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Significance of Stent Abutment in Gastroduodenal Stent Placement for Gastric Outlet Obstructions. J Vasc Interv Radiol 2017; 28:1147-1153. [PMID: 28291717 DOI: 10.1016/j.jvir.2017.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 01/11/2017] [Accepted: 01/24/2017] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To evaluate the frequency, severity, and clinical significance of stent abutment (SA) after gastroduodenal stent placement in patients with gastric outlet obstruction caused by unresectable gastric cancer. MATERIALS AND METHODS A retrospective study was conducted in a single tertiary referral university hospital to identify the incidence and clinical significance of SA in 318 patients who underwent self-expandable metallic stent placement. SA was defined as abutment of the distal end of the stent to the duodenal wall and/or superior duodenal flexure. The outcomes included technical and clinical success, complications, repeat intervention, stent patency, and survival. RESULTS A total of 318 patients, 107 with SA (33.6%) and 211 without, were included. SA occurred partially (n = 64; 59.8%) and completely (n = 43; 40.2%). The technical and clinical outcomes and survival were similar in the groups with and without SA. Food impaction and resultant repeat intervention rates were higher in the SA group than in the non-SA group (P < .001 and P < .001, respectively), and were associated with complete SA (P = .007). Stent patency rate was lower in the SA group than in the non-SA group (P = .003). CONCLUSIONS SA was associated with increased food impaction, resulting in a greater incidence of stent malfunction and shorter stent patency compared with a lack of SA. The concept of SA may be useful for the improvement of stent patency and avoidance of food impaction.
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Oh SY, Kozarek RA. Management of gastroduodenal stent-related complications. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2015. [DOI: 10.18528/gii150008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Stephen Y. Oh
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
| | - Richard A. Kozarek
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
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Gastroduodenal stent placement versus surgical gastrojejunostomy for the palliation of gastric outlet obstructions in patients with unresectable gastric cancer: a propensity score-matched analysis. Eur Radiol 2015; 26:2436-45. [PMID: 26662027 DOI: 10.1007/s00330-015-4106-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 08/12/2015] [Accepted: 11/10/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To compare the outcomes between stent placement and surgical gastrojejunostomy (GJ) for the palliation of gastric outlet obstruction (GOO) in patients with unresectable gastric cancer. METHODS A retrospective study was performed in a single university hospital in 224 patients with GOO, and who were treated either by stent placement (n = 124) or surgical GJ (n = 100). The outcomes were assessed with reference to the following variables with the use of propensity-score matching: success rates; complications; dysphagia scores, albumin, and body mass index; survival; symptom-free duration; and hospitalization. RESULTS We identified a well-balanced cohort of 74 pairs of patients, matched on the basis of propensity score. The dysphagia score 7 days after treatment was significantly better in the stent group (P < 0.001). Albumin level 1 month after treatment was significantly lower in the stent group (P < 0.001). Symptom-free duration and hospitalization were significantly longer in the surgery group (P = 0.002, P < 0.001, respectively). The recurrence rate was significantly higher in the stent group (P = 0.032). CONCLUSIONS Stent placement can provide faster symptom relief and shorter hospitalization, while surgical GJ can provide longer symptom-free duration, less recurrent obstruction symptoms and better nutritional status. KEY POINTS • The two methods are equally effective in palliating gastric outlet obstruction symptoms • The stent group showed rapid and efficient palliation of symptoms • Recurrent symptoms were more frequent in the stent group • Surgical gastrojejunostomy provides a longer symptom-free duration and better nutritional status.
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DaVee T, Irani S, Leggett CL, Berzosa Corella M, Grooteman KV, Wong Kee Song LM, Wallace MB, Kozarek RA, Baron TH. Stent-in-stent technique for removal of embedded partially covered self-expanding metal stents. Surg Endosc 2015; 30:2332-41. [PMID: 26416379 DOI: 10.1007/s00464-015-4475-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 06/27/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Removal of embedded partially covered self-expanding metal stents (PCSEMS) is associated with an increased risk of adverse events compared with removal of fully covered self-expanding stents (FCSES) due to tissue ingrowth. Successful removal of embedded PCSEMS has been described by the stent-in-stent (SIS) technique. AIMS To report the first US experience from three high-volume quaternary care centers on the safety and efficacy of the SIS technique for removal of embedded PCSEMS. METHODS Retrospective study of outcomes for consecutive patients who underwent the SIS for removal of embedded PCSEMS over a 5-year period. RESULTS Twenty-seven embedded PCSEMS were successfully removed using the SIS technique (100 %) from 25 patients (11 males), median age 65 (range 37-80). All stents were successfully removed in one endoscopic session (no repeat SIS procedures were required for persistently embedded stents). The embedded PCSEMS had been in situ for a median of 76 days (range 26-501). Median SIS dwell time (FCSES in situ of PCSEMS) was 13 days (interquartile range 8-16 days; range 4-212 days). One adverse event (self-limited bleeding) occurred during a median follow-up period of 3 months (range 1-32). No patients died, required surgery, or had long-term disability due to adverse events attributed to the SIS technique. Twelve patients required additional interventions following SIS procedure for persistence or recurrence of the underlying pathology. CONCLUSION When performed by experienced endoscopists, safe and effective removal of embedded PCSEMS can be achieved via the SIS technique.
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Affiliation(s)
- Tomas DaVee
- Gastroenterology, Vanderbilt University, Nashville, TN, USA
| | - Shayan Irani
- Gastroenterology, Virginia Mason Medical Center, Seattle, WA, USA
| | | | | | | | | | | | | | - Todd H Baron
- Gastroenterology, University of North Carolina, Chapel Hill, NC, USA.
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Oh SJ, Song HY, Nam DH, Ko HK, Park JH, Na HK, Lee JJ, Kang MK. Bleeding after expandable nitinol stent placement in patients with esophageal and upper gastrointestinal obstruction: incidence, management, and predictors. Acta Radiol 2014; 55:1069-75. [PMID: 24226292 DOI: 10.1177/0284185113511080] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Placement of self-expandable nitinol stents is useful for the treatment of esophageal and upper gastrointestinal (GI) obstruction. However, complications such as stent migration, tumor overgrowth, and bleeding occur. Although stent migration and tumor overgrowth are well documented in previous studies, the occurrence of bleeding has not been fully evaluated. PURPOSE To evaluate the incidence, management strategies, and predictors of bleeding after placement of self-expandable nitinol stents in patients with esophageal and upper GI obstruction. MATERIAL AND METHODS We retrospectively reviewed the medical records and results of computed tomography and endoscopy of 1485 consecutive patients with esophageal and upper GI obstructions who underwent fluoroscopically guided stent placement. RESULTS Bleeding occurred in 25 of 1485 (1.7%) patients 0 to 348 days after stent placement. Early stent-related bleeding occurred in 10 patients (40%) and angiographic embolization was used for 5/10. Late bleeding occurred in 15 patients (60%) and endoscopic hemostasis was used for 7/15. Twenty-two of 25 (88%) patients with bleeding had received prior radiotherapy and/or chemotherapy. CONCLUSION Bleeding is a rare complication after placement of expandable nitinol stents in patients with esophageal and upper GI obstruction, but patients with early bleeding may require embolization for control. Care must be exercised on placing stents in patients who have received prior radiotherapy or chemotherapy.
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Affiliation(s)
- Se Jin Oh
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ho-Young Song
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Deok Ho Nam
- Department of Radiology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Heung Kyu Ko
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jung-Hoon Park
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Han Kyu Na
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong Jin Lee
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min Kyoung Kang
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Kang MK, Song HY, Kim JW, Kim JH, Park JH, Na HK, Lee JJ, Oh SJ. Additional gastroduodenal stent placement: retrospective evaluation of 68 consecutive patients with malignant gastroduodenal obstruction. Acta Radiol 2013; 54:944-8. [PMID: 23761545 DOI: 10.1177/0284185113485500] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Self-expandable metallic stent placement is widely used to manage malignant gastroduodenal obstructions. However, the techniques and effectiveness of additional gastroduodenal stent placement have not been evaluated until now. PURPOSE To evaluate the technical feasibility, clinical effectiveness, and complications of additional gastroduodenal stent placement in patients with recurrent obstructive symptoms after primary gastroduodenal stenting. MATERIAL AND METHODS We retrospectively analyzed data from 68 consecutive patients who had additional gastroduodenal stents placed for recurrent obstruction. Clinical effectiveness was assessed using technical and clinical success rates, gastric outlet obstruction score improvement after primary and additional stent placement, and complications. RESULTS Additional stent placement was technically successful in 66 of the 68 patients (97%) and symptomatic improvement was achieved in 58 (85%). The gastric outlet obstruction score improved after primary stent placement (0.3 to 1.4) and additional stent placement (0.2 to 1.4). Complications occurred in 12 of 68 patients (18%) and were caused by tumor overgrowth (n = 7), stent collapse (n = 2), food impaction (n = 1), jaundice (n = 1), and duodenal perforation (n = 1). CONCLUSION Additional gastroduodenal stent placement is technically feasible and clinically effective for patients with recurrent gastric outlet obstruction after stent placement.
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Affiliation(s)
- Min Kyoung Kang
- Departments of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Chauvin A, Viala J, Marteau P, Hermann P, Dray X. Management and endoscopic techniques for digestive foreign body and food bolus impaction. Dig Liver Dis 2013; 45:529-42. [PMID: 23266207 DOI: 10.1016/j.dld.2012.11.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 11/02/2012] [Indexed: 02/07/2023]
Abstract
Ingested foreign bodies, food bolus impaction, migration or retention of medical devices are frequent, in children as well as in adults. Most of these foreign bodies will naturally pass through the gastro-intestinal tract. Complications are rare but sometimes severe (oesophageal perforations are the most frequent and most feared). We aimed to review the literature on therapeutic management of digestive foreign bodies and food bolus impaction, with special focus on endoscopic indications, material, timing and techniques for removal. The role of the gastroenterologist is to recognise specific situations and to plan endoscopic removal in a timely manner with the most adequate conditions and extraction tools. Risk factors and underlying pathology, for example eosinophilic esophagitis, must be investigated and if necessary treated.
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Affiliation(s)
- Armelle Chauvin
- Emergency Endoscopy Unit, Department of Gastroenterology, APHP, Lariboisière Hospital, & iTEC Paris Diderot Paris 7 University, Paris, France
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Loffeld RJLF, Dekkers PEP. Palliative stenting of the digestive tract: a case series of a single centre. J Gastrointest Oncol 2013; 4:14-9. [PMID: 23450097 DOI: 10.3978/j.issn.2078-6891.2012.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 08/25/2012] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND AND AIM Obstruction of the gastrointestinal tract due to cancer can be treated with stenting. The aim was to review the local experience with endoscopic stenting. All patients treated with stenting in a ten years period from 2001-2010 were studied. RESULTS Fifty one patients received 57 stents because of oesophageal cancer. Mean survival after stent placement was 141 days. No case of perforation occurred. In nine cases (17%) clogging with food occurred. Tumour overgrowth was noted in four cases. Twenty four patients received 28 stents in their colon or rectum. The stents were placed in the rectum (n=6), the sigmoid (n=14), the descending colon (n=1), and the transverse colon (n=3). Mean survival was 276 days. Perforation did not occur. Tumour ingrowth was seen in two patients. One patient received a second stent. Dislocation occurred in two cases. There were two cases of clogging (8%) by stool. Fourteen patients received a total of 18 stents because of obstructing stomach cancer. Mean survival after placement was 121 days. There was no perforation, one case of clogging, and four cases of tumour ingrowth. Eight patients had stent placement in their duodenum. Mean survival after stent placement was 84 days. No perforation or clogging occurred. But three cases of tumour ingrowth were seen. CONCLUSIONS The present series shows that placement of expandable stents in the digestive tract in normal daily practice is feasible, safe, with a low number of complications, and provides good palliation for their remaining life.
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Affiliation(s)
- Ruud J L F Loffeld
- Department of Internal Medicine and Gastroenterology, Zaans Medical Centre Zaandam, The Netherlands
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Larssen L, Medhus AW, Körner H, Glomsaker T, Søberg T, Gleditsch D, Hovde Ø, Tholfsen JK, Skreden K, Nesbakken A, Hauge T. Long-term outcome of palliative treatment with self-expanding metal stents for malignant obstructions of the GI tract. Scand J Gastroenterol 2012; 47:1505-14. [PMID: 23046494 DOI: 10.3109/00365521.2012.711854] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Self-expanding metal stents (SEMS) are commonly used in the palliative treatment of malignant gastrointestinal (GI) obstructions with favorable short-term outcome. Data on long-term outcome are scarce, however. AIM To evaluate long-term outcome after palliative stent treatment of malignant GI obstruction. METHOD Between October 2006 and April 2008, nine Norwegian hospitals included patients treated with SEMS for malignant esophageal, gastroduodenal, biliary, and colonic obstructions. Patients were followed for at least 6 months with respect to stent patency, reinterventions, and readmissions. RESULTS Stent placement was technically successful in 229 of 231 (99%) and clinically successful after 1 week in 220 of 229 (96%) patients. Long-term follow-up was available for 219 patients. Of those, 72 (33%) needed reinterventions. Stent occlusions or migrations (92%) were the most common reasons. Esophageal stents required reinterventions most frequently (41%), and had a significantly (p = 0.02) shorter patency (median 152 days) compared to other locations (gastroduodenal, 256 days; colon, 276 days; biliary, 460 days). Eighty percent of reinterventions were repeated endoscopic procedures that successfully restored patency. Readmissions were required for 156 (72%) patients. Progression of the underlying cancer was the most common reason, whereas 24% were readmitted due to stent complications. CONCLUSIONS Long-term outcome after palliative treatment with SEMS for malignant GI and biliary obstruction shows that 70% had a patent stent until death, and that most reobstructions could be solved endoscopically. Hospital readmissions were mainly related to progression of the underlying cancer disease.
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Affiliation(s)
- Lene Larssen
- Department of Gastroenterology, Oslo University Hospital, Ullevål, Oslo, Norway.
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How to design the optimal self-expandable oesophageal metallic stents: 22 years of experience in 645 patients with malignant strictures. Eur Radiol 2012; 23:786-96. [PMID: 23011213 DOI: 10.1007/s00330-012-2661-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 08/15/2012] [Accepted: 08/23/2012] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To evaluate the clinical efficacy and safety of self-expandable metallic stent (SEMS) placement for malignant oesophageal strictures and their relationship with stent designs. METHODS Seven generations of SEMS were used to treat 645 consecutive patients with oesophageal strictures. Logistic regression models were constructed to identify predictive factors associated with complications. RESULTS Stent placement was technically successful in 641 of 645 patients (99.4%). The clinical success rate was 95.5%. There were 260 (40.3%) complications after stent placement. Due to complications, 68 stents were removed; 66 of 68 stents (97.1%) were removed successfully. Stainless steel (SS) stents (odds ratio [OR] 4.18; 95% confidence interval [CI] 2.10, 8.32) and radiation therapy (RT) before stent placement (OR 4.23; CI 2.02, 8.83) were significantly associated with severe pain. Flared ends (OR 9.63; CI 3.38, 27.43), stricture length <6 cm (OR 2.01; CI 1.13, 3.60), and a stent diameter <18 mm (OR 3.00; CI 1.32, 6.84) were predictive factors of stent migration. Polyurethane membranes were associated with more frequent tumour ingrowth than polytetrafluoroethylene (PTFE) membranes (P = 0.002). CONCLUSIONS Despite the relatively high complication rate, retrievable self-expandable PTFE-covered nitinol stents equipped with a head and a tail appeared to be an effective treatment for malignant oesophageal strictures.
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