Stent-related Complications Research Articles

Self-Expandable Metal Stents in the Management of Benign and Malignant Colorectal Obstruction

Background: Self-expandable metal stents (SEMS) can be used to relieve benign and malignant colorectal obstruction. Aim: To determine the feasibility, efficacy, and outcomes of SEMS for colorectal obstruction. Methods: Retrospective chart review of patients who underwent endoscopic SEMS placement under fluoroscopic guidance at a cancer center from 2001 to 2007. Results: 43 patients (21M, 22F), mean age 60 yr (24-82) underwent 46 procedures. 42 patients had SEMS placement for palliation and 1 as a bridge to surgery. Cancer type included: 26 colorectal, and 16 metastatic (4 gastric, 3 ovarian, 3 lung, 2 pancreatic, 1 esophageal/prostate/small bowel/unknown). 1 patient had a benign sigmoid stricture in the setting of ALL. Stricture location: 10 rectum, 23 sigmoid, 3 descending, 2 splenic flexure, 3 transverse, 1 hepatic flexure, 1 ascending. Wallstents were placed in 63% and Ultraflex and Wallflex in the rest. Technical success was achieved in all cases. 3 patients required multiple stents due to immediate proximal migration, lack of full stent expansion, and deployment failure. Clinical success was achieved in 39/43 cases (91%). One patient continued to have obstructive symptoms and required APC tumor ablation. 2 perforations were detected immediately and at 5 days, resulting in 1 death and 1 emergent surgery. One patient presenting with obstruction and free air failed to have relief of obstruction after palliative stenting. Mean follow-up was 114 days (2-1210). In 2 cases (4.6%), the stents migrated distally to the rectum at 4 and 20 days, and were removed successfully with a snare. One went to surgery and the second required no further intervention. One patient with a rectosigmoid tumor developed pain after stent placement. Endoscopic removal of the stent was unsuccessful. 2 patients (4.6%) had stent occlusion from tumor ingrowth at 3.5 and 8.5 mo. and were treated with repeat stenting. There were 27 deaths, all from metastatic disease and multiorgan failure unrelated to stent placement except for the 1 case of procedure related perforation. Conclusions: Placement of SEMS for the treatment of colorectal obstruction is feasible and safe. In our institution where SEMS are primarily used to palliate terminal disease, technical and clinical success rates were high without significant morbidity and mortality. On long term follow-up, patients died from their advanced disease without recurrent obstruction or stent-related complications.

Covered Self Expandable Metal Stents in Border-Line Resectable Pancreatic Carcinoma: Prospective Study Concerning Effectiveness and Safety

Aims: Placement of biliary self expandable metal stents (SEMS) in patients with pancreatic carcinoma suitable of surgical treatment has been controversial. Since covered SEMS (SEMSc) became available, the possibility of inserting these stents in potentially surgical patients is safer as they can be removed if necessary in 85-95% of cases. The aim of this study is to assess the effectiveness and safety of SEMSc in patients with malignant jaundice secondary to border-line resectable pancreatic carcinoma. Material and Method: 33 consecutive patients (23 m/10f; age 69.1 yrs) with obstructive jaundice secondary to border-line resectable pancreatic carcinoma (superior mesenteric vein invasion,large tumor, retroperitoneal growth) were included in the study. After biliary drainage with a SEMSc,patients underwent neoadjuvant treatment with gemcitabin and radiotherapy during 8 weeks. Patients were reevaluated after treatment by CT scan and tumors staged as unresectable or potentially resectable. In those patients harbouring potentially resectable tumors surgery was indicated. Effectiveness in jaundice palliation, accomplishment of neoadjuvant therapy and stent removal requirements during presurgical period were assessed. Stent related postsurgical complications were also evaluated. Results: SEMSc could be inserted in all patients although in one case the stent had to be removed 72 hours after placement due to acute cholecystitis (3%). 32 patients completed oncologic treatment with no toxicity related to the stent. After CT reevaluation,21 patients (65.6%) were considered unsuitable for surgery and 11 patients (34.4%) candidates for tumor resection. Bilirubin levels dropped from 15.3 to 1.1 mg/dl (p < 0.01) in surgical patients with no episodes of cholangitis. In 4 of the 11 patients stent removal was indicated prior to surgery to assure bilioenteric anastomosis. It was successfully performed in all patients with a polypectomy snare after a mean post insertion period of 11.5 weeks. At operation,4 patients were not resected due to peritoneal disease and 7 patients finally resected (21.9%). Cholangitis pathological features were present in all surgical specimens but clinical cholangitis or anastomotic fistula were not registered during postoperative follow up in any patient. Conclusions: 1. SEMSc are effective in presurgical jaundice palliation in patients with border-line resectable pancreatic carcinoma. 2. These stents allow neoadjuvant oncologic treatment accomplishment without any added toxicity. 3. The possibility of stent removal when needed is a remarkable advantage in terms of safety. 4. Postoperative complications do not increase in relation to presurgical SEMSc insertion.

Ureteric stents in pyeloplasty: a help or a hindrance?

Objective To examine whether routine ureteric stenting influences outcome of pyeloplasty for pelvi-ureteric junction obstruction (PUJO). Patients and methods A 10-year review was conducted of 105 consecutive open Anderson–Hynes dismembered pyeloplasties performed for PUJO, covering two periods: (1) pyeloplasties performed without ureteric stents (1994–1998) and (2) pyeloplasties performed with ureteric stents (1999–2003). Outcomes (expressed as means ± SEM) of unstented patients (UPs; n = 47) and stented patients (SPs; n = 58) were compared and results analysed using ANOVA and chi-square tests. Results Fifty-five patients (53.9%) presented with antenatal hydronephrosis, whilst 47 (46.1%) presented postnatally (at mean age 88.4 ± 7.1 months) with one or more of the following: pain ( n = 30, 63.8%), urinary tract infection ( n = 16; 34.0%), haematuria ( n = 3, 6.4%), abdominal mass ( n = 3, 6.4%), acute renal failure ( n = 2, 4.3%), incidental finding ( n = 4, 8.5%). Pyeloplasty was performed (at mean age 58.9 ± 5.3 months) for one or more of the following: pain ( n = 40, 38.1%), haematuria ( n = 6, 5.7%), urinary tract infection ( n = 18, 17.1%), poor initial or deteriorating function ( n = 29, 27.6%), severe or deteriorating hydronephrosis ( n = 41, 39.0%), calculus ( n = 1, 0.95%). Recognised complications of surgery were significantly higher in UPs (5 of 47; 10.6%) than SPs (0 of 58); P = 0.016. These were leakage ( n = 4, 8.5%) and obstruction by blood clot ( n = 1, 2.1%). Nine SPs (15.5%) developed stent-related complications, including stent migration ( n = 5, 8.6%), infection ( n = 3, 5.2%) and calculus ( n = 1, 1.7%). SPs had significantly shorter hospital stay (2.71 ± 0.25 days) than UPs (4.30 ± 0.38 days); P < 0.01. Preoperative renal pelvis antero-posterior diameter in SPs (3.24 ± 0.25 cm) and UPs (3.21 ± 0.28 cm) was comparable ( P = 0.80). Following pyeloplasty, a significant improvement from these preoperative baselines occurred earlier in SPs (at 3.10 ± 0.46 months) than UPs (at 15.71 ± 3.05 months); P < 0.01. Conclusion Stented pyeloplasty significantly reduces complications from surgery, particularly leakage, and results in shorter hospital stay and earlier resolution of hydronephrosis, but at the expense of stent-related complications which could be avoided in future by the use of external stents.

Oesophageal stent insertion for palliation of dysphagia in a District General Hospital: experience from a case series of 137 patients

Endoscopic oesophageal stent insertion is a widely used procedure to alleviate dysphagia caused by malignant strictures of the oesophagus and gastric cardia. It can, however, be associated with significant complications, mortality and morbidity. This retrospective case note study was undertaken to assess success rates, complications and mortality of oesophageal stenting when undertaken in a UK District General Hospital (DGH) setting. Patients who underwent oesophageal stenting for malignant disease from January 2000 to January 2006 were included. Of the 137 patients studied, oesophageal adenocarcinoma was present in 57% of patients, squamous cell oesophageal carcinoma in 37% and gastric adenocarcinoma in 6%. Indications for stent insertion were: presence of non-resectable tumours (65%), co-morbidities that contraindicated surgery (25%), refusal by patients for surgery for potentially resectable disease (6%) and a need for enhanced oral nutrition prior to surgery (4%). Prior to stenting 86.4% of patients suffered from advanced dysphagia. A significant improvement in symptoms was seen in 94% of patients. Discharge from hospital was within 48 h in 45% of cases. Chest pain was experienced by 13.9% of patients and serious acute stent-related complications (perforation or bleeding) occurred in 5.8% of patients. Overall 41.6% of patients had at least one complication. Mortality was 4.4% at 7 days and 24.8% at 30 days. Oesophageal stent insertion proved to be an effective palliation of dysphagia in group studied. It is a relatively safe procedure with a low rate of serious acute complications (5.8%) and can be done as a short stay in many patients.

Comparison of Wallstent and Ultraflex stents for palliation of malignant left-sided colon obstruction: a retrospective, case-matched analysis

Self-expandable metal stents (SEMSs) are accepted palliation for malignant colon obstruction. Outcomes of different stent types is unknown. Our purpose was to compare outcomes after palliative placement of the Enteral Wallstent (EW) and the Precision Colonic Ultraflex (PCU) stent. Retrospective study of all SEMS placement during a 7-year period. Tertiary care academic medical center. Malignant left-sided colon obstruction in which through-the-scope (TTS) or non-TTS stent placement was possible. Technical and clinical success rates, stent-related complications, reintervention. Demographics, degree, site, and cause of obstruction were comparable. Technical difficulties were more frequent with EW than PCU (16% vs 9%, P not significant), insufficient stent expansion and stent misplacement being most common. Relief of obstruction occurred in all patients when placement was technically successful. Mean follow-up was 93 days (range 7-691 days). Early (<7 days) stent occlusion (6% vs 0%, P not significant) and migration (4% vs 0%, P not significant) occurred more frequently in the EW group. Self-limited hematochezia was more common with PCU (20% vs 2%, P = .002). Delayed complications (perforation, stent occlusion, migration, and erosion) occurred significantly more often in the EW group (38% vs 20%). Reintervention was needed more frequently for EW, endoscopic (40% vs 17%, P = .01) and operative (46% vs 26%, P = .03). Enteral Wallstents and Precision Ultraflex Colonic stents adequately relieve colonic obstruction. Stent dysfunction, stent-related complications, and need for reintervention are higher after EW placement. Precision Colonic Ultraflex stents appear better suited for palliation of left-sided malignant colon obstruction.

Suspected coronary artery dissection post-stenting, confirmed by optical coherence tomography

Conventional coronary angiography has limitations in detecting stent-related complications. This case highlights this limitation and illustrates how intracoronary imaging with optical coherence tomography helps in this situation. A 60-year-old man...

Complications of Silicone Stent Insertion in Patients With Expiratory Central Airway Collapse

Silicone stent insertion is an alternative treatment for expiratory central airway collapse. This study evaluates the complications (mucus plugging, migration, and granulation tissue) associated with stenting in patients who failed medical therapy and were not surgical candidates. Chart review from 15 consecutive patients treated by silicone stent insertion was done over a 2-year period. Outcomes included (1) changes in functional class, extent and severity of airway collapse (graded from 1 to 4 by using a multidimensional system), procedure- and stent-related complications at 48 hours after stent insertion; (2) frequency of stent-related complications; and (3) frequency of emergent flexible and rigid bronchoscopy (scheduled or emergent) over the follow-up period. Mean functional class and severity and extent of airway collapse significantly improved within 48 hours after treatment (p < 0.05). There were no perioperative deaths. Stent-related complications within 48 hours after stent insertion occurred in 3 patients (1 granulation, 1 migration, and 1 mucus plugging). The mean duration of follow-up for the 12 patients who underwent clinical and bronchoscopic follow-up was 188 days. Twenty-six stent-related complications (12 mucus plugs, 8 migrations, and 6 granulation tissues) were seen in 10 of the 12 patients. Five emergent flexible bronchoscopies and 14 rigid bronchoscopies (6 of which were emergent) were performed during the follow-up period. Silicone stent insertion improves functional status immediately after intervention in patients with expiratory central airway collapse, but is associated with a high rate of stent-related complications and need for repeat bronchoscopic interventions.

Use of the covered Y-shaped metallic stent in the treatment of airway stenoses involving the lower trachea and the tracheal carina:preliminary clinical study

Objective To describe a new kind of Y-shaped metallic stent delivery system and evaluate its feasibility and preliminary effect for managing multiple airway stenoses involving the lower trachea and the tracheal carina.Methods The Y-shaped metallic stent delivery system consisted of three- tier structure.The inner-tier was composed of four parallel guiding tubes,which was used for two guidewires and two threads passing through,the middle-tier was delivery catheter,which contained the four guiding tubes,and the outer-tier was introducer sheath.Under the fluoroscopic guidance,15 patients with multiple stenoses involving the lower trachea and the tracheal carina were treated with the new covered self-expandable Y-shaped metallic stents.Results Stent placement in the tracheo-bronchial tree was technically successful in all patients with obliteration of the dyspnea immediately after stent placement,and SaO_2 was increased form preoperative 75%—89% to postoperative 96%—99%.During follow-up a period of 3—58 weeks (M 22 weeks),all stenosis were resolved without stent-related complications,and the general physical of all 15 patents was improved with no occurrence of obviously dyspnea and bleeding.Karnofsky performance status(KPS)was improved from preoperative 26%—45% to postoperative 72%—95%.Five patients died of the following causes unrelated to stent insertion:multiple organ failure(n=3),cachexia(n=1)and pulmonary infection caused by gastrobronchial fistula(n=1),and the remaining 10 patients were alive with no evidence.of dyspnea at the time of this report.Conclusion Deployment of the covered Y-shaped metallic stent with the use of Y metallic stent delivery system in the management of airway stenoses involving the lower trachea and the tracheal earina was a simple and safe procedure and with a good short-term clinical efficacy.

Self-expandable metallic stents for malignant biliary obstruction with an anomalous pancreaticobiliary junction

Anomalous pancreaticobiliary junction (APBJ) is associated with pancreaticobiliary cancer. Limited data are available on endoscopic biliary drainage for unresectable malignant biliary obstruction with APBJ. This study evaluated the efficacy and safety of self-expandable metallic stents (EMSs) for the management of malignant biliary obstruction with APBJ. Between 1993 and 2005, 324 patients with unresectable malignant biliary obstruction underwent insertion of an EMS. Six of these patients with concomitant APBJ constituted the subjects of this study. Early (</=30 days after EMS insertion) and late (>30 days after EMS insertion) stent-related complications and stent patency were evaluated in these six patients. The cause of biliary obstruction was gallbladder cancer in four patients and pancreatic cancer in two patients. Uncovered EMSs were inserted across the common channel without performance of a biliary sphincterotomy. The diameter of the uncovered EMS used was based on the diameter of the common channel. For all six patients, endoscopic biliary drainage was successful, and their jaundice subsided steadily. None of the six patients experienced early complications, including acute pancreatitis. The mean stent-related complication-free period was 163 days. Stent occlusion caused by tumor ingrowth occurred in two patients. Acute cholangitis and cholecystitis were observed in one patient each. Uncovered EMSs are effective for palliation of unresectable malignant biliary obstruction in patients who have APBJ without increasing the risk of stent-related early complications.

Delayed Complications after Placement of Self-Expanding Stents in Malignant Esophageal Obstruction: Treatment Strategies and Survival Rate

Placement of self-expanding metal stents is regarded as a safe and effective treatment in patients with incurable malignant esophagogastric obstruction. However, proceeding and possible benefit of re-interventions in patients with recurrent dysphagia due to delayed complications (>4 weeks after stent insertion) is unclear. In 133 patients with malignant stricture of the esophagus or the esophagogastric junction 164 expandable metal stents were placed. About 89 patients were followed up until death. All tumor- or stent-related complications and consequent re-interventions were recorded. The overall incidence of delayed complications was 53.4% (71 of 133 pts.), with 34 patients (25.6%) experiencing more than one complication. Recurrent dysphagia due to tumor ingrowth (22%) or overgrowth (15%), bolus obstruction (21%), stent migration (9%), and development of esophagorespiratory fistula (9%) was successfully treated by dilatation (24%), placement of a second/third stent (27%), laser therapy (16%), and/or placement of a feeding tube (PEG, 19%). The median survival of patients with endoscopic therapy was significantly longer (222 +/- 26 days) compared to patients without re-intervention (86 +/- 14 days, P < 0.0001). Delayed complications after metal stent placement for malignant esophageal stricture are common, but can be treated successfully by endoscopic re-intervention in most cases. Regular interventional therapy may also improve survival.

Endoscopic treatment of post-surgical bile duct injuries: long term outcome and predictors of success

Objective:To analyse the short and long term outcome of endoscopic stent treatment after bile duct injury (BDI), and to determine the effect of multiple stent treatment.Design, setting and patients:A retrospective...

Infant feeding tube as urinary tract stent

Background: The infant feeding tube is a cheap and readily available device with many uses in the urinary tract. Many types of stents are available in the market but among other factors, cost and affordability limit their use in developing countries and remote areas. Aim: To document experience with infant feeding tubes as stents in the urinary tract. Methods: Data from the hospital records of patients who required stents at the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria were obtained from their case notes from May 2003 to May 2006. Information extracted from these case notes included: age and sex of patient, indications for stenting, stent-related complications and outcome of surgery. The data were analysed using Microsoft Excel Software. Results: Thirty-three patients who required stents within the period were included in the study. In nineteen patients (57.6%) feeding tubes were used as urethral stents while in 14 (42.4%) as ureteric stents. Operations requiring stents include: dismembered pyeloplasty 9.1% (3), ureteric re-implantation 24.3% (8), ureterolithotomy 9.1% (3), and urethroplasty 57.6% (19). The stents were left in situ for 2-3 weeks depending on the indication. Ureteric stents were left for 3 weeks while urethral stents were usually left for 2 weeks. However, where a significant complication was noted, the stent was removed. Complications noted in 4 patients (12.1%) which were probably stent-related include: bladder spasm, infection and wound dehiscence. Conclusion: Infant feeding tubes can be used as suitable urinary tract stents where expensive stents are not available. Keywords : Feeding tubes, Stents, Urologic surgery. Port Harcourt Medical Journal Vol. 1 (2) 2007: pp. 96-98

Renal Transplantation After Endovascular Repair of Abdominal Aortic Aneurysm

An increasing number of abdominal aortic aneurysms (AAA) occur in renal failure patients because of strong association between atherosclerosis and chronic kidney disease. Endovascular aneurysm repair (EVAR) has proven to be an effective modality to treat AAA, particularly in patients with renal disease, because of its several advantages over the standard open procedure, including lower morbidity, shorter operative time, and shorter hospital stay. A Medline search showed a single publication on renal transplantation (RT) following EVAR of AAA. In this context, we report our case of successful RT in a patient who had undergone EVAR 2 years prior for a 5.7-cm AAA. No stent-related complications, such as graft occlusion, dislodgement, dissection, or endoleak, were observed in the perioperative period. The transplanted kidney had primary function leading to a stable serum creatinine of 115 μmol/L at 6 months. Although the long-term outcome of RT after endovascular repair of AAA remains unknown, currently available evidence shows favorable outcomes of EVAR in the normal population, in patients with renal diseases, and in RT recipients; hence, RT should not be denied to renal failure patients who have undergone EVAR in the past.

Coronary Artery Stent Placement Immediately before Noncardiac Surgery: A Potential Risk?

Coronary Artery Stent Placement Immediately before Noncardiac Surgery: A Potential Risk?

Diamond-Like Carbon Coatings on Ureteral Stents—A New Strategy for Decreasing the Formation of Crystalline Bacterial Biofilms?

Any catheter material placed in the urinary tract provides a surface for bacterial colonization and, therefore, it is susceptible to encrustation with crystalline bacterial biofilm. Encrustation and blockage by biofilms remain a major complication in patient care. Most patients with indwelling ureteral stents experience irritative symptoms related to these implants and many experience discomfort. Plasma deposited diamond-like amorphous carbon coatings are well-known for their excellent biocompatibility. A low temperature, low pressure plasma enhanced chemical vapor deposition technology was developed especially for coating polymeric medical implants with diamond-like carbon. We investigated the ability of diamond-like carbon to decrease the formation of crystalline bacterial biofilm as well as stent related side effects and discomfort. Diamond-like carbon coated ureteral Double-J stents were tested in vivo. In 10 patients with heavy encrustation, different underlying diseases and a stent removal frequency of less than 6 weeks due to encrustation a total of 26 diamond-like carbon coated stents were successfully tested for their ability to decrease the extent of crystalline biofilm formation. There was a 2,467-day period of experience with diamond-like carbon coated stents. No primarily stent related complications occurred. No crystalline biofilm formation was observed in vivo. Excellent and facile handling, a less painful replacement procedure and high tolerance of application were reported by physicians and patients. Due to low friction the coated stents could be placed and removed much more easily than standard stents. The frequency and severity of symptomatic urinary tract infections were distinctly decreased. Diamond-like carbon coating is a new strategy to improve the surface properties of ureteral stents. This novel surface effectively decreases friction, encrustation tendencies and biofilm formation.

Self-Expandable Metallic Stents for Malignant Biliary Obstruction with Anomalous Pancreaticobiliary Junction

Background: Anomalous pancreaticobiliary junction (APBJ) is associated with pancreaticobiliary cancer. Limited data are available for biliary drainage for unresectable malignant biliary obstruction with APBJ. The aim of this study is to evaluate the efficacy and the safety of self-expandable metallic stents (EMSs) for the treatment of malignant biliary obstruction with APBJ. Methods: Between 1993 and 2005, a total of 324 patients with unresectable malignant biliary obstruction received EMS insertion. Of those, 6 patients had concomitant APBJ and were subjects to the present study. Early (≤30 days after EMS insertion) and late (>30 days after EMS insertion) stent-related complications and stent patency were evaluated in these 6 patients. Results: The cause of biliary obstruction was gallbladder cancer in 4 patients and pancreatic cancer in 2. Uncovered EMSs were inserted across the common channel without biliary sphincterotomy. The diameter of uncovered EMSs employed was chosen according to the diameter of the common channel. In all 6 patients, endoscopic biliary drainage was successful and jaundice steadily subsided. None of these 6 patients developed early complications including acute pancreatitis. Mean serum amylase level was not statistically different between before and 18-24 hrs after stent insertion (129.5 IU/l vs. 148.3 IU/l, p = 0.28). Mean stent -related complication free period was 163 days (range 83-268 days). Stent occlusion due to tumor ingrowth occurred in 2 patients (86 days and 83 days after EMS insertion, respectively). Acute cholangitis with no evidence of stent occlusion was observed in one patient 116 days after EMS placement. Acute cholecystitis occurred in one patient 106 days after stent insertion. Conclusions: Uncovered EMSs are effective for palliation of unresectable malignant biliary obstruction in patients with APBJ without increasing risk of stent-related early complication.

Efficacy of a New Nitinol Enteral Stent (Wallflex™) in Malignant Gastric Outlet Obstruction: A Prospective, Open, Multicenter Clinical Trial

Gastric outlet obstruction (GOO) is a late complication of advanced gastric, periampullary and duodenal malignancies. Palliation of symptoms of obstruction is the primary aim of treatment in these patients. Self-expandable metal stents (SEMS) have emerged as a promising treatment option. Methods: The aim of this prospective multicenter study was to investigate the efficacy of a new enteral stent (WallFlex™, Boston Scientific, Natick, MA, USA) in patients who had symptoms from malignant gastro-duodenal obstruction due to incurable distal gastric, periampullary or duodenal malignancy. Consecutive patients who fulfilled the patient selection criteria and presenting at one of the participating hospitals between January 1 st 2005 and February 1 st 2006 were included. In case of biliary obstruction, adequate drainage of the biliary tree with metal stents was achieved prior to stenting. Patients' characteristics, severity of obstruction (symptoms and GOOSS-score (Gastric Outlet Obstruction Scoring System), general condition (Body Mass Index (BMI) and WHO performance status), additional therapy (chemotherapy, radiotherapy) and quality of life questionnaires were collected prior to enteral stent placement. Procedure-related data were recorded by the treating physician. Follow-up data were prospectively collected by telephone on a two-weekly basis, until the patient died. GOO-symptoms were defined as early satiety and/or nausea and/or vomiting and/or inability to eat. Study endpoints were: technical success (successful stent placement and deployment), clinical success (relief of symptoms and/or improvement of GOOSS-score) and intervention-related complications. Results: A total of 51 patients were included (25 male, mean age 69 years). The main cause of GOO was pancreatic cancer (35 patients, 69%). All procedures were technically successful. Clinical success was achieved after 1 week in all but 5 patients. The GOOSS-score improved significantly (Wilcoxon signed ranks test - two-sided; p < 0.0001) when comparing the score prior to stenting with the mean score during the remainder of their lives. Oral intake was resumed at a mean of 1 day (0-9 days) after stent placement. The median survival up to November 1 st 2006 was 63 days (interquartile range 121 days). There were 7 stent-related complications (migration n = 2, tumor ingrowth n = 4, enteral stent obstruction due to distal migration of the biliary stent n = 1) in 5 patients. Conclusion: This single-arm prospective cohort study shows that in patients with non-resectable malignant GOO placement of a WallFlex™ enteral stent is safe and provides a significant relief of obstructive symptoms.

The Niti-S Oesophageal Stent Reduces Migration Rates in the Palliation of Malignant Dysphagia

Background: Self-expanding metal mesh stents (SEMS) are frequently used in the palliation of malignant dysphagia. Our Unit has significant experience of both the Ultraflex stent (Boston Scientific, Natick, Mass) and the Niti-S stent (Taewong Medical, Seoul, Korea). A comparative study was conducted to determine the frequency of stent-related complications with the use of Ultraflex and Niti-S stents in one institution. Methods: Between April 2003 and June 2006 135 patients required SEMS insertion for the palliation of malignant oesophageal obstruction. Individuals received either an Ultraflex (n = 72) or a Niti-S (n = 63) stent. The incidence of complications including retrosternal pain, bleeding, perforation, tumour in-growth or over-growth, migration and 30-day mortality was compared. Results: The age, gender distribution, tumour length, stent length and number of days in hospital after stent insertion were similar between the two groups (median (interquartile range)). The number of patients with retrosternal pain, haematemesis, perforation, bolus obstruction, tumour in-growth or over-growth, and 30-day mortality were also similar. However, the incidence of stent migration was significantly less in the Niti-S stent group. Distal oesophageal and oesophago-gastric junction (OGJ) tumours accounted for 82% of patients receiving an Ultraflex stent and 81% of patients receiving a Niti-S stent. Ultraflex stent migration only occurred in distal oesophageal or junctional cases. Conclusion: The Niti-S stent has design features aimed at reducing stent migration and tumour in-growth. This study has demonstrated a significantly reduced migration rate when compared with the Ultraflex stent with no increase in morbidity or mortality. This finding was sustained even in the distal third and OGJ cancers where the risk of migration is greatest. There was a trend towards reduced tumour in-/over-growth. This study supports the development of a prospective randomised trial. Tabled 1 Ultrafex (n = 72) Niti-S (n = 63) p value Age (years) 74 (62-84) 76 (64-83) n/s Male:female 45:27 44:19 n/s Tumour length (cm) 6 (5-8) 6 (5-9) n/s Distal oesophageal tumour 35 26 n/s OGJ tumour 24 25 n/s Stent length (cm) 9 (7-12) 8 (8-12) n/s Post-stent stay (days) 3 (2-4) 3 (2-5) n/s Tumour in-/over-growth 14 9 n/s Stent migration (all tumours) 8 0 0.02 Stent migration (distal oesophageal tumour) 3 0 n/a Stent migration (OGJ tumour) 5 0 n/a 30-day mortality 2 0 n/a n/s - not significant. n/a - not applicable (numbers too small) Open table in a new tab n/s - not significant. n/a - not applicable (numbers too small)

Effect of stent size on complications and recurrent dysphagia in patients with esophageal or gastric cardia cancer

Stents are commonly used for the palliation of dysphagia from esophageal or gastric cardia cancer. A major drawback of stents is the occurrence of recurrent dysphagia. Large-diameter stents were introduced for the prevention of migration but may be associated with more complications. To compare small- and large-diameter stents for improvement of dysphagia, complications, and recurrent dysphagia. Evaluation of 338 prospectively followed patients with dysphagia from obstructing esophageal or gastric cardia cancer who were treated with an Ultraflex stent (n = 153), a Gianturco Z-stent (n = 89), or a Flamingo Wallstent (n = 96) of either a small diameter (n = 265) or a large diameter (n = 73) during the period 1996 to 2004. Single academic center. Patients with an inoperable malignant obstruction of the esophagus or the gastric cardia, or recurrent dysphagia after prior radiation, with curative or palliative intent for esophageal cancer. Stent placement. Dysphagia score (on a scale from 0 [no dysphagia] to 4 [complete dysphagia]), complications, and recurrent dysphagia. Analysis was by chi2 test, log-rank test, and Cox regression analysis. Improvement in dysphagia was similar between patients with a small- or a large-diameter stent (P = .35). The occurrence of major complications, such as hemorrhage, perforation, fistula, and fever, was increased in patients with a large-diameter Gianturco Z-stent compared with those treated with a small-diameter stent (4 [40%] vs 16 [20%]; adjusted hazard ratio [HR] 5.03, 95% confidence interval [CI] 1.33-19.11) but not in patients with a large-diameter Ultraflex stent or a Flamingo Wallstent. Moreover, minor complications, particularly pain, were associated with prior radiation and/or chemotherapy in patients with a large- or a small-diameter Gianturco Z-stent (HR 4.27, 95% CI 1.44-12.71) but not in those with an Ultraflex stent or a Flamingo Wallstent. Dysphagia from stent migration, tissue overgrowth, and food bolus obstruction reoccurred more frequently in patients with a small-diameter stent than in those with a large-diameter stent (Ultraflex stent: 54 [42%] vs 3 [13%], adjusted HR 0.16, 95% CI 0.04-0.74; Gianturco Z-stent: 21 [27%] vs 1 [10%], adjusted HR 0.97, 95% CI 0.11-8.67; and Flamingo Wallstent: 21 [37%] vs 6 [15%], adjusted HR 0.40, 95% CI 0.03-4.79). Nonrandomized study design. Large-diameter stents reduce the risk of recurrent dysphagia from stent migration, tissue overgrowth, or food obstruction. Increasing the diameter in some stent types may, however, increase the risk of stent-related complications to the esophagus.

Stent-related cardiac events after non-cardiac surgery: Drug-eluting stent vs. bare metal stent

For evaluation of post-operative stent associated cardiac events after drug-eluting stent (DES) implantation we analyzed data of 138 patients who underwent non-cardiac surgery after DES implantation and compared the data with those of 101 patients who underwent non-cardiac surgery after bare metal stent (BMS) implantation. Three patients (2.2%) in DES group developed post-operative cardiac events and none in BMS group ( p = 0.2). One patient died due to suspected stent thrombosis and the other two had myocardial infarction due to angiographically proven stent thrombosis. The time interval between stent implantation and surgery in those with cardiac events was 6, 264, and 367 days, respectively. Our data shows that peri-operative stent-related thrombotic complications can occur long after DES implantation and careful peri-operative monitoring for cardiac events is needed in patients receiving non-cardiac surgery after DES implantation.