Self-expanding Esophageal Stents Research Articles

Sealing of esophageal perforation with a fully covered biliary stent in a pediatric patient

Conservative treatment for esophageal perforations can cause problems related to both nutrition and wound healing in pediatric patients due to its long duration. This case report presents a 14-month-old female patient who underwent endoscopic balloon dilatation for esophageal stricture. The patient had been operated on for esophageal atresia in the neonatal period. Eight hours after discharge, the patient was hospitalized again due to esophageal perforation. Although conservative treatment lasting three weeks was the preferred method, it was unsuccessful. Therefore, a fully covered biliary stent was used instead of an esophageal stent, as the appropriate size stent could not be found. The stent sealed the perforation, and the patient started to be fed orally on the third day. The esophageal stent was removed on the 17th day, and no leakage was observed on the esophagogram. Although conservative methods are the first-line treatment for esophageal perforations in children, their long duration and the inability to feed for a long time are significant disadvantages. Fully covered self-expandable esophageal stents may be a reliable alternative for sealing esophageal perforations in pediatric patients, as they are in adults.

Percutaneous Endoscopic Necrosectomy-A Review of the Literature.

In this article, an attempt was made to clarify the role of percutaneous endoscopic necrosectomy (PEN) in the interventional treatment of pancreatic necrosis. A comprehensive review of the current literature was performed to identify publications on the role of PEN in patients with consequences of acute necrotizng pancreatitis. The aim of the study was to review the literature on minimal invasive necrosectomy, with emphasis on PEN using esophageal self-expanding metal stents (SEMS). The described results come from 15 studies after a review of the current literature. The study group comprised 52 patients (36 men and 16 women; mean age, 50.87 (13–75) years) with walled-off pancreatic necrosis, in whom PEN using a self-expandable esophageal stent had been performed. PEN was successfully completed in all 52 patients (100%). PEN complications were observed in 18/52 (34.62%) patients. Clinical success was achieved in 42/52 (80.77%) patients, with follow-up continuing for an average of 136 (14–557) days. In conclusion, the PEN technique is potentially effective, with an acceptable rate of complications and may be implemented with good clinical results in patients with pancreatic necrosis.

Pneumatic dilation for the treatment of persistent post-laparoscopic fundoplication dysphagia: long-term efficacy and safety

ABSTRACT Background Post-laparoscopic fundoplication (LF) dysphagia occurs in 5%–17% of patients and optimal management remains a topic of expert discussion. We assessed the efficacy and safety of pneumatic dilation (PD) in patients with persistent post-lLF dysphagia. Methods Medical files of patients treated with PD for persistent post-fundoplication-associated dysphagia were reviewed. The primary outcome was long-term clinical success. Secondary endpoints were initial clinical success, dysphagia recurrence rate, and PD-related complication incidence. Results Overall, 46 patients (74% women, 57.9±11.9 years) underwent 74 PD (mean: 1.6±0.8). A 30 mm, 35 mm, and 40 mm balloon was used in 45.9%, 43.2%, and 10.8%, respectively, of dilations. Among 45 patients with available follow-up, the overall long-term success rate of PD was 31/45 (68.9% [55.4–82.4]). Initial clinical success was 36/45 (80% [68.3–91.7]). Dysphagia recurred in 9 patients (25%; 95%CI 10.9–39.1) and 4 of these were effectively treated with a new dilation. Among 14 non-responders to PD, 11 underwent surgery. Four complications (2 perforations, 1 muscularis dilaceration, and 1 peri-procedural bleeding) occurred in 4 patients (incidence: 5.4% [95%CI; 0.3–10.6]) and were treated with partially covered self-expandable esophageal stents andhemostatic clips. Conclusions Pneumatic balloon dilation for post-fundoplication-associated symptoms is associated with a satisfactory long-term success rate and acceptable safety profile.

Contactless Measurement of Integrity of Silicone Coating on Self-Expandable Esophageal Nitinol Stents.

A stent is a mesh tube inserted into a natural passage in the body to prevent disease induction. Self-expandable esophageal nitinol stents such as SX-ELLA Stent Esophageal HV (HV Stent Plus) can be indicated for palliation of malignant esophageal strictures, for the treatment of benign esophageal strictures that are refractory to standard therapy and for the treatment of esophago-respiratory fistulas. A silicone-stent coating is used for tumor in-growth prevention and esophago-respiratory fistula occlusion. The thickness of the stent and the overall integrity of the silicone coating of all wires indicate the overall mechanical properties of the esophageal stent and the resistance to external adverse events such as corrosion and mechanical and chemical resistance. The polymer multicomponent epoxy resin - a mixture of Epon and Durcupan - was used as a method for robust sample stabilization. A cutting system using a thin water beam with a powder (Blue Line) was chosen as the best variant to obtain 6 samples for both-sided measurement (10 measuring sides). The optical microscopic reflective light method was used to examine wire crossing points in the sections. Fifty values were measured on either sample side for the internal, external and mesh thickness of the silicone stent layer. The wire crossing points were selected so that the silicone layer structure could be clearly seen, and the wires approached each other most closely. Only approximately 4 to 8 crossing points in each section could be measured when applying this approach. The resolution of the microscope and calibration (based on the camera used) was 0.677 μm/pixel. Additional data could be obtained on 8 planes. Two boundary samples were destroyed by the cutting process. Whole coating of the stent was around all mesh wires, especially in areas with higher mechanical stress (wire crossing). The minimum detectable and admissible value determined for all 3 measuring areas (internal, external, mesh) on the wire crossings was 6.77 μm, i.e., 10 pixels, based on the microscope resolution and manufacturer's methodology. The results were characterized by p < 0.001 for all 3 parameters. We tested opposite samples in each section to verify the section quality and data consistency. For the 4 areas, the data were significantly different, but the thickness differences were only on the order of units percent, so the measurements were not appreciably affected. We assume that the material cutting loss, making up 1-2 mm, contributed to the differences in the sections. We examined the overall integrity of the silicone coating of the esophageal stent. The method of HV stent anchoring in a polymeric bath followed by cutting with a waterjet and sample measurement under an optical microscope proved to be very simple and reliable. Sufficient thicknesses of the silicone layer on the wire cross sections were verified. The coated silicone layer thickness appeared to be significantly different along the stent from the proximal part to the distant part, presumably due to the manufacturing technology.

Necrosectomía endoscópica percutánea en el manejo step-up de walled-off necrosis

The drainage of liquid pancreatic collections is complex and technically challenging as for Its technique. In recent decades, endoscopic advances have improved technical and clinical success rates with reduced complications. We present a case of a 72-year-old male patient with severe necrotizing acute pancreatitis after endoscopic papillectomy for recurrent papillary adenoma, with evolution to infected walled-off necrosis. Percutaneous drainage guided by tomography was performed with poor clinical evolution and persistence of collections, predominantly in the tail of the pancreas of solid necrotic remains and air bubbles. Due to the location of the collection and the absence of contact with the gastric wall, percutaneous endoscopic necrosectomy was performed with placement of a self-expanding esophageal metal stent with resolution of the case. This unusual technique is proposed in a step-up approach to the management of walled-off necrosis, when the percutaneous drainage is insufficient and the transgastric endoscopic approach is not possible due to the characteristics of the collection. The management of walled-off necrosis as a late complication of acute necrotizing pancreatitis suggests a step-up approach. Endoscopic necrosectomy achieves higher resolution rates with a lower complication rate, resolution time, and cavity recurrence.

S1925 A Case of Acute Esophageal Necrosis (Black Esophagus) Managed With Fully Covered Self-Expandable Stent

INTRODUCTION: Acute esophageal necrosis (AEN) is a rare but serious endoscopic finding characterized by diffuse inflammation and black appearance of the esophageal mucosa. It mainly affects the distal esophagus and discontinues at the gastroesophageal junction (GEJ). We report a case of AEN presenting in the setting of extensive inferior vena cava thrombosis and alcohol intoxication. CASE DESCRIPTION/METHODS: 58-year-old male with history of alcohol abuse presented with 4 days of constant, severe, epigastric pain. The patient was sedentary for approximately four months following a fall from second floor. CT scan revealed inferior vena cava thrombosis at the level of the renal veins extending to the left iliac vein. Anticoagulation with IV heparin was initiated; however, it was discontinued when the patient developed hematemesis. Emergent upper endoscopy demonstrated diffuse necrosis and black discoloration in the entire lower and middle third of the esophagus to the GEJ. Additionally, actively oozing mucosa was found in the middle esophagus. The decision was made to immediately place a fully covered self-expandable esophageal stent to tamponade the bleeding and prevent complications. The patient was then transferred to interventional radiology. On left gastric arteriogram, he was found to have faint arterial extravasation in the distal esophageal area. This was successfully embolized. The patient stabilized and was later discharged on oral anticoagulation and acid suppression therapy. Repeat endoscopy three months later for stent removal showed complete healing of the esophagus with normal appearing mucosa. DISCUSSION: While the exact etiology of AEN is unknown, it is suspected to be multifactorial. It carries poor prognosis thus initial management includes aggressive resuscitation, correction of underlying medical conditions, and aggressive acid suppression and monitoring for signs of infection or perforation. We present a case managed with fully covered self-expandable stent at the time of diagnosis which prevented complications, allowed early feeding and ultimately complete healing.Figure 1.: Acute Necrotizing Esophagitis (Black Esophagus).Figure 2.: Fully Covered Self-Expandable Esophageal Stent Placed In The Distal Esophagus.Figure 3.: Healed Esophagus On Three Month Follow-Up.

A Novel Intragastric Satiety-Inducing Device to Inhibit Weight Gain in Juvenile Pigs: a Pilot Study.

Minimally invasive therapies for obesity are a bridge between lifestyle interventions and bariatric surgery. We developed a novel device to reduce weight gain rate and evaluated its safety and efficacy in juvenile pigs. The intragastric satiety-inducing device (ISD) comprises a self-expandable esophageal metal stent connected to a star-shaped disc placed in the stomach fundus. Eight juvenile pigs were randomized into ISD (n = 5) and control (n = 3) groups. Body weight and serum ghrelin hormone were monitored weekly for 6weeks. One pig was followed up for 4 additional weeks (rebound pig) after ISD removal. Histological examination and immunohistochemistry for the interstitial cells of Cajal (ICCs) were performed. ISD placement was successful in all pigs. Two ISDs (40%) migrated at 4 and 5weeks after placement. Weight gain rates were significantly lower in the ISD group than in the control group from week 1 to 6 but were higher in the rebound pig than in a control pig from week 7 to 10. Mean ghrelin hormone level was higher in the control group than in the ISD group from week 1 to 6. ISD induced reversible inflammatory changes in the esophagus and stomach fundus. The number of ICCs was lesser in ISD pigs than in control and rebound pigs. ISD placement is feasible and safe in juvenile pigs. It decreases weight gain rate but induces reversible inflammatory reaction and tissue hyperplasia. Its mechanism may be related to pressure exertion on the stomach fundus or gastric motility alteration.

1699 Stent Gone Rogue: Endoscopic Removal of a 3-Year-Old Embeded Cystgastrostomy Stent

INTRODUCTION: We present a case of endoscopic removal of a delayed SEMS migration into the retroperitoneum, resulting in a perisplenic abscess and embedding of the SEMS into the gastric and retroperitoneal wall. CASE DESCRIPTION/METHODS: A 60-year-old man with idiopathic acute necrotizing pancreatitis complicated by walled-off pancreatic necrosis (WOPN) status post EUS-guided cystgastrostomy 3 years prior, presented with 3 weeks of worsening chronic abdominal pain and fever. Previous cystogastrostomy was performed with a through the scope 18 mm × 60 mm fully covered self-expandable esophageal metal stent (SEMS). Plan was to have SEMS removed after WOPN resolution; however, patient was lost to follow up. Abdominal CT scan revealed fluid collection in pancreatic tail measuring 4.8 × 1.9 cm and cyst-gastrostomy stent in place, splenomegaly measuring 15.5 cm with a perisplenic subcapsular collection along the lateral and superior splenic margin measuring 13.3 × 1.9 cm, thin fluid tract/collection extending from the pancreatic tail with more superior extension to questionably communicate with perisplenic collection. The 3-year-old SEMS was attempted to remove with a new through the scope fully covered 18 mm × 60 mm esophageal SEMS (Taewoong medical) but failed. Following, a new 20 mm lumen-apposing metal stent (LAMS) (Axios, Boston Scientific) stent was deployed within the embedded 3-year-old SEMS and it was secured to the embedded stent with standard clipping (Cook Medical), and CT abdomen 3 weeks after discharge noted improvement of perisplenic fluid collections. Follow up EGD/EUS allowed successful removal of 6F drainage catheter and inner Axios stent with rat tooth. After prolonged efforts, utilizing snare, biopsy, and piecemeal extraction, the embedded 3-year-old SEMS with wire struts and lattice fixed into the gastric wall and retroperitoneum was removed with no fragment remaining that was confirmed multiple times on endoscopy and fluoroscopy. Finally, Patient remained in good health without recurrence of symptoms at 6-months follow up in the outpatient clinics. DISCUSSION: This is the first case report of successful endoscopic removal of a 3-year-old embedded cystgastrostomy stent. Watch the video: http://bit.ly/2Lvc78C.

1771 Eosinophilic Esophagitis Presenting With Esophageal Wall Dissection

INTRODUCTION: Eosinophilic esophagitis (EoE) is a chronic immune/antigen-mediated, inflammatory disease with a wide spectrum of presentation from mild dysphagia to food impaction. We describe the presentation and management of a patient whose initial presentation of EoE included the rare complication of esophageal dissection. CASE DESCRIPTION/METHODS: A 30-year old Caucasian male presented to the emergency department after 10 days of dysphagia and odynophagia. His physical exam was normal. Initial laboratory evaluation revealed mildly elevated troponin I and leukocytosis. CT imaging with IV contrast showed an air-fluid level within the distal esophagus. EGD could only be completed with a pediatric gastroscope (5.4-mm) due to severe, diffuse narrowing of the esophagus. The entire esophagus had findings of EoE including edema, furrowing, and circumferential rings. The lumen of the proximal esophagus was 12-15 mm with acute narrowing to 7mm at 27-cm. Most notable was a 1-cm x 2-cm hole at 25-cm which communicated with a fluid-filled, granulation tissue lined space that paralleled the distal esophagus (Figure 1). Biopsies showed &gt;50 Eos/hpf consistent with EoE. The patient was started on broad-spectrum antibiotics, IV proton pump inhibitor therapy, topical steroid and kept NPO. CT imaging with IV and gastrograffin contrast demonstrated a long segment intramural dissection with a double-barreled esophageal lumen (Figure 2). Following consultation with cardiothoracic surgery, endoscopic management was pursued. Endoscopic suturing was not attempted given severe luminal narrowing. The tissue proved too fibrotic for hemostasis clips. A through-the-scope, fully-covered self-expanding esophageal stent (FCSEMS) was deployed across the defect and a feeding tube was inserted. An elemental diet was started. Follow-up imaging showed obliteration of the false lumen by post-procedure day 9 (Figure 3). Repeat EGD one month later showed an intact lumen but with delicate-appearing granulation tissue at the location of the previous hole (Figure 4), thus another FCSEMS was placed and elemental diet was resumed with plans for repeat EGD in 4 weeks. DISCUSSION: Intramural esophageal dissection is a rare, potentially life-threatening complication of EoE which can be medically and endoscopically managed. “The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the United States Air Force, the Department of the Navy, Department of Defense, or the U.S. Government.”

Self-expanding esophageal stents for the management of benign refractory esophageal strictures in children: A systematic review and review of outcomes at a single center

BackgroundThis study aimed to evaluate our outcomes and complication rate following placement of self-expanding esophageal stents in children for the management of refractory esophageal strictures and comparing these to the existing literature. MethodsOutcomes following placement of stents in consecutive patients under 18 years at a single center from 2003 to 2018 were reviewed. A PRISMA-guided systematic review was conducted identifying studies with 5 or more children evaluating self-expanding stents published from 1975 to 2018. Endpoints for both the retrospective and systematic reviews were the requirement for further intervention and stent-associated complications. Results25 patients received 65 stents. There were 12 caustic injury-related strictures (48%), 9 anastomotic strictures (36%), and 4 esophagitis-related strictures (16%). Four patients were lost to follow-up. 19/21 patients (90%) required further intervention, and 8/21 (38%) had esophageal replacement. Nine studies, all case series, were included in the systematic review. 97 patients received 160 stents for esophageal strictures and/or perforation. 36 out of 69 patients (52%) with strictures required no further treatment post-stenting, and 22/29 (76%) of esophageal perforations closed with stenting. ConclusionsEsophageal stents may have a role as a bridge to definitive surgery and for the management of esophageal leaks, but complete stricture resolution post-stenting is unlikely. Type of StudyTreatment Study (Case Series with no Comparison Group) Level of EvidenceLevel IV

Fully covered self-expandable esophageal metallic stents in patients with inoperable malignant disease who survived for more than 6 months after stent placement.

To investigate the clinical outcomes of fully covered self-expanding metal stent (FCSEMS) placement in patients with malignant esophageal obstruction who survived longer than 6 months. From January 2002 to January 2018, 88 FCSEMS were placed in 64 patients (mean age 62.9 ± 11.6 years; 58 males) with inoperable malignant esophageal obstruction with or without esophago-respiratory fistula. Only patients who survived more than 6 months with FCSEMS in place were included. Data regarding technical and clinical success, complications, reinterventions, stent patency, and patient survival were obtained from a prospectively maintained hospital database. The technical and clinical success rates were 100 % (64/64). During follow-up, the median dysphagia score significantly improved (3.09 ± 0.68 to 1.05 ± 0.60, p < 0.001). The complication rate was 48.8 %. Multivariate analysis revealed that only longer stenting duration was associated with complications [hazard ratio = 1.220, 95 % confidence interval (CI) (1.074-2.760), p = 0.039]. The median follow-up duration was 257 days (range, 181-969). The median stent patency duration was 289 days [95% CI (209.9-368.1)]. The median survival was 254 days [95% CI (219.7-288.3)]. Our data suggest that esophageal FCSEMS placement is an effective option for patients with malignant dysphagia when survival longer than 6 months is expected. The rate of complications increases with time, and SEMS development is needed to keep up with the advancement in oncological treatment. Fully covered esophageal self-expandable stent placement is effective in patients surviving more than 6 months, however, the rate of complications also increases. SEMS development is needed to cope with the advancement in oncological treatment.

A Review of Self-Expanding Esophageal Stents for the Palliation Therapy of Inoperable Esophageal Malignancies.

Esophageal cancer is a very deadly disease, killing more than 15,000 people in the United States annually. Almost 400,000 new cases happen in the worldwide every year. More than 50% esophageal cancer patients are diagnosed at an advanced stage when they need an esophageal stent to open the blocked esophagus for feeding and drinking. Esophageal stents have evolved in stages over the years. Current clinically used stents commonly include stainless steel or nitinol self-expandable metallic stent (SEMS) and self-expandable plastic stent (SEPS). There are many choices of different types of stents and sizes, with fierce competition among manufacturers. However, current stent technology, whether uncovered, partially covered, fully covered SEMS or SEPS, has their own advantages to solve the dysphagia, stricture, and fistula problems, but they also cause some clinical complications. The ideal stent remains elusive. New 3D printing technique may bring new promising potential to manufacturing personalized esophageal stents. Drug-eluting stents could be the new avenue to do more than just pry open a stricture or cover a defect in the esophageal lumen, a possibility of proving local anticancer therapy simultaneously. Additionally, the lack of esophageal cancer animal models also hinders the progress of stent development. This paper reviews these topics for a comprehensive understanding of this field. In a conclusion, the ultimate goal of the future esophageal stent would have multifunction to treat the underlying conditions and restore esophageal function to near normal.

Successful Salvages of Partially Covered Esophageal Metal Stent Using Repeated Sessions of Argon Plasma Coagulation

Esophageal stents have utility in temporizing esophageal leaks and benign or malignant strictures, but their removal can be complicated by tissue embedment. Special methods for removal include argon plasma coagulation (APC) induction of tissue necrosis and stent-in-stent technique (SIS). APC is a non-contact thermal technology that uses argon gas to deliver plasma of thermal energy to an area adjacent to the probe, and it is widely used as a method to control bleeding. APC can be set at a precise setting to limit necrosis to the superficial layer of the esophageal mucosa. On the other hand, SIS utilizes a second esophageal stent that is placed within the first stent to induce necrosis of embedded tissue, enabling removal of both stents. We present two cases with successful removal of embedded, partially-covered self-expandable esophageal metal stents (SEMS) using APC at a precise setting of 50W. One case showed the flexibility of APC in removal of a migrated SEMS in a 75-year-old female patient with metastatic esophageal cancer. The stent had migrated into the stomach with the distal tip eroding into gastric mucosa with embedment of proximal stent into distal esophagus. Given the positioning, SIS was not possible. APC was used to induce necrosis of embedded tissue. Two days later, repeat APC treatment was performed with removal of the stent with grasping forceps<./p> The second case demonstrated the efficacy of APC in removal of a SEMS placed for an esophageal leak after sleeve gastrectomy in a 44-year-old female patient. A partially-covered SEMS was chosen to minimize migration. After esophageal leak resolution one month later, APC was used to induce tissue necrosis of areas of stent embedment. On repeat endoscopy, the esophageal stent was easily dislodged using blunt dissection with a plastic cap with minimal bleeding. We propose that APC is a superior technique for esophageal stent removal compared to the SIS. APC is more readily available with decreased cost compared to the SIS which requires a second stent. Placing a stent within another can be complicated by incomplete induction of necrosis, severe pain and tracheal compression. APC and SIS both require at least two separate days of endoscopy, but APC in our study has only needed an interval time of 2-4 days versus median time of 9-14 days for SIS. Given the small sample sizes, further investigation is needed to determine the optimal technique for esophageal stent removal.2115_A Figure 1. CT Scan of Abdomen showing esophageal stent migration with erosion into gastric fundus.2115_B Figure 2. #1 shows the migrated esophageal stent. #2 Induction of tissue necrosis with APC.

Transcutaneous Endoscopic Necrosectomy for Walled-off Pancreatic Necrosis in the Paracolic Gutter.

Walled-off pancreatic necrosis (WON) is a sequelae of acute pancreatitis that requires debridement, once infected. Recently, endoscopic necrosectomy has become the mainstay for management. However, peripancreatic collections that extend to the paracolic gutter or lesser sac, are more challenging to treat endoscopically. We report an endoscopic method for management of necrotic collections that extend into the paracolic gutter. Consecutive patients, with symptomatic WON extending into the retroperitoneum, were included in a prospective registry. Each patient underwent transcutaneous endoscopic necrosectomy (TEN) through a fully covered self-expanding esophageal metal stent. After resolution of the collection, the external stent was removed, and the cutaneous fistula was allowed to close by secondary intention. Clinical success was defined as resolution of the WON, and successful removal of all percutaneous drains. Patient demographics, procedural/periprocedural adverse events, and follow-up data, were collected. Nine patients underwent direct TEN. Patients initially underwent CT-guided percutaneous drainage, with an average of 31 days between initial drainage and endoscopic necrosectomy. All patients had a technically successful placement of a fully covered esophageal metal stent through the cutaneous fistula. After a median of 3 endoscopic debridement sessions, 8 of 9 (89%) patients had successful removal of all percutaneous drains, and resolution of necrotic collections. One patient died of multisystem organ failure from severe acute pancreatitis. TEN for infected WON is a safe and efficacious technique for patients with endoscopically inaccessible collections.

Reconstrucción de pared esofágica con colgajos musculares

La perforación esofágica concomitante con perforación aórtica secundaria a cuerpo extraño, es una patología poco frecuente que condiciona alta mortalidad. Se han descrito muy pocos casos que hayan recibido manejo híbrido y resultados satisfactorios, en especial cuando el diagnóstico es tardío. En este documento se presenta un caso de perforación esofágica torácica y aórtica secundaria a cuerpo extraño diagnosticado en forma tardía, que recibió manejo híbrido con reparación aórtica vía endovascular, stent esofágico autoexpandible y reconstrucción de la pared esofágica con colgajo muscular sin reparación primaria.

Do esophageal stents have a role in Boerhaave syndrome? Case reports

Spontaneous esophageal rupture or Boerhaave syndrome results from exponentially increased intra-esophageal pressure against closed glottis leading to transmural esophageal injury. There are no classical signs and symptoms for diagnosis. Vomiting, pain, and subcutaneous emphysema are the usual triad of presentation. It may also present as nonspecific chest discomfort to rapidly progressive subcutaneous emphysema. Covered endoscopic self-expanding and removable esophageal metal stents are rapidly emerging minimally invasive techniques to manage this condition with good success. We report two cases of Boerhaave syndrome who were treated endoscopically with covered self-expanding metallic esophageal stents.

Mo1087 Successful Management of Cervical Esophageal Fistulae With Biliary and Narrow Diameter Self-Expandable Esophageal Stents

Mo1087 Successful Management of Cervical Esophageal Fistulae With Biliary and Narrow Diameter Self-Expandable Esophageal Stents

Migrated esophageal stent posing a challenge for ventilation

Self-expandable esophageal stents are being commonly used for palliative treatment in advanced esophageal cancer patients to relieve dysphagia, prevent tracheoesophageal fistula, and facilitate symptomatic betterment. The modern covered stents reduce the ingrowth of the tumor but have seen an increase in the incidence of stent migrations. We report a rather complicated presentation of an esophageal stent for esophageal dilatation and a challenging management of a difficult tracheostomy.

Adverse events of self-expandable esophageal metallic stents in patients with long-term survival from advanced malignant disease

Self-expandable metallic stents are considered the best palliative treatment of dysphagia for patients with advanced esophageal cancer. Adverse events (AEs) are a major concern, especially in patients with better prognosis and longer survival. The present study aimed to evaluate the AEs of patients who survived longer than 6 months with esophageal stents in place. This is a retrospective analysis of a prospectively collected database including all patients submitted to esophageal stent placement for the palliation of malignant diseases during the period from February 2009 to February 2014 at a tertiary care academic center who had stents longer than 6 months. Sixty-three patients were included. Mean follow-up was 10.7 months. Clinical success was achieved in all patients, and the median stent patency was 7.1 months. AEs occurred in 40 patients (63.5%), totaling 62 AEs (mean, 1.5 AEs per patient). Endoscopic management of AEs was successful in 84.5% of cases, with a mean of 1.6 reinterventions per patient. The univariate analysis revealed that performance status, age, and post-stent radiotherapy presented a trend to higher risk of AEs. The multivariate analysis revealed that only performance status was associated with AEs (P= .025; hazard ratio, 4.1). AEs are common in patients with long-term esophageal stenting for malignancy. However, AEs were not related to higher mortality rate, and most AEs could be successfully managed by endoscopy. Only performance status was a risk factor for AEs. Our data suggest that metallic stenting is a valid option for the treatment of malignant esophageal conditions, even when survival longer than 6 months is expected.

Extensive caustic esophageal stricture in children can be treated by serial dilatations interspersed with silicone-covered nitinol stenting

AbstractRecurrent esophageal stenosis secondary to caustic ingestion may be challenging to treat. Self-expandable esophageal stents may be an alternative to repetitive endoscopic esophageal dilatation. We report a case of a 2-year-old male child with an extensive esophageal caustic stricture successfully treated using a combination of endoscopic dilatation and stenting. After 5 months of serial balloon dilatations, three nitinol internal silicone covered self-expandable stents were placed through the patient’s gastrostomy spanning the entire esophagus. The stents were positioned using a combination of both endoscopic and fluoroscopic guidance. The procedure was repeated with only one stent 3 months later. A new stricture in the proximal esophagus needed surgical resection and anastomosis, followed by two pneumatic dilatations with progressively longer asymptomatic intervals. The results are promising with the patient able to use his own esophagus; however, this is a single case and optimal stent standing time is still to be determined.