Placement Of Multiple Stents Research Articles

The utility of self-expanding metal stents in benign biliary strictures- a retrospective case series

BackgroundBenign biliary strictures can have a significant negative impact on patient quality of life. There are several modalities which can be utilized with the goal of stricture resolution. These techniques include balloon dilatation, placement of multiple plastic stents and more recently, the use of metal stents. The aim of this study was to evaluate the local success of self-expanding metal stents in successfully resolving benign biliary strictures.MethodsThis was a single institution, retrospective case series. Patients included in our study were patients who underwent endoscopic retrograde cholangiopancreatography with placement of self expanding metal stents for benign biliary strictures at our institution between 2016–2022. Patients were excluded for the following: malignant stricture, and inability to successfully place metal stent. Data was evaluated using two-sided t-test with 95% confidence interval.ResultsA total of 31 patients underwent placement of 43 self-expanding metal stents and met inclusion criteria. Mean age of patients was 59 ± 10 years, and were largely male (74.2% vs. 25.8%). Most strictures were anastomotic stricture post liver transplant (87.1%), while the remainder were secondary to chronic pancreatitis (12.9%). Complications of stent placement included cholangitis (18.6%), pancreatitis (2.3%), stent migration (20.9%), and inability to retrieve stent (4.7%). There was successful stricture resolution in 73.5% of patients with anastomotic stricture and 33.3% of patients with stricture secondary to pancreatitis. Resolution was more likely if stent duration was > / = 180 days (73.3% vs. 44.4%, p < 0.05). There was no demonstrated added benefit when stent duration was > / = 365 days (75% vs. 60.9%, p = 0.64).ConclusionsThis study demonstrates that self expanding metal stents are a safe and effective treatment for benign biliary strictures, with outcomes comparable to plastic stents with fewer interventions. This study indicates that the optimal duration to allow for stricture resolution is 180–365 days.

Short and long outcomes of endoscopic bilateral metal stent placement for malignant hilar biliary obstruction: Tertiary care oncology centre experience.

Placement of biliary self-expanding metal stents (SEMS) has been effective for palliation of unresectable hilar malignant biliary obstruction. Optimal drainage in hilar obstruction may require placement of multiple stents. Data on multiple SEMS placement in hilar obstruction from India is sparse. Retrospective review of patients with unresectable malignant hilar obstruction who underwent endoscopic bilateral SEMS insertion from 2017 to 2021 was done. Demographic details, technical success and functional success (decrease in the bilirubin value below 3mg/dL at fourweeks), immediate complications with 30-days mortality, requirement of re-intervention, stent patency and overall survival were studied. Forty-three patients were included (mean age 54.9years, 51.2% females). Thirty-six patients (83.7%) had carcinoma gallbladder as primary malignancy. Twenty-six patients (60.5%) were metastatic at presentation. Cholangitis was seen in 4/43 (9.3%). On cholangiogram, 26 (60.4%) had Bismuth type II block, 12 (27.8%) had type IIIA/B, 5 (11.6%) had type IV block. Technical success was achieved in 41/43 (95.3%) patients (38, side-by-side SEMS placement; 3, SEMS-within-SEMS in Y fashion). Functional success was achieved in 39 patients (95.1%). No moderate-severe complications were reported. Median post-procedure hospitalization was five days. Median stent patency was 137days (interquartile range [IQR] 80-214days). Re-intervention was required in four patients (9.3%) after mean 295.7days. Median overall survival was 153days (IQR 108-234days). Endoscopic bilateral SEMS in complex malignant hilar obstruction has good outcomes in the form of technical success, functional success and stent patency. Survival is dismal despite optimal biliary drainage.

Clinical and Radiological Outcomes of Vertebral Artery Dissecting Aneurysms Treated with Endovascular Treatments: A 12-year Single-Center Experience

We aimed to compare the clinical and radiological outcomes of vertebral artery dissecting aneurysms (VADAs) stratified using different endovascular treatment methods. We retrospectively reviewed 116 patients with VADAs treated at a single tertiary institute between September 2008 and December 2020. We analyzed and compared the clinical and radiological parameters according to different treatment methods. In total, 127 endovascular procedures were performed in 116 patients. We initially treated 46 patients with parent artery occlusion, nine with coil embolization without stent, 43 with single stent with or without coil, 16 with multiple stents with or without coils, and 13 with flow-diverting stent. At the last follow-up (mean 37.8 ± 30.9 months), the complete occlusion rate (85.7%) was higher in the multiple stent group than in the groups that received other reconstructive treatment methods. Moreover, the recurrence (0%) and retreatment (0%) rates were significantly lower in the multiple stent group (p<0.001). The coil embolization-only group showed the highest recurrence (n=5, 62.5%) and incomplete occlusion (n=1, 12.5%) rates. The single-stent group showed higher recurrence (n=9, 22.5%) and retreatment (n=3, 7%) rates. Multivariate logistic regression analyses showed that coil embolization without stent placement (OR=172.76, p=0.002, 95% confidence interval [CI] 6.83-4366.85) was significantly associated with recurrence. At the last follow-up (mean 42.1 ± 37.7 months), we achieved favorable clinical outcomes (mRS ≤ 2) in 106 of 127 patients. When treating VADAs, multiple stent placements may play a key role in achieving favorable long-term radiological outcomes.

Successful retrieval of migrated and embedded fully covered self-expanding metal stent using "snare and lithotripter" technique.

A 52-year-old woman with benign perihilar left intrahepatic duct stricture underwent repeated stricture dilation and multiple plastic stent placements. Subsequently, an 8 mm × 12 cm multi-hole fully covered self-expanding metal stent (MH-FCSEMS) was inserted. Six months later, she had abnormal liver biochemistry. Endoscopic retrograde cholangiography (ERC) revealed supra-papillary stent migration and tissue ingrowth at the proximal end ([Fig. 1]). Cholangioscopy (SpyGlass System; Boston Scientific Corp., Marlborough, Massachusetts, USA) showed that the stent lumen was obliterated by stone cast ([Fig. 2]). Stent removal with forceps and snare failed. The patient was referred to our center for a second opinion.

S2995 Gallstone Ileus: An Unusual Cause of Small Bowel Obstruction After Liver Transplantation

Introduction: Liver transplantation is the only curative treatment for patients with decompensated liver disease. The prevalence of biliary complications after a deceased donor liver transplant is estimated between 10 to 15%. Biliary leaks and strictures are the most common biliary complications. We are presenting a rare case of gallstone ileus at the biliary limb in a patient with a complicated post-liver transplant course. Case Description/Methods: A 78-year-old female with a history of NASH cirrhosis for which she underwent a deceased donor liver transplant ten years before presentation. Post-transplant course was complicated by anastomotic biliary strictures, recurrent choledocholithiasis, and recurrent cholangitis requiring multiple ERCPs with placement of multiple biliary stents. She underwent Roux-en-Y hepaticojejunostomy three years before presentation with marked improvement in the number of cholangitis episodes. She presented with intractable nausea and vomiting. Physical exam showed abdominal distention and periumbilical tenderness but no rebound tenderness or rigidity. Labs were significant for a mild rise in serum creatinine but no leukocytosis and liver chemistries were normal. CT abdomen revealed small bowel obstruction with a transition point at the right lower quadrant anastomosis suspecting phytobezoar at the jejuno-jejunal anastomosis. The patient underwent push enteroscopy to decompress the obstructed limb and remove the suspected food material. The scope was advanced to the jejuno-jejunal anastomosis. About 15 cm beyond the afferent limb, the lumen was entirely occluded by a giant stone measuring (3.5 cm x 2.5 cm). The stone had sequential rings and appeared as a cholesterol stone. The stone was fragmented using grasping forceps, snares, and dilating balloons. It was successfully fragmented into 15-20 smaller stones over three hours duration. The scope was advanced beyond the fragmented stones. A nasogastric tube was inserted for decompression. Patient symptoms resolved following the procedure, and she was discharged home with no recurrence. (Figure) Discussion: Biliary leaks and strictures are the most common biliary complications following liver transplant. Gallstone ileus should be considered in liver transplant patients presenting with small bowel obstruction, especially if they have a history of recurrent biliary complications. Prompt recognition of this complication is key, endoscopic lithotripsy should be attempted first in these patients as they are usually high risk surgical candidates.Figure 1.: Panel A: CT abdomen and pelvis showing dense luminal material at the transition point. Panel B: Endoscopic image of the cholesterol stone occluding the lumen before lithotripsy. Panel C: Endoscopic image of the cholesterol stone after the lithotripsy.

332.10: Pre-transplant Coronary Angiography Findings Based on Coronary or Aorto-Iliac Calcification on CT Imaging in Asymptomatic Patients With a Negative Cardiac Stress Test

Purpose: Cardiac events are now the leading cause of early mortality after kidney transplantation. Long term exposure to immunosuppression also increases cardiometabolic stress after transplantation. Several studies in general population have shown that the presence of coronary artery calcification increases the risk of future cardiovascular events. Among pre-kidney transplant candidates, there remains wide variation in cardiac risk assessment practices across transplant centers. We report coronary angiography findings in asymptomatic candidates undergoing Kidney transplant evaluation with negative stress test but with findings of coronary or aorto-iliac calcification on CT imaging. Methods: We conducted a retrospective single center study of 76 Pre-Kidney transplant recipients who had a negative stress test and underwent coronary angiography between 2010 to 2021. All patients underwent coronary angiography based on coronary or aortoiliac calcification on CT imaging. Mean age was 60 years in both groups. Demographics and results are listed in table 1. Results: Results at our academic center showed that 18 out of 76 patients (23.6%) had a 70% stenosis in one or more coronary vessels. 11 out of 76 patients (14.4%) underwent single or multiple vessels stent placement and one underwent CABG. 7 out of 76 patients (9%) had significant distal disease or vessels were too small for intervention. In CAD group, 13 out of 18 patients (72%) were diabetic. All patients underwent successful kidney transplantation. Post Operative hypotension was more common in non-CAD group, in 9 patients as compared to 3 patients in CAD group. 5 patients in non-CAD recipients had post-op Atrial fibrillation Vs 1 in CAD group. Conclusions: In addition to traditional risk factors and other cardiac risk stratification modalities, Coronary or aorto-iliac calcification on CT imaging is a predictor of significant coronary artery disease in patients undergoing evaluation for kidney transplant surgery. coronary angiography before transplantation should be considered for potential candidates for Kidney transplant with negative stress test but significant vascular calcification. Table 1 - N=76 CAD=18 No CAD=58 Stent 11 NA CABG 1 NA Male/Female 12/6 34/24 Dialysis/Preemptive 12/6 46/12 DM 13 34 Former Smoker/ Nonsmoker 9/9 19/39 Months onHD (Mean) 32.2 32.4

Traction method using slim biopsy forceps for prevention of stent migration during multiple biliary stent placement.

Traction method using slim biopsy forceps for prevention of stent migration during multiple biliary stent placement.

Management of distal benign biliary stricture

Endoscopic treatment consists of passing the stricture and placement of at least one large bore plastic stent, followed by further sessions of stenting with multiple plastic stents. Temporary placement of multiple plastic stents is the recommended approach in patients with benign biliary strictures. Self-expandable metal stents have a larger diameter compared to plastic stents and can be covered and uncovered. Placement of uncovered metal stents in patients with benign biliary strictures is strongly discouraged. However, covered self-expandable metal stents can be safely placed in selected patients.

Late results in the endoscopic treatment of cicatricial bile duct strictures

Aim. To evaluate the late results of staged endoscopic treatment of patients with corrosive bile duct strictures.Materials and methods. The study included 41 patients with corrosive bile duct strictures varying in etiology and localization. The patients were observed over a seven-year period, most of whom had already undergone endoscopic treatment.Results. The technical success rate amounted to 100%. The procedure of staged stenting was completed in 34 out of 37 patients under observation. The clinical success rate, defined as the release of a stricture, reached 94%. In the postoperative period, the incidence of complications amounted to 8.8%. Only 2 out of 34 patients who had undergone stenting exhibited stricture recurrence.Conclusion. The staged placement of multiple plastic stents is characterized by high technical and clinical success rates while involving few complications, as well as a consistently low rate of stricture recurrence in the long-term period.

Usefulness of a screw tip stent retriever as a dilator during side-by-side placement of multiple stents for malignant hilar biliary obstruction.

Usefulness of a screw tip stent retriever as a dilator during side-by-side placement of multiple stents for malignant hilar biliary obstruction.

CHA2DS2 VASc score and brachial artery flow-mediated dilation as predictors for no-reflow phenomenon in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

BackgroundFollowing primary percutaneous coronary intervention (PCI), no-reflow is associated with a high rate of long-term unfavorable clinical outcomes. Despite the importance of early no-reflow prediction in cardiovascular medicine, noninvasive assessment is lacking. This study aimed to evaluate the preprocedural CHA2DS2 VASc score and the brachial artery flow-mediated dilation percentage (FMD%) as predictors of the no-reflow phenomenon in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI.ResultsThis study included 150 patients who presented with acute STEMI, underwent primary PCI, and were divided into two groups according to the flow result, reflow group and a no-reflow group. The CHA2DS2 VASc score was calculated and evaluation of endothelial function by measuring the brachial artery FDM% was done for each patient before the procedure. There were 39 (26%) patients in the no-reflow group and 111 (74%) in the reflow group. The no-reflow patients were older and had significantly higher body mass index (BMI), higher frequency of diabetes mellitus, hypertension, history of heart failure, dyslipidemia, Killip class IV on admission, thrombus grade V, multiple affected vessels, conventional stenting, and multiple stents placement, longer ischemic times, higher CHA2DS VASc score, and lower brachial artery FMD% (p-values of < 0.05 for all). Moreover, there was a significant negative correlation between CHA2DS VAS score and preprocedural FMD%, with the higher the score indicating lower FMD among cases (p-value = 0.000).ConclusionsPreprocedural CHA2DS2 VASc score and the brachial artery FMD can be used as predictors for the no-reflow phenomenon in patients with STEMI, undergoing primary PCI.

Fully Covered Self-expanding Stents are Cost-effective at Remediating Biliary Strictures in Patients With Chronic Pancreatitis

Benign biliary strictures (BBS) develop in up to 10% to 30% of patients with chronic pancreatitis (CP).1 Endoscopic endoprosthetics via endoscopic retrograde cholangiopancreatography (ERCP) has become the standard of care for remediating these strictures. Seventy percent to eighty percent of these strictures resolve with sequential or concurrent placement of multiple plastic stents (MPS).1,2 More recently, placement of fully covered self-expanding metal stents (FCSEMS) have been shown to have similar outcomes as MPS.3-6 FCSEMS provide a larger radial diameter and require fewer procedures, but may have drawbacks, including a higher risk of migration, cholecystitis, delamination, and tissue ingrowth. A recent study demonstrated that FCSEMS with a 12-month indwell had similar outcomes to MPS with fewer ERCP needed.7 However, the cost-effectiveness of either strategy for managing BBS has not been assessed previously nor has the impact of additional reimbursement to cover the cost of FCSEMS on the cost-effectiveness of FCSEMS utilization.

Metal versus plastic stents in the management of benign biliary strictures: systematic review and meta-analysis of randomized controlled trials.

Benign biliary strictures (BBS) are usually treated with endoscopic retrograde cholangiopancreatography (ERCP) with the placement of multiple plastic stents (MPS) or a covered self-expandable metal stent (CSEMS). In this meta-analysis, we compared the efficacy and safety of MPS and CSEMS in the management of BBS. We reviewed several databases from inception to 28 April 2021 to identify RCTs that compared MPS with CSEMS in the management of BBS. Our outcomes of interest were stricture resolution, stricture recurrence, adverse events, stent migration and mean number of ERCPs to achieve stricture resolution. Data were analyzed using a random-effects model. We included eight RCTs with 524 patients. We found no significant difference in the rate of stricture resolution (risk ratio, 1.02; 95% CI, 0.96-1.10), stricture recurrence (risk ratio, 1.68; 95% CI, 0.72-3.88) or adverse events (risk ratio, 1.17; 95% CI, 0.73-1.87) between groups. Mean number of ERCPs was significantly lower in the CSEMS group (SMD, -1.99; 95% CI, -3.35 to -0.64). The rate of stent migration was significantly higher in the CSEMS group. CSEMS are comparable in efficacy and safety to MPS in the management of BBS but require fewer ERCPs to achieve stricture resolution.

Fishing line assisted endoscopic placement of multiple plastic biliary stents for unresectable malignant hilar biliary obstruction: a retrospective study

Background and aimsStent migration is one of the most common complications during the placement of multiple plastic biliary stents (MPBS) under endoscopy. This study aims to evaluate the feasibility and efficiency of the fishing line assisted (FLA) method for preventing the complication.Methods Patients with unresectable malignant hilar biliary obstruction (MHBO) who undergone endoscopic placement of MPBS using the FLA or conventional method from May 2018 to April 2021 in our center were enrolled in the study. The endpoints of this study were the stent migration rate, technical success rates, adverse events rates, times of stent migration, and the procedure time.ResultsFLA group (N = 19) and conventional group (N = 22) had similar baseline characteristics of the patients. The technical success rates (100% vs. 95.5%; P > 0.05), ERCP-related adverse events rates (5.3% vs. 4.5%; P > 0.05), and the stent-related adverse events rates (0% vs. 4.5%; P > 0.05) were no significant differences between the FLA and conventional groups. MPBS inserted using the conventional method consumed more time (median, 33.9 min vs. 15.6 min; P < 0.05) method and increased the times of stent migration (median, 3 times vs. 0 times; P < 0.05) than using the FLA method. Even if no statistical difference was detected in the stent migration rate between groups, this rate was lower in the FLA group than the conventional group (0% vs. 13.6%; P > 0.05).ConclusionsFLA method is an effective technique for MPBS implantation to prevent stent migration during endoscopic retrograde cholangiography (ERCP). The method should be applied to patients with unresectable MHBO who need to place MPBS.

Use of endoscopic ultrasound-guided biliary drainage as a rescue of re-intervention after the placement of multiple metallic stents for malignant hilar biliary obstruction.

Endoscopic transpapillary re-intervention (ETP-RI) after multiple self-expandable metallic stent (SEMS) placement for unresectable malignant hilar biliary obstruction (MHBO) is challenging, but endoscopic ultrasound-guided biliary drainage (EUS-BD) could be an alternative following failed ETP-RI. We investigated appropriate re-intervention (RI) methods in MHBO after multiple SEMS placement and evaluated RI with EUS-BD (EUS-RI) benefits following ETP-RI failure. Patients requiring RI after multiple SEMS placement for MHBO between October 2017 and April 2021 were enrolled. Patients' characteristics, metallic-stent type, stent-placement configuration, overall survival, stent patency, re-intervention results, and re-intervention technical and clinical success rates were reviewed. Forty-nine patients underwent ETP-RI for MHBO. ETP-RI's technical success rate was 69.4%. Of 15 failed ETP-RI cases, all underwent EUS-RI, achieving technical and clinical success rates of 86.7% and 100%, respectively. Time to recurrent biliary obstruction (TRBO) after RI was significantly different between EUS-RI and ETP-RI (212 vs 84days; P=.01). On multivariate analysis, EUS-RI was the only factor associated with TRBO (odds ratio: 4.48; 95% confidence interval: 1.01-19.91; P=.04). Acute pancreatitis and bile peritonitis were present in 6.1% of ETP-RI and 13.3% of EUS-RI cases, respectively; both improved conservatively. EUS-RI was effective and safe in difficult ETP-RI cases after multiple SEMS placement for MHBO.

A DISAPPEARING ACT: DEFINITIVE MANAGEMENT OF REFRACTORY VANISHING BRONCHUS INTERMEDIUS SYNDROME

TOPIC: Transplantation TYPE: Medical Student/Resident Case Reports INTRODUCTION: Vanishing Bronchus Intermedius Syndrome (VBIS) is a post-transplant pathology where the Bronchus Intermedius (BI) of a transplanted right lung undergoes non-infectious ischemic and necrotic transformation distal to the surgical anastomosis, resulting in airway occlusion. The stenosis can be refractory to dilation and stenting, requiring increasingly stringent interventions. Here we report a patient who required definitive surgical management for VBIS. CASE PRESENTATION: A 64 year old male with IPF post single right lung transplant was evaluated by our interventional pulmonology team for BI stenosis. One month post transplant, the patient developed respiratory symptoms and a drop in PFTs, which on serial bronchoscopy revealed mucous plugging and a stenotic mass obstructing the BI. Biopsy of the stenosis ruled out infection, revealing only necrotic changes with granulation tissue, thus supporting a diagnosis of VBIS. Stenosis was only intermittently relieved by repeated balloon dilation and forceps debulking. Thus, the BI was stented with a RML fenestration.However, extension of the stenosis to adjacent lobar bronchi and around the stent required repeated placement, revision, and removal of multiple bronchial stents. Repeated cryoablation and laser ablation of the stenosis only resulted in intermittent relief, but segments also developed slight malacia. Direct injections of steroids and Mitomycin were trialed to arrest proliferation of the granulation tissue. Due to persistent symptoms, bronchial sleeve resection of the stenosis was performed for definitive management, resulting in resolution of stenosis. His symptoms related to VBIS improved significantly, with FEV1 improved from 1.18 to 1.59 pre / post surgery. DISCUSSION: The development of VBIS necessitates a multidisciplinary approach to prevent and manage. Ischemic injury is believed to initiate VBIS, and risk factors reflect this (eg. intraoperative blood loss, ECMO, prolonged ventilation, high PEEP). Balloon dilation and stenting is trialed first, followed by debulking by forceps, cryoablation, or laser. Silicone stents are preferred due to ease of removal. Fully covered self expanding metal stents are preferred if adjacent bronchi become affected but are susceptible to epithelialization. Steroids and antimitotic agents may be attempted to inhibit the proliferating granulation tissue when debulking fails. When conservative treatments fail, surgical excision is feasible with good physiologic and symptomatic results. To the authors knowledge, only two other cases of successful BI sleeve resection for VBIS have been reported in the literature. CONCLUSIONS: In the post-transplant setting, risk factors should be assessed to prognosticate for development of VBIS. VBIS may not respond to dilation and debulking, and a mixture of procedural interventions may abate restenosis. Definitive management may require bronchial sleeve resection. REFERENCE #1: Alraiyes AH, Inaty H, Machuzak MS. Vanishing Bronchus After Lung Transplantation: The Role of Sequential Airway Dilatations. Ochsner J. 2017 Spring;17(1):71-75. REFERENCE #2: Santacruz JF, Mehta AC. Airway complications and management after lung transplantation: ischemia, dehiscence, and stenosis. Proc Am Thorac Soc. 2009 Jan 15;6(1):79-93. REFERENCE #3: Marulli G, Loy M, Rizzardi G, Calabrese F, Feltracco P, Sartori F, Rea F. Surgical treatment of posttransplant bronchial stenoses: case reports. Transplant Proc. 2007 Jul-Aug;39(6):1973-5. DISCLOSURES: No relevant relationships by Gustavo Cumbo-Nacheli, source=Web Response no disclosure on file for john egan;research relationship with United Therapeutics Please note: 2016- ongoing Added 04/19/2021 by Reda Girgis, source=Web Response, value=Grant/Researchresearch relationship with Pfizer Please note: 2014-2020 Added 04/19/2021 by Reda Girgis, source=Web Response, value=Grant/Research Speaker/Speaker's Bureau relationship with Boehringher Ingelheim Please note: 2016-ongoing Added 04/19/2021 by Reda Girgis, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Genentech Please note: 2016-ongoing Added 04/19/2021 by Reda Girgis, source=Web Response, value=Honoraria No relevant relationships by Ryan Hadley, source=Web Response No relevant relationships by Edward Murphy, source=Web Response No relevant relationships by Ranuka Sinniah, source=Web Response

Comparison of clinical outcomes of multiple plastic stents and covered metal stent in refractory pancreatic ductal strictures in chronic pancreatitis- a systematic review and meta-analysis

BackgroundSymptomatic pancreatic duct (PD) strictures in chronic pancreatitis refractory to single plastic stenting are usually managed by placement of multiple plastic stents (MPS). Fully covered self-expanding metallic stents (FCSEMS) have also been used in the management of these patients. However, the overall efficacy and safety of different types of stents is unclear from the currently available studies. We performed this meta-analysis to assess the efficacy and complications from MPS and FCSEMS in patients with PD strictures refractory to treatment with single plastic stents. MethodsSeveral electronic databases were searched for all the studies evaluating the outcome of placement of multiple plastic stents and fully covered metal stents in patients with PD strictures refractory to single plastic stenting. We calculated the Weighted Pooled Ratio (WPR) with Confidence Interval (CI) between the MPS and FCSEMS. ResultsA total of 13 studies (including 2 abstracts) were included in the analysis. MPS were placed in 106 patients and FCSEMS in 192 patients. Improvement in pain after stenting (P = 0.794), risk of recurrence of pain after removal of stent (P = 0.48) and stricture recurrence after stent removal (P = 0.52) were comparable between MPS and FCSEMS. Risk of endoscopic re-intervention was also comparable between metal stents and MPS. However, FCSEMS was associated with overall higher risk of adverse events (P < 0.0001). ConclusionFCSEMS are comparable to multiple plastic stents in the treatment of symptomatic refractory PD strictures. However, use of FCSEMS is associated with increased risk of adverse events.

Endoscopic 'suction room' to treat complex enteral stump leaks after upper gastrointestinal surgery.

Leaks/dehiscence of the enteral stump associated with infected peri-enteric collections after upper gastrointestinal surgery are a life-threatening adverse event, not usually endoscopically treatable. We describe a new endoscopic approach to treat complex entero-cutaneous fistulas (CECF) by creating a “suction room” through placement of multiple stents (enteral, biliary and/or pancreatic) and a large nose-enteral suction tube inside the enteral stent maintained on a continuous negative aspiration suction. Between January 2016 and December 2019, six consecutive patients referred to our unit with CECF of the enteral stump after failed redo surgeries underwent creation of a “suction room.” In five patients, enteral, biliary and pancreatic stents were positioned before a nose-to-stent or nose-to-collection large 18 Fr tube placement. In one patient, a pancreatic stent was not placed. Technical and clinical success were achieved in all patients. Mean and median times of aspiration were 49 and 27 days, respectively, with a mean hospital stay of 56 days after the endoscopic procedure. Stents were successfully removed. Mean post-procedural follow-up was 17.3 months. Endoscopic creation of the “suction room” offers the unique possibility of treating complex entero-cutaneous fistulas in surgically altered sites, which are difficult to manage with standard endoscopic methods.

Bilateral balloon expandable biodegradable stent (Y-stent) for postcholecystectomy perihilar biliary stricture.

Bilateral balloon expandable biodegradable stent (Y-stent) for postcholecystectomy perihilar biliary stricture.

Large Thrombosed Basilar Trunk Aneurysm Treated with Multiple LVIS Stent Placement: A Case Report

Large Thrombosed Basilar Trunk Aneurysm Treated with Multiple LVIS Stent Placement: A Case Report