Esophageal Stent Research Articles

Remote training and teleproctoring in gastrointestinal endoscopy for practicing surgeon in rural Uganda.

There is a significant, unmet need for endoscopy services in rural Uganda. With limited diagnostic and therapeutic interventions, patients in these communities often present with advanced disease. Practicing surgeons must continually adapt to new techniques to meet the needs of their patient populations. Here, we present a remotely proctored endoscopy training program for a surgeon practicing in an area devoid of endoscopic capabilities. This was a retrospective case series conducted between February 2020 and December 2022 at Kyabirwa Surgical Center (KSC). After a 1-week in-person training camp, one surgeon performed endoscopy under guidance of a remote proctor. Patient data and outcomes were collected retrospectively. The previously endoscopic naïve practicing Ugandan surgeon was remotely proctored for 139 endoscopic cases and he subsequently independently performed 167 diagnostic colonoscopies and 425 upper endoscopies. Therapeutic endoscopy was conducted under remote guidance after proficiency in diagnostic endoscopy. A total of 43 therapeutic procedures were performed, including 29 esophageal stent placements, 5 variceal bandings, and 9 foreign body retrievals. All procedures were completed without complication. Our center developed a remotely proctored endoscopy program that allowed for training of practicing surgeons in an area lacking endoscopic services. Despite its limitations, remotely proctored endoscopy serves as a unique but highly valuable method of expanding access to endoscopy, particularly in areas that lack adequate training opportunities.

A Case of Perforation of the Abdominal Esophagus Due to Esophageal Stenting of Lymph Node Metastases from Lung Cancer Treated by Emergent Surgical Management

A Case of Perforation of the Abdominal Esophagus Due to Esophageal Stenting of Lymph Node Metastases from Lung Cancer Treated by Emergent Surgical Management

Nanocomposite hydrogel based on chitosan/laponite for sealing and repairing tracheoesophageal fistula

Tracheoesophageal fistula (TEF) is an abnormal connection between the trachea and esophagus that severely impairs quality of life. Current treatment options have limitations, including conservative treatment, surgical repair, and esophageal stent implantation. Here, we introduced laponite (LP) nano-clay to improve chitosan-based hydrogels' rheological properties and mechanical properties and developed an endoscopically injectable nanocomposite shear-thinning hydrogel to seal and repair fistulas as an innovative material for the treatment of TEF. Excellent injectability, rheological properties, mechanical strength, self-healing, biodegradability, biocompatibility, and tissue repair characterize the new hydrogel. The introduction of LP nano-clay improves the gel kinetics problem of hydrogels to realize the sol–gel transition immediately after injection, avoiding gel flow to non-target sites. The addition of LA nano-clay can significantly improve the rheological properties and mechanical strength of hydrogels, and hydrogel with LP content of 3 % shows better comprehensive performance. The nanocomposite hydrogel also shows good cytocompatibility and can promote wound repair by promoting the migration of HEEC cells and the secretion of VEGF and FGF. These findings suggest that this nanocomposite hydrogel is a promising biomaterial for TEF treatment.

Comparison of Short-term Outcomes Between Esophageal Bypass Surgery and Self-expanding Stent Insertion in Esophageal Cancer: A Propensity Score-matched Analysis Using a Large-scale Inpatient Database.

Advanced esophageal cancer is occasionally accompanied by difficulty swallowing owing to esophageal stenosis or tracheoesophageal fistula formation. Esophageal bypass surgery and stent insertion are considered feasible palliative management options. The aim of this study was to evaluate the short-term outcomes of these palliative treatments. Patient data were obtained from a large-scale inpatient database of 42 National University Hospitals in Japan. Patients with advanced esophageal cancer who underwent esophageal bypass surgery or stent insertion between April 2016 and March 2021 were included in this study. One-to-one propensity score matching of patients who underwent bypass surgery or stent insertion was performed. The primary outcomes were time to diet resumption and length of hospital stay after surgery. The secondary outcome was the incidence of postoperative complications. In 43 propensity score-matched pairs, the incidence of postoperative respiratory complications was significantly higher in the bypass group than in the stent group (32.6% vs. 9.3%, P = 0.008). Postoperative length of hospital stay was longer in the bypass group than in the stent group (24 vs. 10d, P < 0.001). Logistic regression analysis revealed that stent insertion was associated with a decreased risk of respiratory complications (odds ratio 0.077, P < 0.007). Among patients who underwent the interventions (bypass surgery or stent insertion) and subsequently underwent anticancer therapy (chemotherapy/radiotherapy) during hospitalization, the interval between the intervention and anticancer therapy was longer in the bypass group than in the stent group (25 vs. 7d, P = 0.003). Esophageal stent insertion provides better short-term outcomes than bypass surgery in patients with advanced unresectable esophageal cancer.

Infigratinib, a Selective Fibroblast Growth Factor Receptor Inhibitor, Suppresses Stent-Induced Tissue Hyperplasia in a Rat Esophageal Model.

Stent-induced tissue hyperplasia remains a challenge for the application of self-expanding metal stents in the management of esophageal stricture. This study aimed to evaluate the efficacy of infigratinib, which is a selective fibroblast growth factor receptor inhibitor, in the prevention of stent-induced tissue hyperplasia in a rat esophageal model. Twenty-four male Sprague-Dawley rats underwent esophageal stent placement and were randomized to receive 1ml of vehicle, 5mg/kg infigratinib in 1ml of vehicle, or 10mg/kg infigratinib in 1ml of vehicle via naso-gastric tube once daily for 28days. Follow-up fluoroscopy was performed on postoperative day 28, and the stented esophageal tissues were harvested for histological and immunofluorescence examinations. All rats survived until euthanasia on postoperative day 28 without procedure-related adverse events. The incidence of stent migration was 12.5%, 12.5% and 25% in the control group, the 5mg/kg infigratinib group and, the 10mg/kg infigratinib group, respectively. The percentage of granulation tissue area, the submucosal fibrosis thickness, the number of epithelial layers, the degree of inflammatory cell infiltration, the degree of collagen deposition, the number of fibroblast growth factor receptor 1 (FGFR1)-expressing myofibroblasts, and the number of proliferating myofibroblasts were all significantly lower in both infigratinib groups than in the control group (P < 0.05) but were not significantly different between the two infigratinib groups (P > 0.05). Infigratinib significantly suppresses stent-induced tissue hyperplasia by inhibiting FGFR1-mediated myofibroblast proliferation and profibrotic activities in a rat esophageal model.

Sealing of esophageal perforation with a fully covered biliary stent in a pediatric patient

Conservative treatment for esophageal perforations can cause problems related to both nutrition and wound healing in pediatric patients due to its long duration. This case report presents a 14-month-old female patient who underwent endoscopic balloon dilatation for esophageal stricture. The patient had been operated on for esophageal atresia in the neonatal period. Eight hours after discharge, the patient was hospitalized again due to esophageal perforation. Although conservative treatment lasting three weeks was the preferred method, it was unsuccessful. Therefore, a fully covered biliary stent was used instead of an esophageal stent, as the appropriate size stent could not be found. The stent sealed the perforation, and the patient started to be fed orally on the third day. The esophageal stent was removed on the 17th day, and no leakage was observed on the esophagogram. Although conservative methods are the first-line treatment for esophageal perforations in children, their long duration and the inability to feed for a long time are significant disadvantages. Fully covered self-expandable esophageal stents may be a reliable alternative for sealing esophageal perforations in pediatric patients, as they are in adults.

Surgical Management of Intra-gastric Balloon Complications, Single-Center Experience, and Literature Review.

In Saudi Arabia, the prevalence of obesity has multiplied in the last decades leading to a surge in bariatric surgery and other endoscopic modalities. The intra-gastric balloon (IGB) is the most used endoscopic modality. Surgical management for IGB complications is required for gastrointestinal perforation and/or obstruction. However, the literature seems to underestimate these complications. A retrospective descriptive study was conducted in King Fahd University Hospital, Saudi Arabia, from Jan 2017 to Dec 2021, including all patients with complicated IGB who necessitated any surgical procedure. Exclusion criteria were patients with complicated IGBs that were only managed conservatively or endoscopically. A total of 326 patients were admitted with different complications after bariatric procedures. Of them, six patients were referred due to IGB complications that necessitated operative intervention. All patients were young females. Three patients had gastric wall perforation, and were managed by endoscopic removal of the IGBs followed by exploratory laparotomy. One patient had an intestinal obstruction on top of a migrated IGB that was surgically removed. One patient had failed endoscopic retrieval of IGB and required a laparoscopic gastrostomy. Another patient had an esophageal rupture that required left thoracotomy, pleural flap, and insertion of an esophageal stent. All cases were discharged and followed up with no related complications. IGB is an endoscopic alternative, within specific indications, for the management of obesity. However, surgical management may be necessary to manage its complications, including gastrointestinal perforation, IGB migration, and failure of endoscopic removal.

Re-irradiation for local primary-recurrence esophageal squamous cell carcinoma treated with IMRT/VMAT

PurposeLocal primary-recurrence of esophageal squamous cell carcinoma (ESCC) after definitive treatment has the potential for increasing overall survival with re-irradiation (Re-RT), especially with advanced technique. This study aimed to evaluate the efficacy and toxicities of Re-RT using intensity-modulated radiotherapy (IMRT)/volumetric modulated arc therapy (VMAT) for local primary-recurrence of ESCC.Materials and methodsA total of 130 ESCC patients with local primary-recurrence from Xijing hospital between 2008 and 2021 were enrolled and 30 patients underwent IMRT/VMAT based salvage Re-RT. Cox regression analysis was used to analyze the prognostic factors for overall survival (OS) and after recurrence survival (ARS). The toxicities of 30 patients receiving Re-RT were also assessed.ResultsThe median OS and ARS of the 130 recurrent patients were 21 months (1−164 months) and 6 months (1−142 months). The 1-, 2-, and 3-year OS rates were 81.5%, 39.2%, and 23.8%, respectively. Besides, the 1-, 2-, and 3-year ARS rates were 30.0%, 10%, and 6.2%. Multivariate analysis showed that Re-RT ± chemotherapy (p = 0.043) and chemotherapy alone (p < 0.001) and esophageal stents (p = 0.004) were independent prognostic factors for OS. The median OS of 30 patients treated with Re-RT were significantly better than that of 29 patients treated with chemotherapy (34.5 months vs. 22 months, p = 0.030). Among 30 ESCC patients treated with Re-RT, the median OS and ARS were 34.5 months (range 12–163 months) and 6 months (range 1−132 months), respectively. The recurrence-free interval (RFI) (> 12 months) and initial radiation dose (> 60 Gy) were significantly associated with improved OS. Radiation esophagitis (Grade 1–2) occurred in 16 patients and myelosuppression (Grade1−2) occurred in 10 patients. Grade 3 toxicities (radiation esophagitis and myelosuppression) were only 13.3%. There were no grade 4 toxicities.ConclusionOur results demonstrated that IMRT/VMAT-based Re-RT was an effective therapeutic option for ESCC patients with local primary-recurrence compared with chemotherapy alone or without any treatment. Re-RT had improved OS but unfavorable ARS.

Alleviation of malignant dysphagia in inoperable lung cancer.

Due to the close anatomical relationship between the esophagus and the bronchial tree, lung cancer can cause malignant dysphagia. Patients with this complication may require palliation through esophageal and/or bronchial tree restoration. Between the years 2008 and 2018, malignant dysphagia was diagnosed in 84 lung cancer patients. Their response to esophageal and/or bronchial tree stenting was studied retrospectively. Patients were stratified into three groups: esophageal compression without obstruction of the bronchi (Group I, n=64), esophageal compression and bronchial obstruction without fistulas (Group II, n=12), and dysphagia and esophagotracheal fistula (Group III, n=8). Group I had one stent implanted, whilst in Groups II and III, two stents were introduced. Both self-expanding stents and silicone Y stents were utilized. Prior to intervention and during the follow-up period, patients were assessed for degree of dysphagia and dyspnea, quality of life, and survival. Following endoprosthetic restoration, dysphagia score improved in all patient groups with reductions in Group I (2.68 vs. 1.2, P=0.0001), in Group II (2.76 vs. 1.3, P=0.0001), and in Group III (2.74 vs. 1.3, P=0.0001). There was no dyspnea recorded in Group I before an intervention, however it was present and reduced in Group II (2.86 vs. 0.4, P=0.001) and Group III (2.89 vs. 0.5, P=0.0001) following intervention. Quality of life was improved for all patient groups, with an increase in Karnofsky performance scale in Group I (56 vs. 72, P=0.0001), Group II (56 vs. 70, P=0.0001) and Group III (53 vs. 67, P=0.0001). Three patients (3.6%) developed respiratory failure and 1 patient (0.8%) died. Two patients (2.4%), following esophageal stenting, required bronchial tree stenting. Dysphagia occurred in 5 patients (6.0%) due to granuloma formation. In these cases, the stents were removed and re-stenting was carried out. In 3 of the patients (3.6%) the stents were removed due to migration and re-stenting was performed. Patients with malignant dysphagia due to lung cancer may require esophageal stenting as well as bronchial tree stenting. This treatment offers improvements in dysphagia and dyspnea scores, as well as in quality of life, and allows for the implementation of oncological treatments.

The Prognostic Predictors of Airway Stenting in Malignant Airway Involvement From Esophageal Carcinoma.

In locoregional esophageal carcinoma (EC), airway involvement is the most common route of extraesophageal metastasis. The prognosis remains poor even with a multimodality approach. Although airway stenting is well known for restoration of the airway, the survival benefit is still lacking. A total of 37 of patients with airway involvement from EC who underwent airway stenting at a single institution from 2015 to 2020 were retrospectively reviewed. Survival curves after stent placement among different groups were analyzed using Kaplan-Meier method. Of 37 patients, 34 were male, and the mean age was 58.9 years (42 to 80). EC was commonly located at midesophagus (51.4%). The site of airway involvement was left main bronchus (48.6%), trachea (32.4%), multiple sites (16.2%), and right main bronchus (2.7%). The nature of airway involvement was tumor invasion (91.9%), compression (62.2%), and fistula (37.8%). Twenty-three patients (62.2%) had airway involvement at the time of esophageal cancer diagnosis. Only 4 patients underwent esophageal stenting. The median survival time after stent placement was 97 days (5 to 539). Chemotherapy and/or radiotherapy were given before stent placement in 18 patients (48.6%). Treatment-naive before airway stenting and diagnosis of airway involvement at the same time of EC diagnosis were independent predictors for the increased survival after stent placement (P<0.05). Poststent treatment was associated with improved survival (P=0.002). In patients with malignant airway involvement from EC who underwent airway stenting, the prognostic predictors for improved survival were treatment-naive status, receiving treatment after airway stenting, and early-onset of airway involvement.

Feasibility and Safety of Through-the-scope versus Over-the-wire Stents for the Palliation of Malignant Dysphagia. A Cohort Real- Life Study.

In the presence of malignant dysphagia in non-surgical candidates, a self-expanding metal stent (SEMS) represents a safe and effective approach. Recently, a through-the-scope (TTS) SEMS was launched. The aim of our study was to assess the feasibility and safety of the TTS versus over-the-wire (OTW) SEMS in patients with malignant dysphagia. This single-center retrospective cohort study included patients with malignant dysphagia undergoing esophageal TTS and OTW-SEMS from 2012 to May-2022. The primary outcomes were the technical and the clinical success of the SEMS placement. Secondary outcomes included adverse events, patency, and survival. Patients were prospectively followed until death or loss of follow-up. A total of 98 patients were enrolled, including 34 patients in the TTS group and 64 patients in the OTW group. TTS and OTW SEMS placement were feasible in 33 (97.1%) and 64 (100%) procedures , respectively (p=0.118). Overall, 32 patients (94.1%) in the TTS group and 62 patients (96.9%) in the OTW group showed an improvement in Ogilvie score (p=0.432). Recurrent dysphagia occurred in 30 patients, 12 in TTS group and 18 in OTW group, due to migration (4 vs. 5), stent deformation (1 vs. 1), tissue ingrowth (5 vs. 5) and overgrowth (2 vs. 7). No patient died from a stent-related cause. Median survival was 123 days (IQR: 59-209) in TTS group and 113 days (IQR: 73-271) in OTW group (p=0.349). Placement of esophageal TTS and OTW stents resulted in similar technical and clinical outcomes, stent patency and survival in patients with malignant dysphagia.

Endoscopic Stenting for Malignant Dysphagia in Patients with Esophageal Cancer.

Malignant dysphagia is a common problem in patients with esophageal cancer. Endoscopic stenting can resolve dysphagia caused by malignant stricture; however, controversy exists regarding the use of esophageal stenting for the treatment of malignant stricture, including whether stenting or radiotherapy is superior, whether stenting before or after radiotherapy is safe, whether stenting before or after chemotherapy is safe, and whether low-radial-force stents are safer than conventional stents. Among treatment options for malignant dysphagia, stenting may have some disadvantages in terms of pain relief and the risk of adverse events compared with radiotherapy and in terms of survival compared with gastrostomy. Additionally, the risk of stent-related adverse events is significantly associated with prior radiotherapy. The risk of perforation is especially high when a radiation dose of >40 Gy is delivered to the esophagus after stenting, whereas perforation is not associated with prior chemotherapy or additional chemotherapy after stenting. Nevertheless, stenting remains an important palliative option, especially for patients with a short life expectancy and a strong desire for oral intake, because stenting can facilitate a more rapid improvement in dysphagia than radiotherapy or gastrostomy. The application of a low-radial-force stent should be considered to reduce the risk of adverse events, especially in patients with prior radiotherapy.

Chemoradiotherapy with concurrent durvalumab for the palliative treatment of oligometastatic esophageal and gastroesophageal carcinoma with dysphagia: A single arm phase 2 clinical trial, PALEO.

TPS4172 Background: Many patients diagnosed with esophageal cancer have dysphagia from their primary tumor and de novo metastatic disease. While multiple therapies are available, there is no accepted standard or sequence of therapies to both relieve dysphagia and control distant disease. Our preceding Phase I clinical trial showed that a 2 week hypofractionated chemoradiotherapy (CRT) protocol (30Gy/10# with concurrent weekly carboplatin and paclitaxel) is well tolerated and provides rapid dysphagia relief. Immune checkpoint inhibition has activity in esophageal and gastroesophageal (GEJ) cancer and concurrent radiotherapy may improve T cell priming through tumor antigen release. In PALEO, patients begin durvalumab concurrent with primary tumor CRT, and receive stereotactic body radiotherapy (SBRT) (24Gy/3#) to a single metastasis to maximize the breadth of tumor antigen exposure. Tissue and blood-based studies are planned to identify biomarkers for response, including immunosequencing to test for post-radiotherapy expansion in T cell receptor diversity. Methods: Eligible patients have biopsy-proven esophageal or GEJ cancer, either squamous cell or adenocarcinoma histology, with oligometastatic (1-5 metastases on FDG-PET scan outside the primary tumor radiotherapy field) or locoregionally advanced disease unsuitable for surgery, dysphagia (Mellow score &gt;0), and ECOG PS 0-2. Key exclusion criteria are prior treatment, tumor HER2 positivity, prior thoracic radiotherapy, tracheo-esophageal fistula, esophageal stent in situ and contraindications to immunotherapy. Patients begin durvalumab 1500mg q4w with CRT to the primary tumour (30Gy/10# with weekly carboplatin AUC2 and paclitaxel 50mg/m2), and continuing to disease progression, unacceptable toxicity or 2 years. SBRT to one metastasis (24Gy/3#) is delivered in week 7. Trial primary endpoint is progression free survival rate at 6 months (PFS6) with the aim to rule out a PFS6 rate of 50% in favor of 67.5%, with 80% power and a one-sided 0.05 significance level. Secondary endpoints include dysphagia relief, nutritional status change (patient weight, removal of enteral feeding tubes, PG-SGA score), quality of life, response rate, toxicity, overall survival and exploratory translational endpoints. PALEO is sponsored by the Australasian Gastro-Intestinal Trials Group (AGITG) for conduct at 8 sites in Australia and New Zealand. 6 of planned 54 patients have been enrolled. ACTRN12619001371189. Clinical trial information: Clinical trial information: ACTRN12619001371189 .

Clinical applications of esophageal stents

Clinical applications of esophageal stents

Endoscopic treatment of stenosing esophageal cancer

Objective. To highlight the main criteria for selection of patients and materials for endoscopic stenting in stenotic esophageal cancer of different localization, to consider the key stages of surgery and its possible complications. Materials and Methods. 102 endoscopic stenting surgeries in patients with stenotic esophageal cancer of various degrees of obstruction were performed in S. P. Botkin GKB in the period from 2019 to 2021. The analysis of the literature data and comparison of the existing types of esophageal stents were performed, the stenting technique used in our clinic and the review of the causes of complications after endoscopic stenting were considered. Results. Endoscopic stenting in 101 cases (99%) was technically successful; in 99 patients (97%) stenting resulted in positive clinical effect. Conclusion. Endoscopic treatment of stenotic esophageal cancer is an effective and safe method of surgical treatment of patients with clinical manifestations of severe dysphagia.

Esophago-Vascular Fistulae in Children: Five Survivors, Literature Review, and Proposal for Management

IntroductionEsophago-vascular fistulae in children are almost uniformly fatal with death occurring by exsanguination. We present a single centre series of five surviving patients, a proposal for management and literature review. Materials and methodsPatients were identified from surgical logbooks, surgeon recollection and discharge coding data. Demographics, symptoms, co-morbidities, radiology, management and follow up details were recorded. ResultsFive patients (1M, 4F) were identified. Four were aorto-esophageal and one caroto-esophageal. Median age at initial presentation was 44 (8–177) months. Four patients had cross sectional imaging prior to surgery. Median time from presentation to combined entero-vascular surgery was 15 (0–419) days. Four patients required repair on cardio-pulmonary bypass with four undergoing staged surgical procedures. All required combined esophageal and cardio-vascular surgery.Length of PICU stay following combined surgery was 4 (2–60) days and overall hospital stay was 53 (15–84) days. Median follow up was 51 (17–61) months.Two patients had esophageal atresia and trachea-esophageal fistula managed as neonates. Three had no co-morbidities. Four had esophageal foreign bodies:1 esophageal stent, 2 button batteries, 1 chicken bone. One patient had a complication following colonic interposition. Four patients required an esophagostomy at the time of definitive surgery. All patients were alive and well at last follow up with one having successful reconnection surgery. ConclusionIn this series, outcomes were favourable. Multidisciplinary discussion and surgery are mandatory. If hemorrhage is controlled at presentation, then survival to discharge is possible but the magnitude of surgical intervention is both significant and very high risk. Level of evidenceLevel 3.

Cleft palate: a rare complication following esophageal stent implantation.

A 50-year-old woman was referred to our hospital because of increasing dysphagia. She had been diagnosed with systemic lupus erythematosus 2 years previously and started on treatment with tacrolimus and corticosteroids. Multiple diverticula of the esophagus were confirmed and the largest diverticulum was located next to the cardia. Esophagogram showed delayed passage of contrast into the stomach, and gastroscopy revealed a dilated esophagus with retained liquid and increased resistance at the cardia ([Fig. 1 a–c]). The patient refused to undergo endoscopic or surgical myotomy as she was concerned about the treatment risks. Therefore, esophageal stent implantation was believed to be an option for this case.

Impact of radiotherapy on adverse events of self-expanding metallic stents in patients with esophageal cancer.

Self-expanding metallic stents (SEMS) are considered the treatment of choice for the palliation of dysphagia and fistulas in inoperable esophageal neoplasms. However, the safety of SEMSs in patients who received or who will be submitted to radiotherapy (RT) is uncertain. The study aimed to evaluate the impact of RT on adverse events (AEs) in patients with esophageal cancer with SEMSs. This is a retrospective study conducted at a tertiary cancer hospital from 2009 to 2018. We collected information regarding RT, the histological type of the tumor, the model of SEMSs and AEs after stent placement. Three hundred twenty-three patients with malignant stenosis or fistula were treated with SEMSs. The predominant histological type was squamous cell carcinoma (79.6%). A total of 282 partially covered and 41 fully covered SEMSs were inserted. Of the 323 patients, 182 did not received RT, 118 received RT before SEMS placement and 23 after. Comparing the group that received RT before stent insertion with the group that did not, the first one presented a higher frequency of severe pain (9/118 7.6% vs. 3/182 1.6%; P = 0.02). The group treated with RT after stent placement had a higher risk of global AEs (13/23 56.5% vs. 63/182 34.6%; P = 0.019), ingrowth/overgrowth (6/23 26.1% vs. 21/182 11.5%; P = 0.045) and gastroesophageal reflux (2/23 8.7% vs. 2/182 1.1%; P = 0.034). Treatment with RT before stent placement in patients with inoperable esophageal neoplasm prolongs survival and is associated with an increased risk of severe chest pain. Treatment with RT of patients with an esophageal stent increases the frequency of minor, not life-threatening AEs.

The Use of Esophageal Stents in the Management of Postoperative Fistulas-Current Status, Clinical Outcomes and Perspectives-Review.

We searched the PubMed and MEDLINE databases for the keywords postoperative esophageal anastomotic leak and postoperative esophageal anastomotic leak stent, and retrieved relevant papers published until December 2022. The endoscopic discovery of the fistula is usually followed by the insertion of a fully covered esophageal stent. It has an efficiency of more than 60% in closing the fistula, and the failure is related to the delayed application of the method, a situation more suitable for endo vac therapy. The most common complication is migration, but life-threatening complications have also been described. The combination of the advantages of endoscopic stents and vacuum therapy is probably found in the emerging VACstent procedure. Although the competing approaches give promising results, this method has a well-defined place in the treatment of esophageal fistulas, and it is probably necessary to refine the indications for each individual procedure.

Retrospective cohort study on treatment modalities and survival time after oesophageal fistula in patients with oesophageal cancer in a regional cancer care centre in China

BackgroundOesophageal fistula (perforation) is a devastating complication in patients with oesophageal cancer . The optimal treatment remains uncertain.ObjectiveWe sought to present real-world evidence on treatment modalities and survival postfistula in...