Palliative Treatment Of Malignant Strictures Research Articles

The Role of Self-Expandable Metallic Stents in the Treatment of Malignant Strictures in all Segments of the Gastrointestinal Tract.

Management of malignant gastrointestinal (GI) obstruction presents a significant challenge. Most patients are in a profoundly decompensated state due to underlying malignancy and are not ideal candidates for invasive surgical procedures. Self-expandable metallic stents (SEMSs) are used to provide permanent or temporary patency in all endoscopically accessible stenosis of the GI tract. In this study, it is aimed to analyse the characteristics and the efficacy of patients with malignant stenosis treated with SEMS, in all segments of the GI tract. The sample consisted of 60 patients who underwent SEMS replacement, between 10 March 2014 and 16 December 2020, to treat malignant-related strictures in the GI tract at the Gastroenterology Department of the Health Sciences University Umraniye Training and Research Hospital. The data of the patients, hospital data processing database and electronic endoscopic database records were retrospectively scanned and recorded. The general characteristics of the patients and the treatment-related features were analysed. The mean age of patients who were placed SEMS was 69.7 ± 13.7 years. Uncovered (15%, n: 9), fully covered (13.3%, n: 8), or partially covered (71.6%, n: 43) SEMS were successfully placed in all patients. Clinical success in patients with SEMS was 85.7% in the esophagus, 100% in the small intestine and 90.9% in the stomach and colon. About 11.4% migration, 14.2% pain, 11.4% overgrowth and 5.7% ingrowth were detected in patients who had SEMS placed in the oesophagus. Pain was detected in 9.1% and ingrowth in 18.2% of patients who had SEMS placed in the stomach. Pain was detected in 18.2% of the patients who had SEMS placed in the colon and migration was found in 9.1%. SEMS implant is a minimally invasive effective method in the palliative treatment of malignant strictures of the GI tract.

Comparison of outcome of rigid and self-expanding stents for palliation of malignant dysphagia

Between 1984 and 2019, 1005 rigid prostheses and 423 self-expanding stents were inserted for palliation of malignant esophageal stenosis. The aim of this study was the comparison of the treatment results using the two types of prosthesis. Retrospective analysis has been performed comparing the characteristics and treatment results of the two patients groups referring to the technical success of the procedures, procedure-related complications, change in the quality of life, and survival time. A comparison of average ages, duration time of dysphagia, quantity of weight loss, and the progress of the malignancy proves that palliation with self-expanding stents made it possible to treat more patients in worse condition. The number of complications in the patient group treated with stents was significantly higher at 29.3%/20.9%. Endoscopic intervention was performed to treat complications in 68.6% of cases with rigid prostheses and in 53.2% of patients treated with stents. Relevant improvement of dysphagia and the patients' quality of life was observed in 97% of those who were treated with a rigid prosthesis and in 91.3% of those who were treated with self-expanding stents. The survival time in the group of patients treated with stents was significantly shorter by 4.3/5.4 months than in the other group. The use of self-expanding stents in palliative treatment of malignant strictures have brought significant changes in everyday practice with increasing the possibilities. The treatment results were not improved by their application as much as the worse condition of the patient group worsened them. Orv Hetil. 2022; 163(49): 1952-1961.

Fully covered stents are similar to semi-covered stents with regard to migration in palliative treatment of malignant strictures of the esophagus and gastric cardia: results of a randomized controlled trial

IntroductionStent migration is a significant clinical problem in palliation of malignant strictures in the esophagus and gastro-esophageal junction (GEJ). We have compared a newer design of a fully-covered stent to a widely used semi-covered stent using migration >20 mm as the primary outcome variable. Effects on dysphagia, quality of life (QoL) and re-intervention frequency were also investigated.MethodsPatients with dysphagia due to non-curable esophagus/GEJ cancer were randomized to receive either a more recent design of a fully-covered stent (n = 48) or a conventional semi-covered stent (n = 47). Chest x-ray, dysphagia and QoL were studied at baseline, one week, four weeks and three months thereafter.ResultsThere were no significant differences either in stent migration distance or in the migration frequency. Stent migration during the total study period occurred in 37.2 % in the semi-covered group compared to 20.0 % for the fully-covered group. Dysphagia was measured with Watson and Ogilvie scores and with the dysphagia module in the QoL scale (QLQ-OG25). On average, there was a tendency to better dysphagia relief for the fully-covered design as scored with the two latter dysphagia instruments (p= 0.081 and p= 0.067) at three months and towards more re-interventions in the semi-covered group (p= 0.083).ConclusionIn spite of its somewhat lower intrinsic radial force, the fully-covered stent was comparable to the conventional semi-covered stent with regard to stent migration. The data further suggest a potential benefit of the fully-covered stent in improving dysphagia in patients with longer life expectancy.

An antireflux stent versus conventional stents for palliation of distal esophageal or cardia cancer: a randomized clinical study

Self-expandable metal stents placed across the esophagogastric junction for palliative treatment of malignant strictures may lead to gastroesophageal reflux and pulmonary aspiration. This study compared the effects of a Dua antireflux stent with those of a conventional stent. Patients with incurable cancer of the distal esophagus or gastric cardia were randomly assigned to receive an antireflux stent (n = 19) or a standard stent (n = 22) at nine Swedish hospitals during the period September 1, 2003 to July 31, 2005. Complications were recorded at clinical follow-up visits. Survival rates were assessed through linkage to the Population Register. Dysphagia, reflux symptoms, esophageal pain, dyspnea, and global quality of life were assessed as changes in mean scores between baseline and 1 month after stent insertion through validated questionnaires. No technical problems occurred during stent placement in the 41 enrolled patients. Fewer patients with complications were observed in the antireflux stent group (n = 3) than in the standard group (n = 8), but no statistically significant difference was shown (p = 0.14). The survival rates were similar in the two groups (p = 0.99; hazard ratio, 1.0; 95% confidence interval, 0.5-2.0). The groups did not differ significantly in terms of studied esophageal or respiratory symptoms or quality of life. Clinically relevant improvement in dysphagia occurred in both groups. Dyspnea decreased after antireflux stent insertion (mean score change, -11), and increased after insertion of standard stent (mean score change, +21). Antireflux stents may be used without increased risk of complications, mortality, esophageal symptoms, or reduced global quality of life. These results should encourage large-scale randomized trials that can establish potentially beneficial effects of antireflux stents.

Palliative Treatment for Inoperable Malignant Colorectal Obstruction By Means of Self-Expanding Metalic Stent and Transanal Ileus Tube

Palliative Treatment for Inoperable Malignant Colorectal Obstruction By Means of Self-Expanding Metalic Stent and Transanal Ileus Tube Yamada Tomonori, Sasaki Makoto, Shimura Takaya, Oshima Tadayuki, Tanida Satoshi, Kataoka Hiromi, Joh Takashi Background and Aim: Self-expanding metalic stent (SEMS) have been used in the management of malignant colorectal obstruction as an alternative to palliative surgery. Because most of the published series describe the stenting of the left-sided colon and the use of uncovered stents, the aims of our study are to prospectively evaluate the efficacy, safety, and outcome of covered and uncovered SEMSs for the palliative treatment of malignant strictures in the rectum to the distal ascending colon. Methods: 21 patients (10 males, 11 females, median age 73 years old with a range of 52 to 93 years) with inoperable malignant colorectal obstruction underwent placements of SEMS under fluoroscopic and endoscopic control. Seventeen patients had primary colorectal cancers, 2 had recurrent colonic cancers, 1 had ovarian cancer and 1 had bladder cancer. Before stenting, total colorectal obstructions as defined, if there was no passage of gas and feces, were adequately decompressed with the transanal ileus tubes. In Japan, the dedicated colorectal SEMS is not available and the esophageal stent with technical modifications is substituted. Covered or uncovered Esophageal SEMSs (Ultraflex; Boston Scientific) with 7 to 15 cm long and had a 17 to 23 mm central diameter were used. Results: In 22 lesions of 21 patients, SEMS insertions were performed as palliative to relieve obstruction. Prior to stent insertion, 10 lesions with total obstructions (45.5%) were decompressed with transanal ileus tubes. The sites of obstruction were ascending colon in 2 patients, descending colon in 2, sigmoid colon in 7, rectum in 10. With respect to the types of stents, the covered type of stents was employed in 13 lesions and the uncovered type in 9. Technical success in SEMS placements was achieved in 22 (100%) strictures. But one patient with a sigmoidvesical fistula subsequently underwent colostomy for an uncontrollable infection at the fistula after one week. All but this patient obtained clinical success in 21 (95.5%) lesions and the median stent patency was 121 days with a range of 26 to 511 days. There were no serious complications related to stent placement. In 4 lesions (19.0%), stents spontaneously evacuated from anus 98 to 148 days after insertion. After migration, Additional insertion of stent was required in two patients, tumor resection was performed in one patient, and colostomy was performed in one patient. There was no reobstruction of tumor ingrowth. Conclusions: By means of the covered stent and decompressions with the transanal ireus tube, SEMS may provide safe and effective palliation of patients with malignant obstructions in rectum to distal ascending colon.

Management of Malignant Stricture of the Esophagogastric Junction with a Newly Designed Self-Expanding Metal Stent with an Antireflux Mechanism

When stents are placed across the esophagogastric junction for palliative treatment of malignant strictures, they may lead to esophagogastric reflux. The aim of this study was to compare the effectiveness of a newly designed antireflux stent with that of a standard open stent and a currently available antireflux stent (Dostent) in preventing gastroesophageal reflux symptoms in patients with inoperable cancer at the esophagogastric junction. Thirty-six consecutive patients with cancer at the esophagogastric junction were randomly assigned to undergo placement of a newly designed antireflux stent (n = 12), a Dostent (n = 12), or a standard open stent (n = 12). Technical and clinical success, dysphagia score, reflux symptoms, complications and ambulatory 24-h esophageal pH monitoring were assessed. The technical success rates were 100 %. After 1 week, dysphagia had improved in all patient groups ( P < 0.05), but the degree of improvement did not differ between the three groups. The DeMeester score was significantly lower in the group with the newly designed antireflux stent than in the other groups. The fraction of the total recording time during which esophageal pH was below 4 was 3.14 +/- 5.78 % using the newly designed antireflux stent, in comparison with 29.25 +/- 15.41 % in the Dostent group and 15.01 +/- 11.72 % in the standard open stent group ( P < 0.001). Fewer reflux episodes occurred with the newly designed antireflux stent than with the Dostent or standard open stent. There were no complications with any of the three stents. The newly designed antireflux stent is effective in relieving dysphagia caused by malignant cancer at the esophagogastric junction. The newly designed antireflux stent is significantly more effective in preventing gastroesophageal reflux than currently available antireflux stents.

Treatment of malignant esophageal/cardiac stricture with self-expanding antireflux metallic stents: A preliminary report from 17 patients

BACKGROUND: Different types of self-expanding metallic stents are available for the palliative treatment of malignant strictures at the gastroesophageal junction. To overcome some of the disadvantages in the design of these metallic stents, we designed a silicone-covered self-expanding antireflux metallic stent that can prevent free gastroesophageal reflux after stent placement. METHODS: Seventeen silicone-covered antireflux prototypes were used in 17 patients with dysphagia caused by inoperable malignant tumors involving the gastroesophageal junction. RESULTS: Stent implantation was technically successful in all 17 patients. There were no procedure-related perforations or deaths. As a group, the mean dysphagia grade improved significantly (2.56 ± 0.49 vs 1.00 ± 0.51, P < 0.001) and the mean lumenal diameter was greatly increased (4.11 ± 1.02 vs 14.72 ± 4.01, P < 0.001) after stent placement. Ten patients received ambulatory 24-h esophageal pH monitoring and compared with the healthy volunteers, there were no postprocedural abnormal gastroesophageal refluxes in any patient. Three patients had substantial chest pain requiring long-term analgesics. No other complications were observed. CONCLUSIONS: The newly developed self-expanding antireflux metallic stent is safe and effective for use in the palliation of dysphagia caused by malignant strictures at the gastroesophageal junction. A larger patient population would be required to give valid conclusions.