complaints of cough on deglutition. On follow-up bronchoscopy, migration of stent was observed. A rare procedure of double hitch stitch was performed with fixation of the tracheal stent (tracheal SEMS) using a percutaneous anchoring stitch, embedded in the subcutaneous tissue. Follow-up bronchoscopy after 1 month of the procedure showed no migration of stent.ConclusionFor the treatment of large tracheoesophageal fistula, stenting of both the trachea and the esophagus along with the double hitch stitch proved to be lifesaving. Stent migration prevention using “double hitch-stitch” is simple, safe, and successful, without any complications.

TECHNICAL DIFFICULTIES AND PROCEDURAL COMPLICATIONS IN CLOSING MALIGNANT ESOPHAGEAL-RESPIRATORY FISTULAS.

SUMMARYThe aim of the study was to outline technical difficulties and procedural complications of using partially covered esophageal self-expandable metal stents (SEMSs) in malignant esophageal respiratory fistulas (ERFs) as a palliative treatment option. In this study, 150 patients with malignant dysphagia underwent treatment with SEMSs. A total of 36 ERFs were detected through endoscopic or clinical assessment. Complete fistula sealing with SEMSs was possible in 35 of the 36 patients. The majority of fistulas were diagnosed in male patients with advanced esophageal cancer. All of them presented with prolonged dysphagia and cachexia. Stent migration or tumoral overgrowth was identified in 6 cases with recurrent dysphagia, and required a second stent insertion. SEMSs were highly efficient in 98% of the patients studied with ERFs, with successfully sealed ERFs after the first attempt, with an overall median survival rate of 92 days. The technique of esophageal SEMS placement is simple and can be rapidly mastered. Patients with ERFs have a respiratory shunt that makes intubation difficult and is often avoided. Restoring oral feeding increased the patient quality of life. SEMS placement is generally safe, but has few associated postoperative complications.

Adaptation of endovascular technique of self-expandable metal esophageal stent implantation in palliative treatment of malignant dysphagia in the course of esophageal and bronchial cancers: A one-center study.

Esophageal stent implantation is an alternative for microjejunostomy or total parenteral nutrition in the palliative treatment of malignant dysphagia in the course of esophageal and advanced bronchial cancers infiltrating the esophagus. The procedure of implanting an esophageal self-expanding metal stent (SEMS) is performed with gastroscopic guidance under general anesthesia. To analyze the efficacy and safety of a simplified technique (without gastroscopic guidance in local anesthesia) of esophageal SEMS implantation in patients with malignant dysphagia in the course of esophageal and bronchial cancers. This is a retrospective analysis of consecutive procedures of uncovered esophageal SEMS implantation performed with a simplified adaptation of the endovascular technique (Seldinger wire) in patients with esophageal and bronchial cancers and poor performance status. The procedures were done in a single surgical center over an 8-year period in 27 patients who were referred from oncology departments with esophageal stenosis confirmed using gastroscopy and who were being treated for malignant dysphagia. The study endpoints were effectiveness (a decrease in dysphagia from grade 3 or 4 to grade 1 after the procedure) and complications related to the procedures (including restenosis and stent migration). In all 27 patients, the SEMS were effectively implanted, enabling enteral nutrition after the procedure. No early complications related to the procedure were observed. A single patient developed restenosis 14 days after the procedure, which required re-stenting. The simplified method for SEMS implantation described herein may be considered an option in the palliative treatment of patients with malignant dysphagia in the course of esophageal and bronchial cancers and poor performance status, especially in facilities with limited access to endoscopy.

Performance and Predictors of Migration of Partially and Fully Covered Esophageal Self-Expanding Metal Stents for Malignant Dysphagia

Self-expanding metal stents (SEMS) are routinely used to palliate malignant dysphagia. However esophageal SEMS can migrate or obstruct due to epithelial hyperplasia. The aim of this study was to evaluate the rates and factors predicting migration and obstruction, and the nutritional outcomes in partially covered (pc) vs. fully covered (fc) SEMS vs. fcSEMS with antimigration fins (AF) placed for malignant dysphagia. A retrospective review of consecutive patients undergoing SEMS placement for malignant dysphagia at three academic medical centers. Among 357 patients, there were 55 (15.4%) stent migrations, 45 (12.6%) obstructions from epithelial hyperplasia, and 20 (5.6%) food impactions. Median overall survival was 79 days (IQR 41,199). The percent weight change/change in albumin at 30 and 60 days after SEMS placement were -2.24%/-0.544 g/dL and -2.98%/-0.55 g/dL, respectively. Stent migration occurred significantly more often with fcSEMS than pcSEMS (25.3% vs 10.9%; P < .003), but there was no difference when either group was compared to fcSEMS-AF (19.3%). The overall rate of epithelial hyperplasia resulting in stent obstruction was low (12.6%) and not different between stent types. Factors associated with increased risk of SEMS migration on multivariable logistic regression included stricture traversability with a diagnostic endoscope (OR,2.37; 95% CI, 1.29-4.35) and use of fcSEMS (OR, 2.56; 1.31-5.00) or fcSEMS-AF (OR, 2.30, 1.03-5.14). Traversability of a malignant esophageal stenosis predicts SEMS migration. In these patients with a limited overall survival, pcSEMS are associated with lower rates of stent migration and similar rates of obstruction compared to fcSEMS.

Clinical score predicting a successful endoscopic approach of esophageal anastomotic leaks: external validation.

Recently, a clinical prediction rule has been proposed to predict the chance of successful endoscopic stenting in benign esophageal anastomotic leakage, perforation and fistula. We aimed to validate this score in a cohort of patients with anastomotic leaks managed with self-expanding metal esophageal stents, by assessing technical and clinical success rates and comparing the agreement between the predicted and the actual clinical success. A multicenter retrospective cohort study including patients submitted to endoscopic stenting due to anastomotic leak was conducted. Variables of the score (leak size, location and C-reactive protein) were collected and the chance of success (≤50, 50-70 and ≥70%) and its accuracy was assessed. Fifty-three patients, submitted to esophageal stenting after cancer (n = 47) and bariatric surgery were included. Clinical success was achieved in 62% of patients. The area under the ROC curve to differentiate between successful and failed therapies showed a good discriminative power of the score (AUC 0.705; P < 0.01). For a predicted chance of success >50%, the positive predictive value was 72.5%; for a chance of success ≤50%, the negative predictive value was 69.2%. The application of this predictive model in patients with anastomotic leaks proved to be valid in a different cohort from that in which it was derived. Its usefulness in clinical practice may be anticipated, favoring stenting in patients with a chance of success >50%. However, we must be cautious in patients with a lower probability of success and a case-by-case decision should be made.