Malignant Obstruction Research Articles

783 Comparison of the survival between patients with malignant central airway obstruction managed by microwave ablation vs. other methods of airway recanalization

783 Comparison of the survival between patients with malignant central airway obstruction managed by microwave ablation vs. other methods of airway recanalization

Optimizing Care and Maintenance of Enteric Tubes: Insights into Percutaneous Radiologically Placed Gastrointestinal Luminal Tubes

AbstractPercutaneous enteric tubes, including gastrostomy, gastrojejunostomy, and percutaneous transesophageal gastrostomy, are essential for patients who cannot maintain adequate oral nutrition or require gastric decompression due to conditions like malignant bowel obstruction. Proper care and maintenance are crucial to prevent complications and maintain function. Enteric tubes are inserted using various techniques at different locations based on patient needs and anatomical considerations. Enteric tubes play a vital role in patient care, and continued research and innovation are necessary to improve outcomes and reduce complications. Routine care involves regular flushing and site maintenance to prevent occlusion and infection. While complications are common, they can be effectively managed or avoided with proper care. This review outlines the care, maintenance protocols, and post-placement complication management for enteric tubes.

Safety and Effectiveness of Colonic Stenting for Ileocecal Valve Obstruction and Usefulness of Two-Step Strategy: Single-Center Retrospective Study

Background: Endoscopic self-expandable metallic stent (SEMS) placement is a widely accepted treatment for malignant left-sided colorectal obstruction (LSO) because of its lower invasiveness and quicker symptomatic relief compared to surgery. However, SEMS placement for ileocecal valve obstruction (ICVO) has not been established due to its technical difficulties. Methods: This single-center retrospective study compared the clinical outcomes of patients who underwent SEMS placement for ICVO (ICVO group, n = 13) and LSO (LSO group, n = 146). Particularly in cases with severe small-intestine dilation, we applied a “Two-Step Strategy”, which involved long intestinal tube insertion followed by SEMS placement to ensure safety and overcome technical challenges. Results: Patients in the ICVO group were significantly more likely to undergo SEMS placement with the Two-Step Strategy compared to those in the LSO group (76.9% vs. 6.9%, p < 0.001). Both groups achieved similarly high technical and clinical success rates (100% vs. 98.6%, p = 1.000; 92.3% vs. 88.4%, p = 1.000), and the incidence of adverse events also showed no significant difference between the groups (7.7% vs. 13.0%; p = 1.000). Furthermore, the median time to recurrent colorectal obstruction and survival time after SEMS placement did not differ between patients with palliative stenting for ICVO and LSO (not reached vs. 430 days, p = 0.586; 119 days vs. 200 days, p = 0.303). Conclusions: SEMS placement for malignant ICVO is as safe and effective as it is for malignant LSO, and the Two-Step Strategy might be useful in ICVO cases.

A biodegradable polymer plug for liver tract embolization after percutaneous or surgical placement of transhepatic biliary drainage tubes: a feasibility study.

To evaluate the feasibility of liver tract embolization after transhepatic biliary drainage using a biodegradable polymer plug (IMPEDE-FX, Shape Memorial Medical, Santa Clara, CA, USA).In a retrospective observational study, 15 plug embolizations were performed in 13 patients at risk for tract-related adverse events (AEs). Risk factors included coagulopathy, cirrhosis, central bile duct puncture, previous drain-related bleeding, malignant obstruction, large tract diameter, or multilevel strictures. Clinical and imaging follow-up was performed at 24 hours, 3 months, and 6 months. Primary endpoints were technical and clinical success. Technical success was defined as plug deployment in the intended position. Clinical success was defined as the absence of biliary, infectious, or bleeding AEs. To assess clinically occult bleeding or biliary obstruction, periprocedural hemoglobin, hematocrit, and bilirubin levels were compared. Secondary endpoints were plug migration, plug oversizing, and plug visibility on imaging.The technical success rate was 100%. The clinical success rate was 84.6%. There were no infectious or bleeding AEs. In 2 cases where the persistence of biliary congestion was clinically underestimated prior to drain removal, 2 biliary AEs occurred (2 biliocutaneous fistulas including 1 plug migration within 24 hours; 15.4% SIR grade 3 AEs). The median plug oversizing relative to the diameter of the hepatic tract was substantially lower in unsuccessful cases than in successful cases (27% vs. 86%). The plug was visible on ultrasound and CT. On MRI, no plug-related artifacts occurred.The plug could be an option when a non-permanent, precisely deployable device is desired for tract embolization. Adequate plug-to-tract oversizing and biliary decongestion are essential to achieve durable tract closure. Therefore, the plug seems unsuitable for patients with multilevel strictures where complete drainage of the biliary system is not feasible. · The polymer plug can be precisely delivered within the liver tract.. · Plug-to-tract oversizing and biliary decongestion are essential for durable tract closure.. · The plug appears unsuitable for endoscopically incompletely relievable multilevel biliary strictures.. · Thurner A, Giulia Dalla G, Hartung V et al. A biodegradable polymer plug for liver tract embolization after percutaneous or surgical placement of transhepatic biliary drainage tubes: a feasibility study. Rofo 2025; DOI 10.1055/a-2509-5189.

Revisiting malignant gastric outlet obstruction: Where do we stand?

The scope of management of malignant gastric outlet obstruction is ever-expanding. The therapeutic use of endoscopy is gaining popularity not just owing to its technical advancement and satisfactory patient outcomes. With technical success rates close to 96%, stent placement for palliating gastric obstruction has ensured a median survival of about 2 months post-deployment of gastro-duodenal stents. Understanding the correct concept of palliation is the need of the hour in management. Identifying the right patient for palliation, selecting the appropriate intervention and auditing the outcome are vital in delivering optimal care. Also, newer procedures such as endoscopic gastro-enterostomy offer promising outcomes in palliative care.

A Comparison of Endoscopic and Surgical Gastrojejunostomy in Patients with Malignant Gastric Outlet Obstruction: A National Cohort Analysis (2016-2020).

Malignant gastric outlet obstruction (MGOO) is an unfortunate complication of advanced upper gastrointestinal malignancies. Historically, surgical gastrojejunostomy has been the procedure of choice to achieve enteral bypass. Recently, endoscopic techniques have gained popularity in the management of MGOO. We aimed to compare peri-procedural outcomes between surgical and endoscopic gastrojejunostomy in patients with MGOO. The National Inpatient Sample (NIS) was queried for 2016 through 2020. The International Classification of Diseases, Tenth Revision (ICD-10) codes were used to identify adult admissions with a principal diagnosis of gastric, pancreatic, or duodenal cancer undergoing endoscopic gastrojejunostomy (EGJ) or surgical gastrojejunostomy (SGJ). The two cohorts were compared for peri-procedural adverse events. Twenty thousand nine hundred thirty (20,930) hospitalizations undergoing gastrojejunostomy (16,585 SGJ and 4,345 EGJ) for MGOO were identified. The SGJ cohort had a higher proportion of patients with pancreatic cancer (36.16% vs 19.56%) and a lower proportion of patients with gastric cancer (55.16% vs 71.99%). A higher percentage of endoscopic GJs were performed in the Northeast (20.33% vs 27.66%, P<0.001), while a smaller percentage of endoscopic GJs were performed in the South (30.56% vs. 39.52%, P <0.001). Between the two groups, the difference in mortality rates was not significantly different [0.62, 95% CI 0.35-1.10, P =0.106), but the EGJ group had lower odds of respiratory failure [4.7% vs. 7.4%, aOR (adjusted odds ratio) 0.68, 95% CI (confidence interval) 0.48 - 0.96, P =0.032], blood transfusion [9.25% vs. 13.74%, aOR 0.63, 95% CI 0.48 - 0.82, P =0.001], and peritonitis [2.19% vs 4.5%, aOR 0.55, 95% CI 0.33-0.91, P =0.022]. The EGJ group had lesser hospitalization charges [mean $164,794 vs. $183,519, adjusted difference on regression $16,495, 95% CI $29,204 - $3,786, P =0.011], and shorter hospital stays [mean 9.88 vs. 12.56 days, adjusted difference 2.24 days, 95% CI 1.53 - 2.96 days, P <0.001]. The use of EGJ increased over five years [16.86% in 2016 to 24.14% in 2020, P-value for trend=0.002], while the use of SGJ decreased [83.13% in 2016 to 75.85% in 2020, Trend P=0.002]. Compared to surgical GJ, endoscopic GJ is associated with lower rates of peri-procedural adverse events, hospitalization charges, and length of stay. For these reasons, endoscopic GJ should be strongly considered in managing malignant gastric outlet obstruction.

Endoscopic Ultrasound-Guided Treatments for Pancreatic Cancer: Understanding How Endoscopic Ultrasound Has Revolutionized Management of Pancreatic Cancer.

Pancreatic cancer is associated with high rates of morbidity and mortality. Endoscopic ultrasound (EUS)-guided biopsy has become the standard diagnostic modality per the guidelines. The use of EUS has been growing for providing various treatments in patients with pancreatic cancers: biliary and gallbladder drainage for those with malignant biliary obstruction, gastroenterostomy for malignant gastric outlet obstruction, celiac plexus/ganglia neurolysis for pain control, radiofrequency ablation, placement of fiducial markers, and injection of local chemotherapeutic agents. In this review, we explore the recent clinical studies evaluating the EUS-guided treatments in pancreatic cancer.

Self-Expandable Metal Stents for Obstructing Colon Cancer and Extracolonic Cancer: A Review of Latest Evidence.

Colorectal cancer (CRC) is a leading cause of cancer mortality, with many patients presenting with malignant colorectal obstruction (MCO). Self-expandable metal stents (SEMSs) have emerged as a minimally invasive key intervention, both as a bridge to surgery (BTS) in curative setting sand for palliation in advanced disease. This review aims to provide an evidence-based analysis of SEMS indications, contraindications, and efficacy across curative and palliative contexts, with focus on long-term outcomes. Based on data from recent trials and guidelines, we examine SEMS placement outcomes, focusing on specific scenarios, including BTS for left-sided MCO, chemotherapy (with angiogenic agents) safety during stent therapy, the optimal timing between SEMS placement and surgery, and oncological outcomes. We also discuss the use of SEMSs in challenging contexts such as proximal colon obstruction and extracolonic obstruction, and the relevant technical considerations. Findings indicate that using a SEMS in the BTS setting reduces emergency surgery needs, minimizes complications, and decreases stoma formation. Long-term oncologic outcomes, particularly recurrence, are still debated, but recent evidence shows that SEMS placement is safe, without worsening long term outcomes. Palliative SEMS placement shows high efficacy in symptom relief with manageable adverse events. Success depends on patient selection and technical expertise, with multidisciplinary approaches essential for optimal outcomes.

Palliative endoscopic treatment of malignant central airway obstruction

PurposeTo examine the outcome of palliative endoscopic treatment of malignant central airway obstruction (CAO) and identify predictors for Days Alive and Out of Hospital (DAOH), overall survival and treatment related complications.MethodsConsecutive adult patients treated endoscopically for malignant CAO at Aarhus University Hospital from 2012 to 2022 were included in the study. Statistical analyses were carried out to identify predictors for DAOH, survival and complications.Results127 consecutive patients met the inclusion criteria. The majority of patients were categorised with stage IV lung cancer, the majority being males, with a median age of 67 years. The endoscopic interventions were mainly tumour debulking combined with airway stent insertion or tumour debulking alone. The complication rate was 21.0% and the mortality rate was 3.9%. In total, 89.8% of the patients experienced symptom relief following surgery, and the majority (92.1%) were discharged from hospital within two days after intervention. Mean survival time following intervention was 144 days, mean DAOH30 was 20.8 and mean DAOH365 was 157. Survival was associated with comorbidity, type of intervention, preoperative respiratory support and postoperative oncologic treatment. A high preoperative ASA-score, preoperative respiratory support, urgency of intervention, female gender and insertion of airway stent were predictors for a poorer DAOH-outcome.ConclusionEndoscopic palliative treatment of malignant CAO is generally feasible and safe, offering symptom relief in most cases. The method is considered an effective measure for short to median term palliation of respiratory distress.

Infections and Infections and Spectrum of Pathogens in Patients with Malignant Tumors of the Liver and Biliary Tract with Biliary Obstruction after Extensive Liver Resections

A malignant tumor is an independent risk factor for the development of surgical site infections (SSIs), and the risk of postoperative complications in patients is 3 times higher than in patients without a malignant process. Unfortunately, even with perfect adherence to the rules of asepsis and antiseptics, the contamination of the surgical wound is inevitable during surgery. In patients with malignant liver tumors the infection can be caused by malignant obstruction, bile stasis, preoperative manipulations of the biliary tract (drainage or stenting). The objective: to analyze the spectrum of bacterial infections and their pathogens in patients with primary malignant tumors of the liver and biliary tract with obstruction of the biliary tract compared to patients without obstruction of the biliary tract after extended liver resections (ELRs). Materials and methods. 70 statistically homogeneous patients in terms of age and gender took part in the study: 32 persons with hepatocellular carcinoma (HCC) and 38 persons with cholangiocarcinoma (CC). Patients were divided into groups. The 1st (main one) group included 35 patients with primary liver tumors after ELRs with biliary obstruction, the 2nd (control one) group included 35 patients with primary liver tumors after ELRs without biliary obstruction. The age of the patients was 61.2 ± 10.7 years and 64.5 ± 11.4 years, respectively. Objective data, laboratory and instrumental examinations were used to establish the diagnosis and complications that occurred in patients after surgery. Results. In patients with HCC and CC with biliary obstruction after ELRs (main group) the infectious complications occurred in 100% of cases, versus to patients with HCC and CC without biliary obstruction (control group). Opportunistic microorganisms, which were represented by a sufficiently wide spectrum of gram-negative and gram-positive bacteria, were determined in patients after ELRs. Pneumonia (17.1% of cases), cholangitis (14.3%), SSIs (28.6%), SSIs com bined with cholangitis (11.4%), and SSIs in combination with infections of the central circulation (11.4%) were significantly more common in patients with HCC and CC with biliary obstruction after ELRs. Conclusions. The results of the study should be used to develop a strategy to reduce postoperative bacterial complications and additional financial costs after ELRs in the future.

Comparison of short-term outcomes of robotic and laparoscopic surgery for mid-low rectal cancer: a propensity matched analysis

Objective: To investigate the short-term efficacy of robotic and laparoscopic surgery for treatment of mid-low rectal cancer. Methods: This was a retrospective cohort study of clinical data of patients with mid-low rectal cancer (caudad edge of tumor less than 10 cm from the anal verge) treated with laparoscopic or robotic radical surgery in the Northern Jiangsu People's Hospital Affiliated to Nanjing University from July 2019 to November 2021. Patients whose anus had not been completely preserved, with malignant obstruction or perforation, with poor anal function indicated by preoperative low anterior resection syndrome (LARS) scores, or with incomplete follow-up information were excluded. The inclusion criteria were met by 973 patients. After matching participants in a 1:2 propensity ratio with a caliper width of 0.02 standard deviations to reduce bias between patients caused by baseline imbalances, 175 patients were included in the robotic surgery group(RS) and 350 patients in the laparoscopic surgery group(LS). Baseline characteristics did not differ significantly between these two groups. The primary objectives were to compare oncological prognoses between the two groups, including disease-free survival (DFS), overall survival (OS), and anal function as assessed by the low anterior resection syndrome (LARS) scoring system, 6 months and 12 months postoperatively. Secondary outcomes included postoperative quality of life using the quality-of-life questionnaire C30 (QLQ-C30) and the QLQ-CR38 to establish a new scale, these being evaluated 6 and 12 months postoperatively. Higher functional module scores indicate better patient function, whereas lower symptom module scores indicate milder symptoms. Additionally, we compared the incidence of perioperative-related complications in the study patients. Results: (1) Oncological outcomes: The 2-year DFS and OS rates were 89.7% and 93.1%, respectively, for the robotic group and 86.0% and 91.7%, respectively, for the laparoscopic group. These differences are not statistically significant (P=0.230 for DFS, P=0.570 for OS). (2) Anal function: Among patients who had not undergone ileostomy, anal function was better in the robotic than in the laparoscopic group 6 months postoperatively (severe LARS: 9.8% [14/143] vs. 19.2% [56/292], χ2 = 6.712; P = 0.035). However, 12 months postoperatively, anal function did not differ significantly between the two groups. In patients with an ileostomy, anal function did not differ significantly between the two groups at 6 or 12 months postoperatively (both P > 0.05). (3) Postoperative quality-of-life: Compared with the laparoscopic group, the robotic group had better scores in the following aspects of quality of life: physical functioning (mean score 77.1±6.9 vs. 71.7±5.6, t =8.965, P=0.005), role in functioning (mean score 73.4±5.3 vs. 71.6±5.1, t = =3.851, P = 0.010), urinary tract complications (mean score 17.5±1.5 vs. 23.4±1.6, t = 41.40, P =0.001), and gastrointestinal symptoms (mean score 21.2±2.1 vs. 26.6±1.9, t = 29.40, P =0.001). These differences are all statistically significant (all P <0.05). By 12 months postoperatively, there were no statistically significant differences in functional or symptom modules of quality-of-life between the two groups (both P >0.05). (4) Perioperative complications: There was no statistically significant difference in intraoperative complications between the two groups (P > 0.05). The incidence of postoperative urinary retention was significantly higher in the laparoscopic than the robotic group (5.0% [19/350] vs. 1.7% [3/175], χ2 = 4.009, P = 0.044). Conclusion: In our study, robotic radical surgery for rectal cancer achieved short-term oncological outcomes similar to those achieved by laparoscopic radical surgery for rectal cancer. However, robotic radical surgery had advantages in terms of anal function and postoperative quality of life, while also reducing the incidence of perioperative urinary complications.

Adverse Events after Percutaneous Transhepatic Biliary Drainage: A Ten-Year Retrospective Analysis.

To determine the adverse events (AEs) rate associated with percutaneous transhepatic biliary drainage (PTBD) and identify risk factors for their occurrence. This single-center retrospective study included 2310 PTBD (right-side: 1164; left-sided: 966; bilateral: 180) interventions for biliary obstruction (benign/malignant) in 449 patients between 2010-2020. Patients with percutaneous cholecystostomy alone were excluded. There were 455 initial drain placements (66 with cholangioplasty) and 1855 exchanges (202 with cholangioplasty). Stents were placed in 163 procedures (metal: 156; plastic: 86). Demographic and procedural variables were assessed using multivariable logistic regression. A total of 745 AEs were recorded. The three most common AEs were peri-catheter bile leak (331/745; 44.4%), catheter occlusion (110/745; 14.7%), and drain dislodgement (103/745; 13.8%). There was a significantly higher overall AE rate amongst patients with malignant biliary obstruction compared to benign [29.8% vs. 17.6%; p=0.0065; odds ratio (OR)=1.57(1.13-2.18)]. Intra-procedure cholangioplasty was associated with decreased AE rate for initial drains and overall procedures [OR=0.48 (0.25-0.90); p=0.02 and OR=0.63 (0.45-0.89); p=0.0092]. Finally, a right-sided drain was associated with an increased overall AE rate for initial drains and overall procedures [OR=1.62 (1.02-2.55); p=0.04 and OR=1.43 (1.05-1.91); p=0.02]. Malignant obstruction and right-sided drains are associated with a higher risk of PTBD-related AEs, while intra-procedure cholangioplasty reduces risk. These findings offer insights into how this high-impact procedure can be performed more safely and effectively.

Self-expanding metallic stent insertion for malignant bowel obstruction secondary to gynecologic malignancies: a retrospective analysis : SEMS for gynecological MBO is efficient.

Malignant bowel obstruction (MBO) is a common complication in advanced and recurrent gynecologic malignancies, with limited treatment options and poor prognosis. Self-expanding metallic stent (SEMS) insertion has emerged as an alternative palliative measure, yet data specific to gynecologic malignancies remains scarce. A retrospective analysis was conducted on 61 patients with gynecologic malignancies and malignant large bowel obstruction who underwent colorectal stenting between January 2002 and December 2023. Data, including demographics, procedural details, clinical outcomes, and complications, were collected from electronic medical records. The mean age of patients was 65.7years, with ovarian cancer being the most common malignancy (77%). "Technical success" of SEMS insertion was achieved in 91.4% of cases, with a "clinical success" rate of 76.7%. Major complications occurred in 2% and 5% of patients at 30- and 90days post-procedure, respectively. Overall mortality rates were 4% at 30days and 28% at 90days. SEMS for managing MBO is a promising alternative to surgery in patients with advanced or recurrent gynecologic malignancies. It offers high technical and clinical success rates with acceptable complication rates. Further research is needed to delineate optimal patient selection criteria and refine procedural techniques to maximize outcomes in this challenging population.

Initial experience of a novel ureteral silicon-covered metallic mesh stent in malignant ureteric obstruction: a single-center retrospective study

BackgroundThis study aimed to investigate initial experiences and outcomes of a retrograde inserted new silicone-covered metallic ureteric stent (Urexel™) for malignant ureteric obstruction.MethodsWe retrospectively reviewed the medical records for 12 consecutive patients who underwent Urexel™ stent placement for malignant ureteric obstruction from March 2020 to March 2021. The Urexel™ stent is a segmental metallic ureteric stent composed of a nitinol mesh covered with a silicone membrane. We evaluated the clinical outcomes and complications of this new metallic ureteric stent.ResultsThe median age of patients was 61.5 (44–82) years, and the median follow-up was 25.5 (4–37) months. One of the 12 patients underwent bilateral stent insertion, Urexel™ stents were placed in a total of 13 ureteral units. There was no technical failure during stent placement. The median length of obstructions was 9 (1–22) cm. Balloon dilation was necessary in 38.5% (5/13 ureter units) of cases. The 6-month success rate was 83.3%, 1-year success rate was 70%, and estimated success rate was 44.4% at 2-year. Encrustation, migration and hyperplasia were the cause of overall treatment failure in all 6 cases of failure, with median elapsed time to failure of 9.5 (1–30) months. Common complications included persistent pain, acute pyelonephritis, and lower urinary tract symptoms, but they were Clavien-Dindo grade I or II.ConclusionsIn this initial series of novel ureteral silicon-covered metallic mesh stents, Urexel™ provided acceptable success and complication rate in malignant ureteric obstructions.

The Role of Therapeutic Endoscopic Ultrasound in Management of Malignant Double Obstruction (Biliary and Gastric Outlet): A Comprehensive Review with Clinical Scenarios.

Endoscopic ultrasound (EUS)-guided interventions have revolutionized the management of malignant biliary obstruction (MBO) and gastric outlet obstruction (GOO), providing minimally invasive alternatives with improved outcomes. These procedures have significantly reduced the need for high-risk surgical interventions or percutaneous alternatives and have provided effective palliative care for patients with advanced gastrointestinal and bilio-pancreatic malignancies. EUS-guided biliary drainage (EUS-BD) techniques, including hepaticogastrostomy (EUS-HGS), choledochoduodenostomy (EUS-CDS), and antegrade stenting (EUS-AS), offer high technical and clinical success rates, with a good safety profile particularly when Endoscopic Retrograde Cholangiopancreatography (ERCP) is not feasible. EUS-HGS, which allows biliary drainage by trans-gastric route, is primarily used for proximal stenosis or in case of surgically altered anatomy; EUS-CDS with Lumen-Apposing Metal Stent (LAMS) for distal MBO (dMBO), EUS-AS as an alternative of EUS-HGS in the bridge-to-surgery scenario or when retrograde access is not possible and EUS-guided gallbladder drainage (EUS-GBD) with LAMS in case of dMBO with cystic duct patent without dilation of common bile duct (CDB). EUS-guided gastroenterostomy (EUS-GE) has already established its role as an effective alternative to surgical GE and enteral self-expandable metal stent, providing relief from GOO with fewer complications and faster recovery times. However, we do not yet have strong evidence on how to combine the different EUS-guided drainage techniques with EUS-GE in the setting of double obstruction. This comprehensive review aims to synthesize growing evidence on this topic by randomized controlled trials, cohort studies, and case series not only to summarize the efficacy, safety, and technical aspects of these procedures but also to propose a treatment algorithm based essentially on the anatomy and stage of the neoplasm to guide clinical decision-making, incorporating the principles of personalized medicine. This review also highlights the transformative impact of EUS-guided interventions on the treatment landscape for MBO and GOO. These techniques offer safer and more effective options than traditional approaches, with the potential for widespread clinical adoption. Further research is needed to refine these procedures, expand their applications, and improve patient care and quality of life.

Thermal Ablation and Intralesional Cisplatin Injection as Adjunct to Systemic Chemotherapy in Managing Malignant Central Airway Obstruction: A Case Report

Endobronchialultrasound (EBUS)-guidedintralesional chemotherapy and thermal ablation using cryotherapy and electrocautery can be used for the management of malignant central airway obstruction (CAO). This is a case of a 62-year-old male presenting with cough, hoarseness, and shortness of breath. He was diagnosed with squamous cell carcinoma stage IVA (T4N2M1a), causing malignant CAO that progressed to impending respiratory failure (ECOG PS 4). Chest CT scan findings included a left main bronchus mass measuring 3.7 x 5.8 x 5.9 cm causing complete atelectasis, a right pleural-based mass, and osteolytic destruction of the 3rd lateral ribs. Bronchoscopy showed a fungating, friable mass in the carina extending to the orifice of the right and left mainstem bronchus with 70% and 100% occlusion, respectively. A multimodality treatment approach was taken with tumor debulking by thermal ablation with cryotherapy and electrocautery, EBUS-guided intralesional cisplatin, and systemic chemotherapy. Subsequently, there was an interval decrease in the size of the tumor in multiple areas, with left lung re-expansion. The clinical symptoms of the patient significantly improved and ECOG status increased to 1. No adverse effects were noted post procedure. Intralesional cisplatin can be an effective and safe adjunct treatment in malignant CAO, alongside thermal ablation and systemic chemotherapy.

Endoscopic Approaches for Managing Small Intestinal Disease.

The endoscopic evaluation and management of small intestinal diseases continue to evolve and expand. The advent of small bowel wireless capsule endoscopy and deep enteroscopy with either a double- or single-balloon enteroscope now allows complete endoscopic visualization of the entire small intestine and enables access for endoscopic interventions such as biopsies or hemostasis for most of the small bowel. New endoscopic techniques are available to treat proximal malignant small bowel obstruction, including intraluminal stents and endoscopic gastrojejunal stents. Emerging technologies also aim to improve weight loss and diabetes management via small bowel endoscopic interventions.

Endoscopic ultrasound guided-gastroenterostomy is the best choice in the treatment of gastric outlet obstruction.

First of all, I would like to congratulate Vilas-Boas et al on an interesting publication. In this letter the authors write about very interesting topics in the management of patients with malignant gastric outlet obstruction (GOO). GOO developed in up to 20% of patients with advanced hepatopancreatobiliary disease both in benign and malignant form. For this reason, the issue is very current. I fully agree with Vilas-Boas et al that technical aspect of the procedures (surgeon's view) often differs from the patient's view (regarding such factors as cancer-related survival, overall survival, body mass composition, nutritional biomarkers, chemotherapy tolerance and patient-reported quality of life). The mentioned factors should be taken into account when interpreting the effectiveness of treatment modalities for malignant GOO (mGOO), which should be also considered in the future studies in this subject. In my opinion, all above mentioned factors could be summarized in one term: "Improving quality of life of patients with mGOO".

A case of endoscopic colonic stenting for the malignant obstruction in the ileum end

A case of endoscopic colonic stenting for the malignant obstruction in the ileum end

Efficacy and safety of a novel multisegmented fully covered self-expanding metal stent for malignant esophageal obstruction: a prospective pilot study with historical control.

Self-expanding metal stents (SEMSs) are effective for symptom palliation in patients with esophageal obstruction. However, their placement can lead to adverse events such as stent migration and restenosis. A novel fully covered SEMS (FCSEMS) with antimigration properties has been developed to address these issues. This study aimed to evaluate the feasibility and safety of this novel stent in treating malignant esophageal obstruction. This prospective pilot study enrolled patients with malignant esophageal obstruction treated with the novel stent at a tertiary referral center. Primary outcomes included technical and clinical efficacy, whereas secondary outcomes were adverse events. Treatment outcomes were compared between the novel stent and historical control groups. 137 patients were analyzed, comprising 32 in the novel stent group and 105 in the historical control group. In the novel stent group, technical success was achieved in 100% of patients and clinical success in 96.9%. No stent placement-related events, including bleeding or perforation, were observed. Though no significant differences in adverse events were found, the novel stent group had a lower migration rate than the historical control group (9.4% vs. 14.3%, p = 0.565). Median stent patency was similar between the groups (70.5 vs. 43.0days, p = 0.185). The novel multisegmented FCSEMS demonstrated high technical and clinical efficacy with a low migration rate, presenting a promising treatment option for malignant esophageal obstruction. Further studies with larger samples are needed to confirm these findings.