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Tasleem SH, Inayat F, Ali NS, Sattar SBA, Munir A, Zafar F. Small Bowel Perforation Secondary to Esophageal Stent Migration: A Comparative Review of Six Cases. Cureus 2018; 10:e3455. [PMID: 30564534 PMCID: PMC6298618 DOI: 10.7759/cureus.3455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Esophageal stent placement is used to treat benign strictures, esophageal perforations, fistulas and for palliative therapy of esophageal cancer. Although it is a safe and effective method, complications are increasing the morbidity and mortality rate. Small bowel perforation as a result of esophageal stent migration is a remarkably rare occurrence. We report one case from our clinical experience and undertake a review of the previously reported cases retrieved from the PubMed. A total of six cases were found accessible. Abdominal pain was the common clinical presentation. The mean time from stent placement to perforation was 3.4 months (range, two weeks to 12 months). The jejunum was the frequently perforated portion of the small bowel. Surgical intervention was the mainstay of treatment. This comparative review illustrates that clinicians should remain vigilant for small bowel perforation in patients with esophageal stent placement. Further studies are required to delineate the magnitude and scope of this association.
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Affiliation(s)
- Syed H Tasleem
- Gastroenterology and Hepatology, Baylor College of Medicine, Houston, USA
| | - Faisal Inayat
- Internal Medicine, Allama Iqbal Medical College, Lahore, PAK
| | | | | | - Ahmed Munir
- Internal Medicine, Services Institute of Medical Sciences, Lahore, PAK
| | - Fahad Zafar
- Internal Medicine, King Edward Medical University, Lahore, PAK
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2
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Shehab H. Enteral stents in the management of post-bariatric surgery leaks. Surg Obes Relat Dis 2017; 14:393-403. [PMID: 29428690 DOI: 10.1016/j.soard.2017.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 12/10/2017] [Accepted: 12/13/2017] [Indexed: 02/07/2023]
Abstract
A post-bariatric surgery leak is a rare but grave condition and remains every bariatric surgeon's nightmare. Endoscopic therapy with the insertion of self-expandable stents provides an effective minimally invasive approach for the management of leaks. Self-expandable stents, however, are still hampered by their tendency for migration and are not always well tolerated. Recently, double-pigtail stents have been proposed as an alternative endoscopic therapeutic modality. Both types of stents have been shown to be very effective in the management of leaks; however, most studies have pooled gastrointestinal leaks due to different etiologies together. In this article, we review the current status and foreseen innovations in gastrointestinal stenting for post-bariatric surgery leaks.
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Affiliation(s)
- Hany Shehab
- Gastrointestinal Endoscopy unit, Department of Gastroenterology, Cairo University, Cairo, Egypt.
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3
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Kim JE, Kim HC, Lee M, Hur S, Kim M, Lee SH, Cho SB, Kim CS, Han JK. Efficacy of Retrievable Metallic Stent with Fixation String for Benign Stricture after Upper Gastrointestinal Surgery. Korean J Radiol 2016; 17:893-902. [PMID: 27833405 PMCID: PMC5102917 DOI: 10.3348/kjr.2016.17.6.893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 07/31/2016] [Indexed: 11/21/2022] Open
Abstract
Objective To determine the efficacy of retrievable metallic stent with fixation string for benign anastomotic stricture after upper gastrointestinal (UGI) surgery. Materials and Methods From June 2009 to May 2015, a total of 56 retrievable metallic stents with fixation string were placed under fluoroscopy guidance in 42 patients who were diagnosed with benign anastomotic stricture after UGI surgery. Clinical success was defined as achieving normal regular diet (NRD). Results The clinical success rate after the first stent placement was 57.1% (24/42). After repeated stent placement and/or balloon dilation, the clinical success rate was increased to 83.3% (35/42). Six (14.3%) patients required surgical revision to achieve NRD. One (2.4%) patient failed to achieve NRD. Stent migration occurred in 60.7% (34/56) of patients. Successful rate of removing the stent using fixation string and angiocatheter was 94.6% (53/56). Distal migration occurred in 12 stents. Of the 12 stents, 10 (83.3%) were successfully removed whereas 2 could not be removed. No complication occurred regarding distal migration. Conclusion Using retrievable metallic stent with a fixation string is a feasible option for managing early benign anastomotic stricture after UGI surgery. It can reduce complications caused by distal migration of the stent.
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Affiliation(s)
- Jeong-Eun Kim
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Myungsu Lee
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Saebeom Hur
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Minuk Kim
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Sang Hwan Lee
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Soo Buem Cho
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Chan Sun Kim
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
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4
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Malgras B, Lo Dico R, Pautrat K, Dohan A, Boudiaf M, Pocard M, Soyer P. Gastrointestinal stenting: Current status and imaging features. Diagn Interv Imaging 2015; 96:593-606. [PMID: 25953525 DOI: 10.1016/j.diii.2015.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 04/02/2015] [Indexed: 12/13/2022]
Abstract
The use of stents in the gastrointestinal tract has been subjected to major changes. Initially, the use of stents was restricted to malignant strictures in patients with metastatic disease. But thanks to reduction of the morbidity and mortality rates, they are now used with curative intention and in patients with benign diseases after careful selection. However, for patients presenting with colon obstruction due to an advanced colon carcinoma, the mortality and morbidity are still high. The purpose of this review is to provide an overview of indications, techniques and further developments of the stents in the gastrointestinal tract and to highlight the predominant role of multidetector row computed tomography (MDCT) in the detection of potential complications.
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Affiliation(s)
- B Malgras
- Department of Surgical Oncology, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France.
| | - R Lo Dico
- Department of Surgical Oncology, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - K Pautrat
- Department of Surgical Oncology, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - A Dohan
- Department of Abdominal and Interventional Imaging, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France; Sorbonne Paris Cité, université Diderot - Paris 7, 10, avenue de Verdun, 75010 Paris, France; UMR Inserm 965, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - M Boudiaf
- Department of Abdominal and Interventional Imaging, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - M Pocard
- Department of Surgical Oncology, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France; Sorbonne Paris Cité, université Diderot - Paris 7, 10, avenue de Verdun, 75010 Paris, France; UMR Inserm 965, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - P Soyer
- Department of Abdominal and Interventional Imaging, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France; Sorbonne Paris Cité, université Diderot - Paris 7, 10, avenue de Verdun, 75010 Paris, France; UMR Inserm 965, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
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5
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Small bowel perforation due to a migrated esophageal stent: Report of a rare case and review of the literature. Int J Surg Case Rep 2015; 11:113-116. [PMID: 25967554 PMCID: PMC4446686 DOI: 10.1016/j.ijscr.2015.04.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 03/29/2015] [Accepted: 04/26/2015] [Indexed: 02/07/2023] Open
Abstract
Palliation of dysphagia with esophageal stenosis via esophageal stent placement is an effective procedure. Migration is one of the most common complication after stent placement. The lumen of stent is often allow to the passage in the intestine, so symptoms may develop much later. Intestinal perforation is a rare but serious complication of stent migration.
Introduction Endoscopic esophageal stent placement is used to treat benign strictures, esophageal perforations, fistulas and for palliative therapy of esophageal cancer. Although stent placement is safe and effective method, complications are increasing the morbidity and mortality rate. We aimed to present a patient with small bowel perforation as a consequence of migrated esophageal stent. Presentation of case A 77-years-old woman was admitted with complaints of abdominal pain, abdominal distension, and vomiting for two days. Her past medical history included a pancreaticoduodenectomy for pancreatic tumor 11 years ago, a partial esophagectomy for distal esophageal cancer 6 months ago and an esophageal stent placement for esophageal anastomotic stricture 2 months ago. On abdominal examination, there was generalized tenderness with rebound. Computed tomography showed the stent had migrated. Laparotomy revealed a perforation localized in the ileum due to the migrated esophageal stent. About 5 cm perforated part of gut resected and anastomosis was done. The patient was exitus fifty-five days after operation due to sepsis. Discussion Small bowel perforation is a rare but serious complication of esophageal stent migration. Resection of the esophagogastric junction facilitates the migration of the stent. The lumen of stent is often allow to the passage in the gut, so it is troublesome to find out the dislocation in an early period to avoid undesired results. In our case, resection of the esophagogastric junction was facilitated the migration of the stent and late onset of the symptoms delayed the diagnosis. Conclusion Patients with esophageal stent have to follow up frequently to preclude delayed complications. Additional technical procedures are needed for the prevention of stent migration.
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Computed Tomography of Iatrogenic Complications of Upper Gastrointestinal Endoscopy, Stenting, and Intubation. Radiol Clin North Am 2014; 52:1055-70. [DOI: 10.1016/j.rcl.2014.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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7
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Complications of Biliary and Gastrointestinal Stents: MDCT of the Cancer Patient. AJR Am J Roentgenol 2012; 199:W187-96. [DOI: 10.2214/ajr.11.7145] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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8
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Reddy VM, Sutton CD, Miller AS. Terminal Ileum Perforation as a Consequence of a Migrated and Fractured Oesophageal Stent. Case Rep Gastroenterol 2009; 3:61-66. [PMID: 20651967 PMCID: PMC2895178 DOI: 10.1159/000210542] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Covered self-expanding metallic stents are commonly employed to relieve malignant oesophageal obstruction. We report a case of a patient with oesophageal cancer treated by stent insertion and curative chemoradiotherapy with subsequent stent migration to the stomach. The stent fractured with the distal fragment migrating as far as the terminal ileum where it caused perforation of the bowel.
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Affiliation(s)
- V M Reddy
- Department of General Surgery, Leicester Royal Infirmary, Leicester, UK
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Wall I, Baradarian R, Tangorra M, Badalov N, Iswara K, Li J, Tenner S. Spontaneous perforation of the duodenum by a migrated ureteral stent. Gastrointest Endosc 2008; 68:1236-8. [PMID: 18547569 DOI: 10.1016/j.gie.2008.02.083] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Accepted: 02/27/2008] [Indexed: 02/08/2023]
Affiliation(s)
- Ian Wall
- Department of Internal Medicine, Division of Gastroenterology, Maimonides Medical Center, Brooklyn, New York 11219, USA
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Sanyal A, Maskell GF, Hohle R, Murray IA. An unusual complication of oesophageal stent deployment. Br J Radiol 2006; 79:e103-5. [PMID: 16940361 DOI: 10.1259/bjr/66364821] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Insertion of a self-expanding metal stent is commonly used to palliate dysphagia secondary to oesophageal carcinoma. Displacement of the stent itself is a recognized complication which can result in perforation of the upper gastrointestinal tract. We report the first case of bowel obstruction and perforation resulting from the olive of the deployment system. This was probably due to peritoneal deposits on the small intestine obstructing passage of the olive.
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Affiliation(s)
- A Sanyal
- Department of Gastroenterology, Royal Cornwall Hospital, Truro, Cornwall TR1 3LJ, UK
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11
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Bessoud B, de Baere T, Denys A, Kuoch V, Ducreux M, Precetti S, Roche A, Menu Y. Malignant gastroduodenal obstruction: palliation with self-expanding metallic stents. J Vasc Interv Radiol 2005; 16:247-53. [PMID: 15713926 DOI: 10.1097/01.rvi.0000145227.90754.76] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To evaluate the feasibility, efficacy, and tolerance of self-expanding metallic stent insertion under fluoroscopic guidance for palliation of symptoms related to malignant gastroduodenal obstruction. MATERIALS AND METHODS Seventy-two patients (38 men, 34 women) aged 25-98 years (mean, 62 years) with duodenal (n = 43), antropyloric (n = 13), surgical gastrojejunostomy (n = 10), or pyloroduodenal (n = 6) malignant obstruction were referred for insertion of self-expanding metallic stents over a 6-year period. Stent insertion was performed with use of a peroral or transgastric approach when necessary (n = 11). RESULTS Stents were successfully inserted in 70 of the 72 patients (97%) and provided symptom relief in 65 patients (90%). Inserted stents were mainly uncovered vascular (n = 55) or enteral (n = 10) Wallstents. One hundred eight stents were initially inserted: one, two, three, or four stents were indicated in 43, 17, nine, and one patient, respectively. Mean follow-up was 119 days (range, 4-513 days). Mean stent patency was 113 days (range, 4-513 days). Mean survival of patients was 120 days. During follow-up, stent obstruction occurred in seven patients as a result of tumoral overgrowth (n = 5) or ingrowth (n = 2). Complications occurred in 12 of the 72 patients (17%), including stent migration (n = 8), stent fracture (n = 1), duodenal perforation (n = 1), and death related to general anesthesia (n = 1). CONCLUSION Despite a significant complication rate, self-expanding metallic stent insertion under fluoroscopic guidance appears to be a feasible and useful technique in the palliative management of malignant gastroduodenal obstruction.
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Affiliation(s)
- Bertrand Bessoud
- Department of Medical and Interventional Imaging, Institut Gustave Roussy, Villejuif, France.
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12
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Thuraisingam AI, Hughes ML, Smart HL. Down-staging of an advanced esophageal carcinoma with chemoradiotherapy leading to stent migration necessitating colectomy. Gastrointest Endosc 2004; 59:457-60. [PMID: 14997158 DOI: 10.1016/s0016-5107(03)02723-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Cheng YS, Li MH, Chen WX, Chen NW, Zhuang QX, Shang KZ. Complications of stent placement for benign stricture of gastrointestinal tract. World J Gastroenterol 2004; 10:284-6. [PMID: 14716840 PMCID: PMC4717021 DOI: 10.3748/wjg.v10.i2.284] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM: To observe the frequent complications of stent placement for stricture of the gastrointestinal tract and to find proper treatment.
METHODS: A total number of 140 stents were inserted in 138 patients with benign stricture of the gastrointestinal tract. The procedure was completed under fluoroscopy in all of the patients.
RESULTS: Stents were successfully placed in all the 138 patients. Pains occurred in 23 patients (16.7%), slight or dull pains were found in 21 patients and severe chest pain in 2 respectively. For the former type of pain, the patients received only analgesia or even no treatment, while peridural anesthesics was conducted for the latter condition. Reflux occurred in 16 of these patients (11.6%) after stent placement. It was managed by common antireflux procedures. Gastrointestinal bleeding occurred in 13 patients (9.4%), and was treated by hemostat. Restenosis of the gastrointestinal tract occurred in 8 patients (5.8%), and was apparently associated with hyperplasia of granulation tissue. In 2 patients, the second stent was placed under X-ray guidance. The granulation tissue was removed by cauterization through hot-node therapy under gastroscope guidance in 3 patients, and surgical reconstruction was performed in another 3 patients. Stent migration occurred in 5 patients (3.6%), and were extracted with the aid of a gastroscope. Food-bolus obstruction was encountered in 2 patients (1.4%) and was treated by endoscope removal. No perforation occurred in all patients.
CONCLUSION: Frequent complications after stent placement for benign stricture of the gastrointestinal tract include pain, reflux, bleeding, restenosis, stent migration and food-bolus obstruction. They can be treated by drugs, the second stent placement or gastroscopic procedures depend on the specific condition.
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Affiliation(s)
- Ying-Sheng Cheng
- Department of Radiology, Sixth People's Hospital, Shanghai Jiaotong University, Shanghai 200233, China.
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Abstract
Iatrogenic perforation of the gastrointestinal tract is a medical emergency and is inevitable. An endoscopist must maintain a high index of suspicion despite minimal or atypical symptoms and negative radiologic studies, because perforation is a complication with tremendous morbidity and mortality. The endoscopist must know how to manage this complication appropriately and to seek immediate surgical consultation. There is ongoing controversy about when a patient should undergo nonoperative or surgical therapy. An evidence-based approach to manage iatrogenic perforation is not possible. The trend in the modern era is to less invasive, nonoperative therapy, given advancements in ICU care and antibiotics. Laparoscopy or laparoscopic-assisted (minilaparotomy) surgery is also being increasingly used with outcomes comparable with conventional laparotomy. Experience and advancements in accessories have enabled endoscopic repair of iatrogenic perforation in many situations [84]. The management algorithms provided synthesize the pertinent literature into reasonable guidelines to follow. Ultimately, an individualized approach must be taken to manage the patient with an iatrogenic perforation.
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Affiliation(s)
- Rajesh V Putcha
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center at Dallas, Room F.4.310, 5323 Harry Hines Boulevard, Dallas, TX 75390-8887, USA
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Mao AW, Gao ZD, Xu JY, Yang RJ, Xiao XS, Jiang TH, Jiang WJ. Treatment of malignant digestive tract obstruction by combined intraluminal stent installation and intra-arterial drug infusion. World J Gastroenterol 2001; 7:587-92. [PMID: 11819837 PMCID: PMC4688681 DOI: 10.3748/wjg.v7.i4.587] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To study the palliative treatment of malignant obstrution of digestive tract with placement of intraluminal stent combined with intra-arterial infusion of chemotherapeutic drugs.
METHODS: A total of 281 cases of digestive tract malignant obstruction were given per oral (esophagus, stomach, duodenum and jejunum), per anal (colon and rectum) and percutaneous transhepatic (biliary) installation of metallic stent. Among them, 203 cases received drug infusion by cannulation of tumor supplying artery with Seldinger’s technique.
RESULTS: Altogether 350 stents were installed in 281 cases, obstructive symptoms were relieved or ameliorated after installation. Occurrence of restenotic obstruction was 8-43 weeks among those with intra-arterial drug infusion, which was later than 4-26 weeks in the group with only stent installation. The average survival time of the former group was 43 (3-105) weeks, which was significantly longer than 13 (3-24) weeks of the latter group.
CONCLUSION: Intraluminal placement of stent combined with intra-arterial infusion chemotherapy is one of the effective palliative therapies for malignant obstruction of the digestive tract with symptomatic as well as etiological treatment.
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Affiliation(s)
- A W Mao
- Department of Interventional Radiology, Shanghai S.T, Luke's Hospital, 768 Yu Yuan Road, Shanghai 200050, China.
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