Esophageal Stent Research Articles

Efficiency and Complications of Esophageal Stenting in the Management of Postoperative Fistulas.

Esophageal anastomotic fistula (AF) is a frequent and severe complication of an esophagectomy due to esophageal or eso-gastric junction cancer, regardless of the selected surgical technique. AF is usually treated by endoscopic stent placement. Objectives: This study aims to examine the efficacy of stents in the treatment of AF, analyzing the healing period and the factors that contribute to its delay. Methods: We collected data from 55 patients who underwent stent implantation for AF, and analyzed multiple variables related to patient healing time and surgical technique with two primary endpoints: post-stenting hospital stay and the time of stent usage until fistula closure. The patients were divided into three groups based on the anastomosis type (eso-gastric anastomosis, eso-gastric cervical anastomosis and eso-jejunal anastomosis) and they were compared using the primary endpoints. Results: Our findings show the differences between the three groups, with a longer hospital stay for eso-gastric anastomosis, and an extended time of fistula closure in the case of eso-gastric cervical anastomosis. We also found a significant correlation between the size of the fistula and the hospital stay (R = 0.4, p < 0.01). Regarding patients' risk factors, our results show an extended post-stenting hospital stay for those patients that underwent preoperative radiotherapy. Conclusions: Our results offer an extended view of the efficiency, hospitalization duration and healing time for esophageal anastomotic fistula, and reveal some of the factors that interfere with its resolution.

Experimental study on radiational characteristics and nursing care of a novel radioisotope 188Re memory alloy esophageal stent.

Radioactive esophageal stent, known for inhibiting tumor growth and delaying restenosis in malignant esophageal tumors, presents challenges due to potent radiation, leading to side effects. This study aims to support the clinical use of 188Re radioactive esophageal stent. The 188Re stent with 128MBq initial activity was placed in a biomimetic esophageal membrane. Radiation absorption doses were measured by thermoluminescence and calculated using mathematical software. Under simulated positioning, the stent was implanted in the esophagus of an experimental pig, followed by the feeding of Kangfuxin solution and nursing care (KFX-RT). Non-implanted and implanted-only pigs served as normal (CR) and experimental (RT) controls. Blood samples collected on days 7 and 21 were analyzed for inflammatory factors (TGF-β1, TNF-α, IL-6) using enzyme-linked immunosorbent assay. Esophageal tissue cells were assessed for deoxyribonucleic acid index (DI) and subdiploid content through flow cytometry. Absorbed doses at 0.5mm and 5mm reference points were 223.91cGy and 20.55cGy, respectively, with 92.64% absorbed within a 1mm thickness. Radiation dose significantly decreased at 6.5mm, with only 4.72% absorbed at depths ≥6.5mm. On days 7 and 21, levels of inflammatory factors, DI and subdiploid content were significantly increased in the KFX-RT and RT groups compared to the CR group, while all levels in the KFX-RT group were significantly lower than in the RT group. The 188Re esophageal stent exhibits high radiation absorption in superficial tissues and low absorption in deeper tissues. Kangfuxin solution combined with nursing care alleviates radiation-induced inflammatory damage.

Clinical evaluation of oxaliplatin-loaded drug-eluting callispheres beads transarterial chemoembolization for unresectable or recurrent esophageal carcinoma

BackgroundA majority of esophageal carcinoma patients are diagnosed at an advanced stage and are no longer suitable for surgical resection. Drug-eluting beads transarterial chemoembolization (DEB-TACE) with oxaliplatin-loaded CalliSpheres beads (CB) have been used for advanced hepatocellular carcinoma and lung cancer, but they have not been reported for the treatment of unresectable or recurrent esophageal carcinoma.MethodsDEB-TACE was performed on 22 patients with unresectable or recurrent esophageal carcinoma between March 2019 and May 2022. The clinical outcomes, complications, and efficacy were retrospectively recorded and analyzed.ResultsA total of 39 sessions of DEB-TACE were performed in 22 patients, with a technical success rate of 92.3% and clinical success rate of 65.0%. No severe complications such as procedure-related death, esophageal rupture or paraplegia were observed. Complete response, partial response, and stable disease were observed in 14.3% (2/14), 42.9% (6/14), and 21.4% (3/14) of patients 6 months after DEB-TACE, respectively. The objective response rates were 62.5%, 42.9% and 57.1% respectively at 1-, 3-, and 6-month after DEB-TACE. Subsequent interventional treatments were administered to 12 patients, including DEB-TACE for hepatic metastasis in 3 (13.6%), esophageal stenting in 5 (22.7%), and airway stent placement in 5 (22.7%). Two patients were lost to follow up. A total of 9 patients died due to tumor progression (n = 5), pneumatic infection (n = 1), and tumor-related massive esophageal hemorrhage (n = 3). The median overall survivals were 13.9 months and 26.5 months from the first session of DEB-TACE and the diagnosis of esophageal carcinoma, respectively.ConclusionsDEB-TACE with oxaliplatin-loaded CB is suggested as a safe and effective treatment of unresectable or recurrent esophageal carcinoma, and more studies are required to confirm its efficacy and safety.

A clinical case of acute intestinal obstruction as a result of dislocation of the esophageal self-expanding nitinol stent

INTRODUCTION: Covered esophageal self-expanding stents are often used to palliate dysphagia in patients with unresectable esophageal and gastric cardia cancer. Migration of an esophageal stent is a common occurrence in these patients. One of rare complications that can be caused by stent dislocation is intestinal obstruction. The article describes a case of intestinal obstruction in result of migration of a fully covered nitinol esophageal stent. Patient K., 53 years old, was admitted to hospital in a severe condition with complaints of vomiting, abdominal pain and stool retention that had persisted for four days. The patient refused esophagogastroduodenoscopy. A plain abdominal X-ray did not reveal any free gas. In the mesogastrium, numerous pneumatized loops of small intestine with horizontal fluid levels were identified. For life indications, the patient, after preoperative preparation was taken to the emergency operating room; resection of the terminal part of small intestine was performed with placement of an ileostomy and gastrostomy. Taking into account difficulties of diagnosis (refusal of esophagogastroduodenoscopy by the patient and low informative value of X-ray examination), severity of the patient’s condition (due to a malignant neoplasm and intestinal obstruction), anatomical peculiarities (location of the esophageal stent 30 cm from the ileocecal angle, which would complicate potential application of enteroenteroanastomosis), the chosen tactics was to refuse application of enteroenteroanastomosis and exteriorize ileostomy and gastrostomy. CONCLUSION: Acute intestinal obstruction is a threatening complication of migration of an esophageal stent. Patients with placed esophageal stents require careful monitoring, use of a sparing diet and additional methods of stent fixation, which will help reduce the frequency of stent migration and associated complications.

PRP improves the outcomes of autologous skin graft transplantation on the esophagus by promoting angiogenesis and inhibiting fibrosis and inflammation.

Autologous skin graft (ASG) transplantation is a challenging approach but a promising option for patients to prevent postoperative esophageal stricture. Nonetheless, the current strategies require improvement. We aimed to investigate the effectiveness of the injection of platelet-rich plasma (PRP) before skin graft transplantation for extensive esophageal defects after endoscopic resection. Standardized complete circular endoscopic resection (5 cm in length) was performed in 27 pigs allocated into 3 groups. The artificial ulcers were treated with a fully covered esophageal stent (control group), ASG (ASG group), and submucosal injection of PRP with ASG (PRP-ASG group). Macroscopic evaluation and histological analysis of the remolded esophagus were performed 7, 14, and 28 days after surgery. The macroscopic evaluation indicated that submucosal injection of PRP before transplantation effectively promoted the survival rate of skin grafts and decreased the rate of mucosal contraction compared with those treated with ASG or stent alone. Histological analysis of submucosal tissue showed that this modified strategy significantly promoted wound healing of reconstructed tissues by enhancing angiogenesis, facilitating collagen deposition, and decreasing inflammation and fibrogenesis. These findings suggested that PRP might be used as a biological supplement to increase the esophageal skin graft survival rate and improve submucosal tissue remolding in a clinically relevant porcine model. With extremely low mucosal contraction, this novel combination strategy showed the potential to effectively prevent stenosis in extensive esophageal ulcers.

Endoscopic management of Boerhaave syndrome: a comprehensive review of techniques, outcomes and future directions

Boerhaave syndrome, characterized by spontaneous esophageal rupture, presents a critical condition requiring prompt diagnosis and intervention to reduce morbidity and mortality. Traditionally managed with surgical intervention, advancements in endoscopic techniques have emerged as viable alternatives, offering less invasive options with promising outcomes. This article provides a thorough review of the endoscopic management of Boerhaave syndrome, detailing the indications, techniques, and outcomes associated with various endoscopic approaches. We examine the role of esophageal stenting, clipping, and tissue sealants, alongside adjunctive therapies. Furthermore, we discuss patient selection criteria, procedural considerations, and potential complications. Our review highlights the evolving landscape of Boerhaave syndrome management, underscoring the importance of multidisciplinary collaboration and the need for further research to optimize patient outcomes.

EMERGENCY ESOPHAGECTOMY FOR ESOPHAGEAL PERFORATION FOLLOWING BALLOON DILATION DUE TO STENOSIS POST-ENDOSCOPIC SUBMUCOSAL DISSECTION FOR ESOPHAGEAL CANCER: A CASE REPORT

Introduction and importance: Esophageal perforation from endoscopic dilation is rare (0.53% to 0.6% incidence) but serious, with mortality rates of 12.5% to 20%. Optimal treatment is debated and depends on the medical facility’s capabilities, patient’s symptoms, extent of perforation, and severity of associated lesions. Treatment options include medical management (fasting, antibiotics), esophageal stenting, surgical closure, or emergency esophagectomy. Early diagnosis and treatment are crucial to reduce mortality and hospital stay. Case presentation: A 49-year-old male with lower third esophageal cancer (stage cT1aN0M0) underwent endoscopic submucosal dissection (ESD) and developed esophageal stenosis. Dilation attempts led to esophageal perforation, necessitating emergency esophagectomy with gastric conduit reconstruction. The patient improved and was discharged on day 10 post-operation without complications. Clinical discussion: Managing esophageal perforation post-endoscopic dilation is complex. This case highlights the importance of rapid recognition and intervention. Esophageal dilation, while effective for stenosis, carries a perforation risk. Treatment decisions must be tailored to individual patients, considering perforation severity, patient’s health, and facility resources. Here, severe perforation and clinical condition warranted emergency esophagectomy. The successful outcome underscores the efficacy of this surgical intervention when performed timely at specialized centers. Conclusion: Emergency esophagectomy with gastric conduit reconstruction for treating esophageal perforation due to stenosis post endoscopic submucosal dissection for esophageal cancer is considered a safe procedure and can be performed at an experienced esophageal surgery center.

EP502 - Outcome of 5 years of endoscopic oesophageal stenting: a retrospective analysis

Abstract Background Oesophageal endoscopic stenting has a wide range of indications however dysphagia and use in cancer of the oesophagus is by far the most common, being the 14th most common cancer in the UK, despite advances in diagnosis and therapy with patients often presenting at advanced stages of the disease. Greater than 50% of presentations are at an advanced stage of disease where resection is often not possible and palliation is required. Palliation often is a potential combination of palliative chemotherapy, radiotherapy and endoscopic stenting to control the disease burden and improve symptoms. One of the most limiting palliative symptoms is dysphagia for which oesophageal stenting has become the standard of treatment showing immediate results. However, intra/post procedural complication rates can be high leading to: oesophageal perforation, mediastinitis, aspiration pneumonia, failed stent insertion or slippage. Method A retrospective analysis of 97 patients who underwent oesophageal stenting, in a 5 year time period between 2018-2023 in the Dumfries Royal Infirmary, a large district general hospital. Patients electronic notes were retrospectively analysed for patient characteristics, indication for stenting, early complications, successful hospital discharge and mortality. Conclusion The retrospective study demonstrated oesophageal stenting is a relatively safe procedure with a low mortality and the majority of patients being discharged from hospital. However, complications are not uncommon and patients should be properly counselled; on the risks, benefits and also food habits to prevent bolus.

777. COMBINED OESOPHAGEAL AND AIRWAY STENTING FOR MALIGNANT OESOPHAGEAL STRICTURES: THE UK’S LARGEST TERTIARY CENTRE EXPERIENCE AND DEVELOPMENT OF A NOVEL ALGORITHM

Abstract Background Malignant oesophageal strictures can cause airway compromise and fistula formation. Combined oesophageal and airway stenting is a potential treatment yet no guidelines exist. This study aims to describe the outcomes of same-session oesophageal and airway endoscopic stenting for malignant strictures and propose an algorithm for intervention. Methods A retrospective study on patients undergoing same-session gastroenterology (GI) and respiratory endoscopy at University College London Hospital, 2019-2023. All procedures were with anaesthetic-led propofol sedation. Endoscopic decision making was based on pre-procedure multidisciplinary team meeting (MDM) and intra-procedure clinical assessment. Data collected included malignancy type, luminal narrowing, complications, and mortality. Results 26 patients were identified. Mean age was 63 years. Cancer type was oesophageal (81%) or lung (19%). The most common referral indication was dysphagia (42%); airway compromise was often seen on imaging (65%). Stent insertion was oesophageal only (35%), airway only (19%) and dual (27%). Airway stenting was common (80%) if airway stenosis was &amp;gt;50%. No airway stenting occurred if stenosis was &amp;lt;50%. After oesophageal stenting, repeat bronchoscopy showed increased airway stenosis in 4 patients (25%). The only intraoperative complication was one oesophageal perforation. New tracheooesophageal fistula was the most common post-intervention complication (15%). Median time from malignancy diagnosis to death was 7.9 weeks. Conclusion We present the first algorithm (Figure 1) for endoscopic stenting in patients with malignant oesophageal stricture and airway involvement. We suggest upper GI and respiratory MDM to plan same-session endoscopy with decision-making framed by patient-centred goals given their poor prognosis.

326. SPONTANEOUS OESOPHAGEAL PERFORATION TREATED WITH OESOPHAGEAL STENT

Abstract We present the case of a 66-year-old male with spontaneous oesophageal perforation treated with oesophageal stenting. This patient reports sudden onset severe anterior chest pain after coughing and haematemesis with a background medical history of Type II DM, ESRF on Haemodialysis, Hypertension, OSA and takes prophylactic Aspirin. Endoscopy reveals multiple areas of oesophageal perforation in the proximal, middle, and distal oesophagus as well as a haematoma extending the entire length of the oesophagus to the COJ. This was treated with insertion of a WallFlex™ Fully Covered Oesophageal Stent as the patient was unsuitable for surgery. The result was re-epithelialisation of the entire oesophagus and complete resolution of the perforation at the mid-oesophagus. Dutch physician Boerhaave first described spontaneous oesophageal perforation in 1724. Commonly, these were treated surgically with associated high morbidity and mortality. Advances in endoscopic and stent technology has given clinicians a greater armamentarium to treat patients especially in the frail end elderly population. These advances include choices such as stent covers, biodegradable and removable stents, and anti-reflux valves. Complications with oesophageal stents such as fistula formation, stent migration and retrosternal pain are often associated with the length of placement. The choice of a fully covered retrievable oesophageal stent in our case provided reconstitution of oesophageal lumen and minimisation of mediastinal sepsis. With the progress in stent technology, we believe there will be greater use of endoscopic oesophageal stenting for oesophageal perforations bridges the gap between operative and non-operative management.

521. SHORT-TERM PROPHYLACTIC STENTING FOR HIGH-RISK ESOPHAGEAL ANASTOMOSIS: A CASE SERIES

Abstract Background Anastomotic leak after esophagectomy is a cause of major morbidity, increases surgical mortality and can affect long-term survival outcomes. Early recognition and treatment of anastomotic leaks has greatly improved the rescue rates for this catastrophic complication. However, for some patients, successful rescue is not sufficient to prevent major morbidity and worse long-term outcomes. Prevention of esophageal anastomotic leaks would benefit these patients. Prophylactic stenting after esophagectomy can be one of the tools used in addition to all other factors that are implemented to improve surgical outcomes in this complex cohort of patients. Methods We present a series of seven patients who underwent esophagectomy for malignant disease at our institution. They had insertion of prophylactic esophageal stents at the time of esophagectomy due to a combination of patient factors and intraoperative complications. All anastomoses were carried out using the modified Orringer technique of linear stapled esophagogastric anastomosis. All patients underwent insertion of an 18mm diameter, fully covered EGIS (S&amp;G Biotech, Korea) esophageal stent with antireflux valve. This was fixed to the esophagus / gastric tube using two 2-0 Vicryl Rapide (Polyglactin 910) sutures. The stents were removed endoscopically between postoperative day 14 and 28. Results None of the seven patients who underwent prophylactic esophageal stenting had any clinical or radiological evidence of anastomotic leak. In one patient, at the time of stent removal, a possible anastomotic defect was noted but it was not possible to enter the cavity. A new stent was inserted, and the patient was clinically observed. He remained clinically well throughout. Another patient developed a severe hospital acquired pneumonia requiring ventilatory support without evidence of anastomotic leak. Median length of stay was 13 days. There was no mortality within 90 days of surgery. Conclusion Short term prophylactic esophageal stenting is possible and safe. The technique of stent fixation and early removal helps to mitigate the risks of stent migration and erosion. In our small series, the stents were effective in preventing anastomotic leaks with no stent related complications. This provides optimism for patients and surgeons that morbidity from anastomotic leaks can be minimised, enabling patients to recover from surgery and proceed to adjuvant treatment if indicated. The safety profile of prophylactic esophageal stents should be investigated further and both short- term and long-term outcomes compared to current standards of care by randomised studies.

Abstract ID: 42Combined oesophageal and airway stenting for malignant oesophageal strictures: the UK’s largest tertiary centre experience and development of a novel algorithm

Abstract ID: 42Combined oesophageal and airway stenting for malignant oesophageal strictures: the UK’s largest tertiary centre experience and development of a novel algorithm

394. ESOPHAGEAL STENTING IN ESOPHAGEAL CANCER PATIENTS WITH PERFORATION AND FISTULA

Abstract Background Esophageal perforation and fistula to the respiratory system are serious problems in esophageal cancer patients. Esophageal self-expandable metal stent (SEMS) placement has become a popular treatment for this problem. This retrospective study aimed to evaluate the factors associated with clinical outcomes following the placement of a SEMS in esophageal cancer patients with perforation and fistula. Methods Data from 43 esophageal cancer patients with perforation and fistula who underwent esophageal SEMS placement at Prince of Songkla University Hospital between January 2008 and June 2023 were reviewed. Statistical analyses, including chi-square tests and Kaplan-Meier methods, were employed for comparisons and survival calculations. Results The SEMS location was the middle esophagus in 76.8% and 11.6% in each of the lower and upper esophagus. The disease was stage IV in 62.8% and stage III in 37.2%. 46.5% had a history of chemoradiotherapy. The perforation and fistula penetrated into the left bronchus in 39.5%, right bronchus 18.6%, trachea 16.3%, lung 14% and mediastinum 11.6%. The SEMS technique was successful in all patients. The median stent patency was 38.5 days. Tumor overgrowth was the major cause of stent obstruction. The median overall survival was 40 days. Initial success of the SEMS placement was the only predictor of better survival. Conclusion Esophageal SEMS placement in esophageal cancer perforation and fistula cases is technically uncomplicated. Although these advanced esophageal cancer patients had a poor prognosis, the esophageal SEMS provided symptom relief and improved quality of life for their remaining time.

Surgical management of atrioesophageal fistula after catheter ablation of atrial fibrillation: A French nationwide study

ObjectiveThe study objective was to assess the efficacity of different surgical strategies for atrioesophageal fistula after catheter ablation of atrial fibrillation. MethodsBetween January 2010 and April 2023, all patients with a diagnosis of atrioesophageal fistula or pericardo-esophageal fistula after catheter ablation of atrial fibrillation were analyzed retrospectively from the French database EPITHOR. Patients without surgical management were excluded. ResultsEighteen patients were included, 15 with atrioesophageal fistula and 3 with pericardo-esophageal fistula. Median follow-up was 89.5 days with an overall survival of 50%. Five patients underwent esophageal stenting, 2 as a bridge-to-esophagectomy with 50% of survival and 3 in association with esophagus and left atrial direct repair with 66% survival. Primary esophageal repair with flap coverage was performed in 8 patients with 25% survival, most of them with sepsis and neurological failure. Seven patients had an esophagectomy with 71% survival, only 2 of them having a neurological failure. Among them, 5 patients underwent a restorative surgery and are still alive. Four patients had a retrosternal colon interposition, and 1 patient had an esogastric anastomosis. Risk factors for death were neurological failure (hazard ratio [HR], 4.91, 95% CI, 0.95-25.22; P = .0057) in univariate analysis and sepsis (HR, 6.25, 95% CI, 1.17-33.3; P = .032) in multivariate analysis. Esophagectomy tended to offer a survival benefit (HR, 0.163, 95% CI, 0.019-1.340; P = .092). The use of cardiopulmonary bypass did not significantly impact survival (HR, 1.953, 95% CI, 0.392-9.719; P = .413). ConclusionsAggressive surgical strategies for managing atrioesophageal fistula are mandatory to offer the best chance of survival.

770. CLOSURE OF OESOPHAGEAL DEFECTS USING THE VACSTENT DEVICE: INITIAL INSIGHTS FROM THE LARGEST UK CASE SERIES

Abstract Introduction Oesophageal defects are associated with poor morbidity and mortality and often require prolonged hospitalisation and artificial nutrition. Existing endoscopic treatment modalities exhibit limitations. Covered stents are associated with a migration rate of up to 50% and closure with endoscopic clips is limited to simple defects. Vacuum therapy is a well understood and established surgical therapy to promote wound healing. Endoscopic Vacuum Therapy (EVT) utilises these principles in the management of transmural oesophageal defects. The VACstent GITM (MicroTech) is a novel device which synergistically incorporates the advantages of a fully covered oesophageal stent while concurrently employing EVT. This approach seals the defect while mitigating against stent migration through the vacuum effect. Luminal patency is also maintained which helps to preserve nutritional independence. Accelerated healing and enhanced nutrition are thought to help reduce morbidity and enhance patient quality of life. Methods This single-centre prospective case series describes outcomes for patients with transmural oesophageal defects treated with the VACstent GITM device. All procedures were performed with propofol sedation and fluoroscopic guidance. The VACstent GITM was exchanged every 5-7 days until endoscopic closure. A contrast study was used to confirm closure after which oral nutrition was restarted. The primary outcome was clinical success, defined as the endoscopic and radiological evidence of defect closure. Secondary outcomes included number of stent exchanges, technical success, and the adverse event (AE) rate. Results The VACstent GITM device was used for seven patients between October 2023 and February 2024. Four patients had anastomotic leaks with three having iatrogenic perforations. The mean patient age was 60 (± 19.3) years with 57% of the patient cohort being male. The clinical success rate was 86% with a technical success rate of 100% and a median defect closure time of 13 (± 6.6) days. A median number of 1 stent exchanges was required. The median defect size was 8mm (± 6.2). There were no reported AEs. All patients were able to successfully come of artificial nutrition. Conclusion This case series illustrates the safety and efficacy of the VACstent for the treatment of a heterogenous group of oesophageal defects. To our knowledge this represents the largest series in a cohort of patients from the United Kingdom. Larger scale comparative studies incorporating a more diverse patient cohort will further clarify the potential of the VACstent device in reducing the necessity for major surgical interventions in this complex and challenging patient population. It will also help to refine future treatment algorithms for oesophageal defect management.

275. SAFETY AND TREATMENT RESULTS OF SELF-EXPANDABLE METAL STENT (SEMS) PLACEMENT FOR ESOPHAGEAL DISEASE

Abstract Background Self-expandable metal stent (SEMS) placement for esophageal strictures and fistulas caused by malignant tumors has been reported from various institutions as a relatively minimally invasive and safe palliative treatment. SEMS placement is often selected for cancer-bearing patients whose general condition has already deteriorated, but there are many unknowns regarding the risks and benefits of placement. Methods We retrospectively examined swallowing scores, oral intake status, complications and prognosis for 41 cancer-bearing patients who underwent SEMS placement in our hospital from 2011 to 2023. Results There were 29 men and 12 women, with a median age of 77 years. The types of cancer were esophageal cancer / gastric cancer / lung cancer / others in 22/12/3/4 cases, respectively. The reason for stent placement was stricture / fistula in 39/2 cases. Stent placement was successful in 40 cases (97.6%), and complications were observed in 7 cases (17.1%), including bleeding, displacement, and aspiration pneumonia in 2, 3, and 2 cases, respectively. Three patients underwent second stent placement for restenosis, and the median time to restenosis was 57 days. After stent placement, dysphagia score improved in 30 cases (78.9%). After stent placement 35 patients (87.5%) chose palliative treatment and the median survival time (MST) was 1.7 months (0.2-10.8). Comparing patients with PS≦2 and PS≧3 using performance status (PS) at the time of stent placement, patients with PS≦2 significantly ate more after stent placement (median amount of oral intake; 80 % vs. 40%, p=0.037), and the survival period was longer (MST; 3.1 months vs. 1.3 months, p=0.0018). Univariate analysis on the risk of complications by stent placement showed that chemotherapy history, radiotherapy history, and pretreatment dysphagia score were not risk factors, but poor PS (≥3) was the only significant risk factor (Odds ratio: 12.5, 95% CI:1.3-117, p=0.027). Conclusion Esophageal stents are less invasive treatment than any other palliative methods, like esophageal bypass or radiation therapy for patients who strongly desire oral intake. However in patients with poor general condition the risk of complications is high and the survival period is not long, so it should be performed after fully explaining the risks and benefits.

Palliative use of self-expanding metal stents in initially anticancer treatment-intolerant patients with esophageal cancer

BackgroundThe post-insertion clinical course of esophageal self-expandable metal stents (SEMS) in initially frail patients with esophageal carcinoma (EC) with dysphagia remains unclear. This study aimed to assess dysphagia improvement and evaluate prognosis in initially frail patients with advanced EC following SEMS insertion.MethodsWe retrospectively reviewed EC patients with EC who underwent esophageal SEMS insertion at our institution between January 2014 and March 2023. Inclusion criteria comprised Eastern Cooperative Oncology Group Performance Status (ECOG PS) ≥ 3 or ECOG PS 2 for individuals aged ≥ 75 years and recommendation for best supportive care by a multidisciplinary team.ResultsForty-six patients met the inclusion criteria. Among them, 37 patients (80.4%) were ≥ 75 years old, and 21 patients (45.7%) exhibited ECOG PS 3 or 4. Dysphagia score (DS) ≥ 3 was observed in 27 patients (58.7%). All esophageal SEMS insertions were successfully completed. Post-procedure, there were two fatal cases of aspiration pneumonia and one perforation incident. DS improved to ≤ 1 in 25 patients (54.3%), with multivariate analysis indicating DS 3–4 and Glasgow Prognostic Score (GPS) 1–2 as negative predictive factors. The median overall survival was 4.1 months (95% confidence interval 1.8–6.5).ConclusionsEsophageal SEMS insertion effectively alleviated dysphagia in initially frail EC patients, yet prognosis remained poor, with occurrences of some fatal adverse events. Careful selection of candidates for esophageal SEMS insertions is crucial in this demographic, particularly considering the challenges in improving dysphagia for patients with DS 3–4 and GPS 1–2.

Cerebral arterial air embolism after esophageal stenting for recurrence of gastroesophageal junction cancer: a case report.

Cerebral arterial air embolism (CAE) is a rare complication after esophageal stenting, but it can be life-threatening. It is especially a concern for those with a history of previous gastrointestinal cancer therapies. We report a case of CAE after esophageal stenting in a patient with recurrent gastroesophageal junction cancer and a history of multiple cancer treatments. A 71year-old man with a history of a proximal gastrectomy, resection of the lower esophagus, chemotherapy, and radiation presented to our hospital 2weeks after stenting with epigastric and back pain. Mediastinitis was suspected and conservative treatment was begun. The patient suddenly developed altered mental status, left hemiplegia, and anisocoria after drinking water. A brain computed tomography (CT) revealed right-sided predominance of multifocal CAE. Chest and abdominal CT showed a hematoma in the gastric and duodenal wall and an intraluminal hematoma from the esophagus, around the stent, to the upper ileum. CAE was thought to be due to rupture of the recurrent tumor. Unfortunately, despite intensive care, the patient died about 5h after the onset of neurological symptoms. It has been reported that prior treatments, such as chemotherapy and radiotherapy, increase the risk of life-threatening adverse events, including CAE after esophageal stenting. Clinicians should keep in mind the possibility of CAE after esophageal stenting in patients with a history of multiple cancer treatments.

Efficacy and risk factors of stent placement in the treatment of malignant tracheoesophageal fistula.

Due to the low incidence of malignant tracheoesophageal fistula and the paucity of relevant clinical studies, the benefits of stent implantation have not been well documented. It remains unclear which factors may affect fistula closure. Between January 2015 and January 2021, 344 patients who were diagnosed with malignant tracheoesophageal fistula at Zhongda Hospital, Southeast University, were retrospectively enrolled. Demographic and clinical data were collected. Risk factors for fistula closure identified by univariate analysis were further analyzed using multivariable logistic regression. A total of 288 patients were analyzed in this study, of which 94 were treated conservatively, 170 were treated with an esophageal stent, and 24 were treated with a tracheal stent. Among them, the delta Karnofsky's performance status score values (after 2 weeks/before treatment [p = 0.0028], after 1 month/before treatment [p = 0.0103]) were significantly different between conservative and stent treatment. There was a significant reduction of pneumonia incidence in the stenting group (33.53%) compared to the conservative treatment group (77.05%) after one month (p <0.0001). In addition, the closure of fistulas was influenced by four independent risk factors: 1) treatment methods (p < 0.0001), 2) fistula size (p = 0.0003), 3) preoperative white blood cell count (p = 0.0042), and 4) preoperative Karnofsky's performance status score (p = 0.0001). Stent implantation has become an effective method for treating malignant tracheoesophageal fistula compared to conservative treatment. Additionally, stent implantation, smaller fistula size, lower preoperative white blood cell count, and higher preoperative Karnofsky's performance status score suggest a better outcome.

Multisegmented fully covered esophageal stent: a step to the side

Multisegmented fully covered esophageal stent: a step to the side