Self-expandable Metal Stents For Treatment Research Articles

Endoscopic vacuum therapy versus self-expandable metal stent for treatment of anastomotic leaks < 30mm following oncologic Ivor-Lewis esophagectomy: a matched case-control study.

Management of anastomotic leaks after Ivor-Lewis esophagectomy remains a challenge. Although intracavitary endoscopic vacuum therapy (EVT) has shown great efficacy for large dehiscences, the optimal management of smaller leaks has not been standardized. This study aims to compare EVT versus self-expandable metal stent (SEMS) in the treatment of leaks < 30mm in size, due to the lack of current data on this topic. Patients undergoing EVT (cases) or SEMS (controls) between May 2017 and July 2022 for anastomotic leaks < 3cm following oncologic Ivor-Lewis esophagectomy were enrolled. Controls were matched in a 1:1 ratio based on age (± 3years), BMI (± 3kg/m2) and leak size (± 4mm). Cases (n = 22) and controls (n = 22) showed no difference in baseline characteristics and leak size, as per matching at enrollment. No differences were detected between the two groups in terms of time from surgery to endoscopic treatment (p = 0.11) or total number of procedures per patient (p = 0.05). Remarkably, the two groups showed comparable results in terms of leaks resolution (90.9% vs. 72.7%, p = 0.11). The number of procedures per patient was not significant between the two cohorts (p = 0.05). The most frequent complication in the SEMS group was migration (15.3% of procedures). EVT and SEMS seem to have similar efficacy outcomes in the treatment of anastomotic defects < 30mm after Ivor-Lewis esophagectomy. However, larger studies are needed to corroborate these findings.

Analysis of prognostic factors in patients with self-expandable metallic stents for treatment of malignant gastric outlet obstruction

Background and aim Self-expandable metallic stents (SEMSs) are widely accepted as a less-invasive treatment for malignant gastric outlet obstruction (GOO). However, the factors related to prognosis and stent dysfunction after SEMS placement are not well known, and we aimed to investigate them. Methods This was a single-center retrospective cohort study of 212 malignant strictures in 207 patients. Factors related to prolonged overall survival (OS) and time to recurrent GOO (TRGOO) after SEMS placement were evaluated. Results Improvement of oral intake was confirmed in 179 patients (86%). The median OS was 65 days. A Cox proportional hazards model revealed that lower cancer stage, lower performance status score at the time of SEMS placement, and administration of chemotherapy after SEMS placement were significant predictive factors for prolonged OS. The median OS was 182 days in the group of SEMS followed by chemotherapy (group A) and 43 days in the group of SEMS alone (group B) (p< .0001). Chemotherapy after SEMS implantation contributed to the prolongation of survival in gastric cancer (hazard ratio (HR), 0.12) and pancreatic cancer (HR, 0.41). Furthermore, the cumulative incidence rates of stent dysfunction on day 120 after SEMS placement were 30% in group A and 61% in group B (p=.03). Notably, the preventive effect of chemotherapy on stent dysfunction was significant in pancreatic cancer. Conclusions SEMS is a treatment with high technical and clinical success rate for malignant GOO. Furthermore, subsequent chemotherapy prolongs OS especially in gastric cancer, and TRGOO in pancreatic cancer.

Clinical Usefulness and Limitations of Short Fully Covered Self-Expandable Metal Stent for Treatment of Proximal Anastomotic Benign Biliary Stricture after Living-Donor Liver Transplantation

Clinical Usefulness and Limitations of Short Fully Covered Self-Expandable Metal Stent for Treatment of Proximal Anastomotic Benign Biliary Stricture after Living-Donor Liver Transplantation

Influence factors of clinical efficacy of self-expanding metallic stents in treatment of colorectal cancer obstruction

Objective To analyze the clinical efficacy and relative influence factors of self-expanding metallic stents (SEMS) in treating colorectal cancer obstruction. Methods Information of 47 patients received SEMS to treat colorectal cancer obstruction from Mar. 2012 to Dec. 2017 in Beijing Haidian Hospital were collected, who were then followed up in outpatient or by telephone. Effective rate, survival rate and complications were recorded and calculated by the software of SPSS 17.0. Chi-square test was used to analyze relative influence factors. Results Results shown that the clinical efficacy was 100%(47/47). Patients′ 30-day survival rate and 6-month survival rate were 87.2% (41/47) and 68.1% (32/47), respectively. After surgery, 2 patients presented with perforation, 3 patients presented with migration and 5 patients presented with reobstruction. Clinical stage of tumor and stent length were related with complications and survival. Therein, complications presented more in patients with advanced cancer. And the longer stent length, the higher mortality. Conclusions Clinical stage of tumor and stent length maybe risk factors of complications and survival of patients after SEMS surgery of colorectal cancer obstruction. Key words: Stents; Intestinal obstruction; Colorectal neoplasms; Efficacy; Survival rate; Influence factors

Endoscopic Stenting for Colorectal Cancer: Lessons Learned From a 15-Year Experience.

The aim of our prospective study was to analyze the results of endoscopic stenting to treat obstruction due to colorectal cancer and complications after colorectal resection for cancer. Endoscopic stenting for obstructing colorectal cancer has become a common place in clinical practice. However, there is a 2% to 5% risk of bowel perforation, and a percentage of technical failure of 2% to 10%. In a 15-year period (August, 1999 to December, 2013), 153 patients with colorectal cancer had endoscopic placement of a self-expandable metal stent for treatment of an obstructing colorectal cancer (133 patients) or for treatment of complications after colorectal resection for cancer (20 patients). They were prospectively evaluated in a database and they form the basis of this report. There was no case of mortality or major morbidity. Overall technical success was 94.8%. After introducing the use of a pediatric nasogastroscope to pass the obstruction (71 patients), technical success was 100%. Complications in patients in whom the stent was left in place during the follow-up were frequent, requiring a close observation. We had 20 patients with fecal obstruction, 4 cases of stent dislodgment, and 8 cases of obstruction from ingrowth of the tumor. All patients were treated successfully endoscopically. Placement of self-expandable metal stents represents a valid technique. A proper training is required.

The Use of Fully Covered Lumen-Apposing Self-expandable Metallic Stents for Treatment of Benign Strictures of the Upper Gastrointestinal Tract: A Retrospective Case-Controlled Study

Introduction: The AXIOSTM stent (Boston Scientific, Massachusetts, USA) is a fully covered lumen apposing self-expandable metallic stent (fcLASEMS). The stent was developed for transenteric drainage of pancreatic pseudocysts. The dumbbell shaped stent is available in lengths of 10mm or 15mm and can be deployed with or without electrocautery. The aim of this study was to examine the efficacy of fcLASEMSs in the treatment of benign stricture disease of the foregut. Methods: A single center retrospective database of patients who underwent endoscopic treatment of benign strictures was analyzed for this study. A total of 998 endoscopic procedures were identified on these patients between January 2014 and May 2017. Of those, 15 patients underwent endoscopic fcLASEMS placement. The average number of endoscopic dilations prior to stent placement was 2.46. A control group of non-stented patients that underwent 3 or more endoscopic dilations with Savary dilators or controlled radial expansion balloon dilators (n=36) was created. The Mann-Whitney test and twotailed-t test were used to compare the total number of endoscopic interventions between the control and fcLASEMS groups. The patient and stricture characteristics were determined based on review of follow up documentation. Complications were defined as events leading to hospitalization or requiring early removal of the stent. Results: The mean number of endoscopic dilations in the control group was 5.02 (SD 3.873). Whereas the mean number of endoscopic interventions in the fcLASEMS group was 3.385 (SD 0.870). The difference between the 2 groups was statistically significant (t-test (P < 0.0001) and Mann-Whitney test (P=0.017)). The mean duration of fcLASEMS placement was approximately 105 days. fcLASEMS placement provided symptomatic relief in 73% of patients. Stent migration and post procedure complications occurred in 6.6% and 20% of patients respectively. The mean length of follow up for the fcLASEMS and control group was 282 and 225 days respectively. Conclusion: Clinicians should consider the use of fcLASEMSs in patients with recurrently symptomatic benign foregut strictures. Early intervention with an fcLASEMS appears to be a viable option for durable symptomatic relief in patients with persistent benign foregut strictures. The overall number of endoscopic interventions was lower with the use of fcLASEMSs than with standalone serial dilations in patients who required 3 or more endoscopic dilations which may be more cost effective.Table: Table. Results of Fully Covered Lumen-Apposing Self-Expandable Metallic Stents for the Treatment of Benign Strictures of the Upper Gastrointestinal Tract

Self-expandable Metallic Stents in Treatment of Colocutaneous Fistula due to Crohnʼs Disease

Self-expandable Metallic Stents in Treatment of Colocutaneous Fistula due to Crohnʼs Disease

Endoscopic jejunojejunostomy by use of a lumen-apposing self-expandable metal stent for treatment of obstructed efferent loop after subtotal gastrectomy with Roux-en-Y-reconstruction

Endoscopic jejunojejunostomy by use of a lumen-apposing self-expandable metal stent for treatment of obstructed efferent loop after subtotal gastrectomy with Roux-en-Y-reconstruction

Endoscopic management of complications of self-expandable metal stents for treatment of malignant esophageal stenosis and tracheoesophageal fistulas.

Background:Self-expandable metal stent (SEMS) implantation may rapidly improve the symptoms of malignant esophageal stenosis and tracheoesophageal fistulas (TEF). However, dysphagia often returns subsequently and repeated endoscopic intervention may be necessary. The aims of the study were to identify the risk factors of complications, and the frequency and efficacy of repeated endoscopic interventions; and to provide technical recommendations on appropriate stent selection.Methods:We analyzed retrospectively the clinical data of 212 patients with locally advanced esophageal cancer who underwent SEMS implantation.Results:A total of 238 SEMS implantations were performed with 99.06% technical success and 1.26% procedure-related deaths in the enrolled 212 cases. Complications occurred in 84 patients (39.62%) and in 55 cases (25.94%) repeated endoscopic procedures were required. Early reintervention 24–48 h after the stent implantations was necessary due to stent migration (12 cases), arrhythmia (2 cases), intolerable retrosternal pain (1 case) and dyspnea (1 case). An average of 1.98 repeated gastroscopies (range 1–6; median 2), 13.58 weeks (range 1.5–48; median 11) after the stent implantation were performed during the follow-up period: 37 stent repositions, 23 restent implantations, 15 endoscopic esophageal dilations and 7 stent removals. In 48 cases (87.3%) oral feeding of patients was made possible by endoscopic interventions.Conclusions:In a quarter of SEMS implantations, complications occur that can be successfully managed by endoscopic interventions. Our experiences have shown that individualized stent choice may substantially reduce the complications rate and make repeated endoscopic interventions easier.

1141 Fully Covered Self-Expandable Metallic Stent for Treatment of Esophageal Perforation After Bougie Dilation in a Patient With Corrosive Esophageal Stricture

1141 Fully Covered Self-Expandable Metallic Stent for Treatment of Esophageal Perforation After Bougie Dilation in a Patient With Corrosive Esophageal Stricture

720 Self-Expanding Metal Stents for Treatment of Benign Biliary Strictures Secondary to Chronic Pancreatitis - Long Term Results in a Multi-Center Study

720 Self-Expanding Metal Stents for Treatment of Benign Biliary Strictures Secondary to Chronic Pancreatitis - Long Term Results in a Multi-Center Study

Anatomy-shaped design of a fully-covered, biliary, self-expandable metal stent for treatment of benign distal biliary strictures.

Background and study aims: The treatment success of benign biliary strictures with fully covered metal stents (CSEMS) is altered by high stent dislocation rates. We aimed to evaluate a new stent design to prevent dislocation. Patients and methods: Patients with benign biliary strictures were treated with a newly designed double-coned stent (dcSEMS). Mechanical analysis of the new stent was performed and it was compared with a cylindrical stent. Results: A total of 13 dcCSEMS were implanted in 11 patients (2 female, 9 male, median age 47, range 33 – 71). All patients had distal biliary strictures due to chronic pancreatitis. No stent migration occurred. In all but one patient the stents were removed. One patient refused stent extraction and was lost to follow up. Stent occlusion occurred twice leading to cholangitis in both cases. The duration of stent treatment was 170 days (range 61 – 254). After extraction only one patient had early recurrent stricture and received the same stent again. Three stents showed minimal tissue granulation at the papilla. One stent presented ingrowth at the proximal end and was removed after implantation of a second fully covered stent.Mechanical examination revealed significantly lower radial expansion force of the new stent as compared to the cylindrical stent. Conclusions: The new stent design has a low rate of migration. Biomechanical properties may explain this effect.

Su1608 No Distal Migration in Unfixed vs. Fixed Cell Structure Covered Self-Expanding Metal Stents for Treatment of Benign Biliary Disease

Su1608 No Distal Migration in Unfixed vs. Fixed Cell Structure Covered Self-Expanding Metal Stents for Treatment of Benign Biliary Disease

Use of Self-Expanding Metallic Ureteral Stents in the Secondary Treatment of Ureteral Stenosis Following Kidney Transplantation.

To evaluate the safety and efficacy of self-expanding metal stents in the treatment of ureteral stenosis following kidney transplantation. Seven patients who developed benign stenosis after kidney transplantation were treated by a self-expanding metallic stent implantation from June 2007 to March 2014. All patients had undergone at least one open surgical procedure and one endourologic procedure for treatment of the stenosis. The extent of stenosis varied from 1.2 to 3.7 cm. Ultrasonography, urography, diuretic renography, and urine culture were performed every 3 months after stent insertion. Ureteroscopic examination was performed when needed. Stent placement was technically effective in all cases. The mean operative time was 37 minutes (range, 26-59 minutes). Lower urinary-tract symptoms and the ipsilateral flank pain were common early-stage complications and were greatly relieved after an average of 3 months. The mean follow-up duration was 38 months (range, 13-86 months), and no stent migration or fragmentation was observed. Urothelial hyperplasia occurred in only one patient and was effectively managed with a Double-J stent. Five patients had normal stable renal function; the remaining two had impaired renal function, including one patient with a preoperative renal failure who required dialysis at the end of the follow-up period (36 months). As an alternative to open surgery, implantation of a self-expanding metal stent is a safe and effective treatment for ureteral stenosis in patients who have undergone kidney transplantation.

No Distal Migration in Unfixed Versus Fixed Cell Structure Covered Self-Expanding Metal Stents for Treatment of Benign Biliary Disease.

Fully covered self-expandable metal stents (FCSEMS) are increasingly used for treatment of benign common bile duct (CBD) stricture or leakage, but dislodgement of FCSEMS is frequent. To compare dislocation rate and clinical outcome of a standard fixed cell structure FCSEMS (S-FCSEMS) to a novel FCSEMS with an unfixed cell structure (N-FCSEMS). We performed a retrospective analysis of all patients with FCSEMS insertion for benign biliary disease at our Hospital from 03/2008 to 03/2014. Both stent types N-FCSEMS and S-FCSEMS were applied as available unrelated to the indication. Twenty-nine patients (S-FCSEMS: 18, N-FCSEMS: 11) were included. Stent placement was technically successful in 28/29 (96.6%) patients; stent removal was successful in 26/27 (96.2%). Two patients with N-FCSEMS were excluded due to unsuccessful placement and withdrawal of consent for stent removal, respectively. Stent migration into the duodenum (distal migration) was observed in 9/18 (50%) in the S-FCSEMS group compared to 0/9 in the N-FCSEMS (p<0.005). FCSEMS migration into the CBD (proximal migration) was found in 2/18 (11%, S-FCSEMS) versus 2/9 (22%, N-FCSEMS, p=0.514). A foreshortening of the N-FCSEMS occurred in 3/9 patients (33%) compared to 0/18 S-FCSEMS (p=0.08). Clinical resolution of the treated CBD-disease was observed in 5/9 (56%, N-FCSEMS) versus 12/18 (67%, S-FCSEMS) at the time of stent removal (p=0.604) and in 0/9 and 10/18 (56%) cases during follow-up, respectively (p<0.005). An unfixed cell structure of FCSEMS seems to prevent distal migration, but proximal migration still occurs and foreshortening of the N-FCSEMS constrains clinical outcome.

Application of fully-covered self-expandable metallic stent for treatment of pancreatic-biliary diseases

Objective To investigate the potential role of the pore-formation in the hemolytic activity of tentacle-only extract(TOE) from the jellyfish Cyanea capillata.Methods The effects of various cations,including K+,Ca2+,Mg2+,Mn2+,Zn2+,Cu2+,Fe2+,La3+and NH4+ on the hemolytic activity of TOE were compared in two different test systems: 1% whole blood and 0.45% erythrocyte suspension with the same erythrocyte concentration.Results The hemolytic activities of TOE in both tests were inhibited by Mn2+,Zn2+,La3+,Cu2+ and Fe2+,and were promoted to a minor extent by K+,Ca2+,Mg2+ and NH4+.The chelating agent EDTA also inhibited the hemolytic activity of TOE.Conclusion The pore-formation mechanism might play an important role in the hemolytic activity of TOE.

Continuing Medical Education Exam: July 2013

Instructions: The GIE: Gastroinintestinal Endoscopy CME Activity can now be completed entirely on-line. To complete do the following: 1. Read the CME articles in this issue carefully and complete the activity: Kaffes AJ, Liu K. Fully covered self-expandable metal stents for treatment of benign biliary strictures. Gastrointest Endosc 2013; 78:13-21. van Vilsteren FG, Herrero LA, Phoa N. A simplified regimen for focal radiofrequency ablation of Barrett’s mucosa: a randomized multicenter trial comparing two ablation regimens. Gastrointest Endosc 2013;78:30-8. Verlaan T, Rohof WO, Bredenoord AJ, et al. Effect of peroral endoscopic myotomy on esophagogastric junction physiology in patients with achalasia. Gastrointest Endosc 2013;78:39-44. No JH, Kim SW, Lim CH, et al. Long-term outcome of palliative therapy for gastric outlet obstruction caused by unresectable gastric cancer in patients with good performance status: endoscopic stenting versus surgery. Gastrointest Endosc 2013;78:55-62. 2. Log in on-line to complete a single examination with multiple choice questions followed by a brief post-test evaluation. Visit the Journal’s Web site at www.asge.org (members) or www.giejournal.org (nonmembers). 3. Persons scoring greater than or equal to 75% pass the examination and can print a CME certificate. Persons scoring less than 75% cannot print a CME certificate; however, they can retake the exam. Exams can be saved to be accessed at a later date. ou may create a free personal account to save and return to your work in progress, as well as save and track your completed activities o that you may print a certificate at any time. The complete articles, detailed instructions for completion, as well as past Journal CME ctivities can also be found at this site.

Self-expanding metal stents for treatment of anastomotic complications after colorectal resection

Self-expanding metal stents (SEMS) can be used to treat patients with symptomatic anastomotic complications after colorectal resection. In the present case series, 16 patients with symptomatic anastomotic stricture after colorectal resection were treated with endoscopic placement of SEMS. Seven patients had a "simple" anastomotic stricture and nine patients had a fistula associated with the stricture. The anastomotic fistula healed without evidence of residual stricture or major fecal incontinence in seven of the nine patients. Overall the anastomotic stricture was resolved in 10 of the 16 patients. SEMS placement represents a valid adjunctive to treatment in patients with symptomatic anastomotic complications after colorectal resection for cancer.

Clinical application of a fully covered self-expandable metallic stent in treatment of airway fistula

To assess the feasibility, safety and efficacy of the use of a fully covered self-expandable stent for the treatment of airway fistula. From August 2005 to November 2011, 9 patients underwent treatment by the introduction of a tracheo-bronchial or bronchial fully covered self-expandable metallic stent. There were 7 males and 2 females, aged from 28-65 years with a mean of 46 years. In this group, 7 cases were diagnosed as bronchopleural fistula, 1 case as tracheopleural fistula, 1 case as broncho-esophageal fistula, 8 cases with thoracic empyema. The fistula orifices were from 3.5-25.0 mm in diameter with a mean 8.4 mm. All patients received topical anesthesia, and L-shaped stent was placed in 6 patients and I-shaped stent in 3 patients under fluoroscopic guidance. After the stent placement, the patients with empyema were treated with continual irrigation of the empyema cavity. Stent placement in the tracheo-bronchial tree was technically successful in all patients, without procedure-related complications. The operating time was from 5-16 minutes, mean time (10 ± 4) minutes. Except for 1 patient, immediate closure of the airway fistula was achieved in the other patients after the procedure, as shown by the immediate cessation of bubbling in the chest drain system or the contrast examination. In this study, 1 patient coughed the inserted stent out due to irritable cough on the 5th day and had to receive repositioning of a new stent. Among the patients who were with empyema, 1 patient died of septicemia on the 8th day and 1 patient died of brain metastases from lung cancer 6 months after the stent insertion with empyema not cured, the other 6 patients' empyema healed from 2-5 months, mean time 3.7 months. Seven patients were followed from 3 to 36 months with a median of 13.5 months. During follow-up, 1 stent was removed from a patient 8 months after the stent implantation without empyema recurred. The remaining patient presented good tolerability to the existence of stent. The stents remained stable, no migration occurred, no empyema recurred, and the patient with broncho-esophageal fistula fed and drunk well. The use of fully covered self-expandable stents proved to be a safe, effective and fast minimally invasive method to treat airway fistula, especially for patients with a higher surgical risk or other failed treatments.

Short-term stenting using fully covered self-expandable metal stents for treatment of refractory biliary leaks, postsphincterotomy bleeding, and perforations

Fully covered self-expandable metal stents (FCSEMS) have been used as a rescue therapy for several benign biliary tract conditions (BBC). Long-term stent placement commonly occurs, and prolonged FCSEMS placement is associated with the majority of the complications reported. This study evaluated the duration of stenting and the efficacy and safety of temporary FCSEMS placement for three BBCs: refractory biliary leaks, postsphincterotomy bleeding, and perforations. This was a retrospective case series with long-term follow-up of 25 patients who underwent FCSEMS placement for BBCs. This study included 17 patients with postcholecystectomy refractory biliary leaks who had previously undergone unsuccessful sphincterotomy and plastic stent placement, 4 patients with difficult-to-control postsphincterotomy bleeding, and 4 patients with a perforation following endoscopic sphincterotomy. Stents were removed according to clinical evidence of problem resolution. The review included stenting duration, safe FCSEMS removal, clinical efficacy, complications, and long-term outcomes. During the follow-up period, ERCP and cholangioscopy procedures were performed to exclude the possibility of bile duct lesion development. Complete resolution of the initial condition was achieved in all patients. Patients with biliary leaks had a median stent duration time of 16 days (range 7-28 days). Patients with bleeding had stents removed after a median time of 6 days (range 3-15 days). Patients with perforations had their stents removed after a median time of 29.5 days (range 21-30 days). There were no complications related to stenting. Temporary placement of a FCSEMS for 30 days or less is an effective rescue therapy for refractory biliary leaks, difficult-to-control post-endoscopic sphincterotomy bleeding, and perforations. Duration of stenting should be different for each type of condition. Stents can be safely removed, and short-term stenting is associated with the absence of early and late complications.