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Bi Y, Li J, Yi M, Yu Z, Han X, Ren J. Self-expanding segmental radioactive metal stents for palliation of malignant esophageal strictures. Acta Radiol 2020; 61:921-926. [PMID: 31744304 DOI: 10.1177/0284185119886315] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Traditional metal stents are not always suitable for patients with circuitous malignant esophageal stricture. PURPOSE We aimed to report the safety and effectiveness of stent insertion using self-expanding segmental radioactive metal stent in the palliation of malignant esophageal stricture. MATERIAL AND METHODS We conducted a retrospective analysis of 22 consecutive patients who underwent insertion of segmental radioactive metal stents from November 2016 to March 2019. Technical success, dysphagia score, and complications were analyzed. Kaplan-Meier analysis was used to analyze the survival time. RESULTS The stenting procedure was successful in all 22 patients with no procedure-related deaths. Twenty-four segmental radioactive metal stents were successfully implanted. A total of 6 (27.3%) complications were found, mainly 5 (22.7%) stent migrations. The median follow-up period was 3.3 months. Stent removal was required in 4 (12.5%) patients due to complete stent migration. The mean dysphagia score decreased significantly after stent insertion (P<0.0001). During follow up, 13 patients survived with no obvious clinical symptom and nine patients died. The mean survival was 9.9 months. CONCLUSION The stenting procedure using self-expanding segmental radioactive metal stents is safe and effective in dysphagia palliation of malignant esophageal stricture.
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Affiliation(s)
- Yonghua Bi
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Jindong Li
- Department of Thoracic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Mengfei Yi
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Zepeng Yu
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Xinwei Han
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Jianzhuang Ren
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
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Bi Y, Zhu X, Yu Z, Jiao D, Yi M, Han X, Ren J. Radioactive feeding tube in the palliation of esophageal malignant obstruction. Radiol Med 2020; 125:544-550. [PMID: 32062758 DOI: 10.1007/s11547-020-01151-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 02/06/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE A radioactive feeding tube was used to achieve both nutrition and brachytherapy for the treatment for malignant esophageal obstruction. We report the safety and effectiveness of this technique. METHODS We conducted a retrospective analysis of 16 consecutive patients who employed this technique from January 2015 to March 2018. The radioactive feeding tube was made by binding the 125I seed chain on the feeding tube. Under fluoroscopic guidance, the tube was inserted into the obstructed esophagus, with the seed chain crossing over the segment of malignant esophageal obstruction. Technical success rate, dysphagia score, procedure time and complications were analyzed. Kaplan-Meier analysis was used to analyze the survival time. RESULTS The radioactive feeding tube was easy to prepare. The technical success rate was 100%, without serious complications such as bleeding or infection. The median procedure time of tube insertion was 44.0 min. The Kamofsky score and Neuhaus dysphagia grading were significantly improved after tube insertion (p < 0.01). On esophageal radiography, the contrast agent passed through the narrow area smoothly. Complete remission (n = 1) and partial remission (n = 13) of local tumor were obtained in 14 patients, and the local tumor control rate was 87.5% (14/16). During follow-up, four patients survived with no obvious clinical symptom and 10 patients died of cancer. The median survival was 12.0 months. CONCLUSION Preparation of the radioactive feeding tube is simple and easy. The insertion of this kind of tube achieves parenteral nutrition and brachytherapy simultaneously and is safe and effective in dysphagia palliation of malignant esophageal stricture. The radiological-radiotherapeutic procedure could be an alternative tool in the case of refusing other treatments by the patients.
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Affiliation(s)
- Yonghua Bi
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, East Jian She Road, Zhengzhou, 450052, China
| | - Xiaoyan Zhu
- Department of Histology and Embryology, College of Basic Medicine, Zhengzhou University, Zhengzhou, China
| | - Zepeng Yu
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, East Jian She Road, Zhengzhou, 450052, China
| | - Dechao Jiao
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, East Jian She Road, Zhengzhou, 450052, China
| | - Mengfei Yi
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, East Jian She Road, Zhengzhou, 450052, China
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, East Jian She Road, Zhengzhou, 450052, China.
| | - Jianzhuang Ren
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, East Jian She Road, Zhengzhou, 450052, China.
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Bi Y, Ren J, Li J, Yu Z, Han X, Wu G. A novel fully covered self-expandable segmental metallic stents for the treatment of refractory esophageal stenosis. J Thorac Dis 2019; 11:1363-1369. [PMID: 31179078 DOI: 10.21037/jtd.2019.04.02] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background The conventional esophageal stent is not flexible enough for refractory or circuitous esophageal stenosis. After stent placement, the bending stress may stimulate tissue proliferation in both ends of the stent, causing restenosis, severe bleeding or fistula. A fully covered self-expandable segmental stent was designed and used to overcome such shortcoming. This study aims to study the safety and effectiveness of the fully covered self-expandable segmental metallic stents placement in palliation of dysphasia in patients with refractory esophageal stenosis. Methods Retrospective study of hospital records of a consecutive series of 24 patients who underwent placement of fully covered segmental stent from March 2015 to April 2018 was conducted. All procedure was performed under local anesthesia and fluoroscopic guidance. Esophagography was performed by orally take of iodine contrast agent. A 5F catheter and a stiff guide wire were introduced in the esophagus. A fully covered segmental stent was delivered and implanted along the stiff guide wire. The upper endoscopy and chest computed tomography scan were used for the assessment of the location and length of stenosis on admission and during follow-up. The technical success and complications were collected and analyzed. Results Stent placement was successful in all patients without procedure-related deaths. Twenty-four covered segmental stents were implanted. A total of eight major complications (33.3%) were found, and stent migration was the most common complication (16.7%). The median follow-up time was 4.5 months (interquartile range: 0.8-14.0 months). Adjustment was required in 3 patients (12.5%) due to stent migration. The mean dysphagia score before stenting and end of follow-up was 3.3±0.5 and 1.0±1.6 (P<0.0001). Four covered segmental stents were removed due to stent migration or intolerance. Conclusions Stenting using novel fully covered self-expandable segmental metallic stent is safe and effective in dysphagia palliation of refractory esophageal stenosis.
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Affiliation(s)
- Yonghua Bi
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Jianzhuang Ren
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Jindong Li
- Department of Thoracic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Zepeng Yu
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Xinwei Han
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Gang Wu
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
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Bi Y, Li J, Yu Z, Han X, Wu G. Modified Type of Double-Covered Self-Expandable Segmental Metallic Stents for Palliation of Esophageal Fistula. J Laparoendosc Adv Surg Tech A 2019; 29:875-879. [PMID: 30785837 DOI: 10.1089/lap.2018.0722] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: To study the modified type of double-covered self-expandable segmental metallic stents in terms of efficacy, complications, and long-term outcomes. Patients and Methods: A retrospective review of a consecutive series of 24 patients who underwent placement of the modified stent from July 2013 to July 2018 was conducted. Twenty-five modified segmental stents were implanted. Data regarding technical success and complications were collected and analyzed. Results: Stent placement was successful in all patients with no perioperative procedure-related deaths. The median follow-up time was 10.3 months (interquartile range 6.3-23.5 months). Adjustment was required in 9 patients (37.5%) due to stent migration. The mean dysphagia scores before stenting and during follow-up were 3.6 ± 0.7 and 0.9 ± 1.6, respectively (P < .0001). Fifteen modified stents were removed due to complications or cure. Conclusion: Modified double-covered self-expandable segmental metallic stents are safe and effective for palliation of esophageal fistula.
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Affiliation(s)
- Yonghua Bi
- 1 Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jindong Li
- 2 Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zepeng Yu
- 1 Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xinwei Han
- 1 Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Gang Wu
- 1 Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Bona D, Laface L, Bonavina L, Abate E, Schaffer M, Ugenti I, Siboni S, Carrinola R. Covered nitinol stents for the treatment of esophageal strictures and leaks. World J Gastroenterol 2010; 16:2260-4. [PMID: 20458763 PMCID: PMC2868219 DOI: 10.3748/wjg.v16.i18.2260] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare 2 different types of covered esophageal nitinol stents (Ultraflex and Choostent) in terms of efficacy, complications, and long-term outcome.
METHODS: A retrospective review of a consecutive series of 65 patients who underwent endoscopic placement of an Ultraflex stent (n = 33) or a Choostent (n = 32) from June 2001 to October 2009 was conducted.
RESULTS: Stent placement was successful in all patients without hospital mortality. No significant differences in patient discomfort and complications were observed between the Ultraflex stent and Choostent groups. The median follow-up time was 6 mo (inter-quartile range 3-16 mo). Endoscopic reintervention was required in 9 patients (14%) because of stent migration or food obstruction. No significant difference in the rate of reintervention between the 2 groups was observed (P = 0.8). The mean dysphagia score 1 mo after stent placement was 1.9 ± 0.3 for the Ultraflex stent and 2.1 ± 0.4 for the Choostent (P = 0.6). At 1-mo follow-up endoscopy, the cover membrane of the stent appeared to be damaged more frequently in the Choostent group (P = 0.34). Removal of the Choostent was possible up to 8 wk without difficulty.
CONCLUSION: Ultraflex and Choostent proved to be equally reliable for palliation of dysphagia and leaks. Removal of the Choostent was easy and safe under mild sedation.
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White RE, Parker RK, Fitzwater JW, Kasepoi Z, Topazian M. Stents as sole therapy for oesophageal cancer: a prospective analysis of outcomes after placement. Lancet Oncol 2009; 10:240-6. [PMID: 19230771 DOI: 10.1016/s1470-2045(09)70004-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Therapies for inoperable oesophageal cancer include chemoradiotherapy and placement of a self-expanding metal stent (SEMS). Few data are available regarding SEMS as sole therapy for patients with inoperable disease who have not already received, or are unfit for, chemoradiotherapy. The aim of this study was to determine survival, adequacy of palliation, and complications after SEMS placement as sole therapy for inoperable oesophageal cancer in a resource-limited setting. METHODS Data were prospectively gathered on all patients with oesophageal cancer treated with SEMS between Jan 1, 1999, and May 20, 2008, at a hospital in Kenya where chemoradiotherapy is unavailable. Dysphagia scores, morbidity, mortality, and survival were assessed. Follow-up was done during clinic visits, home visits, and by mobile phone. FINDINGS 1000 stents were placed in 951 patients. Long-term follow-up was obtained for 334 patients (35%) with a median survival of 250 days (IQR 130-431, 95%CI 217-301). Mean dysphagia scores improved from 3.3 (SD 0.6) pre-SEMS (n=697) to 1.0 (SD 1.3) for patients (n=78) still alive and 1.8 (SD 1.2) at time of death (n=165). Survival of 17 patients with follow-up who had perforation during tumour dilation (treated with SEMS) was 283 days (IQR 227-538) similar to the 317 patients with follow-up data who did not have a perforation (245 days, 124-430). 20 patients with a tracheo-oesophageal fistula lived a median of 142 days (IQR 73-329). Early complications occurred in 6% (54 of 951 patients) and late complications occurred in 19% (62 of 334 patients). SEMS-related mortality was 0.3% (three of 951). INTERPRETATION SEMS effectively palliate inoperable oesophageal cancer. Survival may be longer than previously reported when SEMS are placed in all patients with inoperable oesophageal cancer, as in our study, rather than those failing or unfit for chemoradiotherapy. SEMS seem to be an appropriate technology for palliation of oesophageal cancer in resource-limited settings. Given the proportion of patients lost to follow up, these findings merit further confirmation.
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Affiliation(s)
- Russell E White
- Tenwek Hospital, Bomet, Kenya; Department of Surgery, Brown Medical School, Rhode Island Hospital, Providence, RI, USA
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Maneglia V, Ben Soussan E, Savoye G, Ducrotté P, Di Fiore F, Dacher JN, Savoye-Collet C. Multidetector CT in patients with esophageal stent as a palliative treatment for stenosing esophageal cancer: a feasibility study. Scand J Gastroenterol 2007; 42:1339-46. [PMID: 17852853 DOI: 10.1080/00365520701396273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The self-expanding metallic stent (SEMS) is widely used in the palliative treatment of stenosing esophageal cancer. Multidetector computed tomography (MDCT) allows volumetric investigation including virtual endoscopy. The aim of this study was to determine the feasibility of MDCT follow-up of esophageal SEMS and to describe the imaging patterns encountered as well as correlating them with fibroscopic evaluation. MATERIAL AND METHODS Thirteen consecutive patients (10 M, mean age 64 years) with esophageal SEMS as a palliative treatment underwent MDCT for recurrent dysphagia (n =7), chest pain and fever (n = 1) or follow-up without symptoms (n = 5). Patency and esophageal wall patterns were studied and compared with diagnosis by fibroscopy. RESULTS No metallic artefact related to the SEMS was observed. At the SEMS level, MDCT revealed a tissular lump (n = 1), a thin recurrent layer of tissue (n = 1), extrinsic compression (n = 1), fluid stasis (n =7) and intussusception of the gastric wall into the SEMS (n =4). The esophageal wall was analyzed by MDCT (peripheral thickening around the stent (n = 8), tumor overgrowth under or above the SEMS level (n = 8)) and showed tracheal compression (n = 3). At the level of the SEMS, fibroscopy showed tumor recurrence (n = 2), a thin recurrent layer of tissue (n = 1), a distorted SEMS (n = 1) and a tumor overgrowth under or above the SEMS level (n = 6). In comparison with fibroscopy, MDCT satisfactorily diagnosed the SEMS patency in 92% of cases and the esophageal wall in 73%. CONCLUSIONS Morphology, patency of the SEMS and analysis of the esophageal wall can be performed by MDCT with a good degree of accuracy as compared to fibroscopy. In such patients in palliative care, a non-invasive investigation is worth promoting as a first-line procedure.
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Affiliation(s)
- Véronique Maneglia
- QUANT-IF-EA4051, LITIS-Radiology Department, Rouen University Hospital Charles Nicolle, Rouen, France
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Rerknimitr R, Naprasert P, Kongkam P, Kullavanijaya P. Trimming a metallic biliary stent using an argon plasma coagulator. Cardiovasc Intervent Radiol 2007; 30:534-6. [PMID: 16933157 DOI: 10.1007/s00270-006-0013-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Distal migration is one of the common complications after insertion of a covered metallic stent. Stent repositioning or removal is not always possible in every patient. Therefore, trimming using an argon plasma coagulator (APC) may be a good alternative method to solve this problem. METHODS Metallic stent trimming by APC was performed in 2 patients with biliary Wallstent migration and in another patient with esophageal Ultraflex stent migration. The power setting was 60-100 watts with an argon flow of 0.8 l/min. OBSERVATIONS The procedure was successfully performed and all distal parts of the stents were removed. No significant collateral damage to the nearby mucosa was observed. CONCLUSIONS In a patient with a distally migrated metallic stent, trimming of the stent is possible by means of an APC. This new method may be applicable to other sites of metallic stent migration.
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Affiliation(s)
- Rungsun Rerknimitr
- Gastroenterology Unit, Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10310, Thailand.
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Conigliaro R, Battaglia G, Repici A, De Pretis G, Ghezzo L, Bittinger M, Messmann H, Demarquay JF, Togni M, Blanchi S, Filiberti R, Conio M. Polyflex stents for malignant oesophageal and oesophagogastric stricture: a prospective, multicentric study. Eur J Gastroenterol Hepatol 2007; 19:195-203. [PMID: 17301645 DOI: 10.1097/meg.0b013e328013a418] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Dysphagia is the most distressing symptom in patients with cancer-related oesophageal obstruction. Endoscopic palliation aims to restore swallowing, avoid reintervention and to reduce hospitalization. This study reports an experience with a new self-expandable plastic stent (Polyflex) in patients with unresectable oesophageal and oesophagogastric junction cancer. METHODS Sixty patients were prospectively collected. The cause of obstruction was oesophageal squamous cell carcinoma (44) and adenocarcinoma (eight), lung cancer (seven) and thyroid tumour (one). RESULTS The stent was successfully placed in 59 patients. Early minor complications occurred in 19 patients (32%), and major complications in 13 (22%). Death occurred in three patients owing to pulmonary embolism (one) and massive haemorrhage (two). Recurrent dysphagia for early stent migration was observed in seven patients. Delayed stent migration occurred in five patients and tumour overgrowth in eight patients. The mean dysphagia score of 2.8 improved to a mean score of 1.0 after stenting (P<0.001). Overall median survival time was 4.6 months. CONCLUSIONS Our study suggests that Polyflex stents are competitive with metal stents, with similar efficacy but lower cost. Technical improvements, however, are required to make these stents more user friendly. Large randomized clinical studies are needed to guide in the choice among the different available stents.
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Affiliation(s)
- Rita Conigliaro
- Department of Digestive Endoscopy, General Hospital, Reggio Emilia, Italy
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Adler DG, Merwat SN. Endoscopic approaches for palliation of luminal gastrointestinal obstruction. Gastroenterol Clin North Am 2006; 35:65-82, viii. [PMID: 16530111 DOI: 10.1016/j.gtc.2005.12.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Much of the workload of a typical gastroenterologist is devoted to screening patients for gastrointestinal malignancies. Efforts such as colorectal cancer screening via colonoscopy and endoscopic surveillance of patients with Barrett's esophagus are widespread and widely endorsed. In recent years, the armamentarium of endoscopy has broadened considerably and now affords physicians a variety of nonsurgical means to palliate malignant obstruction of the gastrointestinal tract. This article reviews endoscopic techniques to treat malignant esophageal, biliary, small bowel, and colonic obstruction.
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Affiliation(s)
- Douglas G Adler
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Texas-Houston Medical School, MSB 4.234, 6431 Fannin, 77030, USA.
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Wenger U, Johnsson E, Bergquist H, Nyman J, Ejnell H, Lagergren J, Ruth M, Lundell L. Health economic evaluation of stent or endoluminal brachytherapy as a palliative strategy in patients with incurable cancer of the oesophagus or gastro-oesophageal junction: results of a randomized clinical trial. Eur J Gastroenterol Hepatol 2005; 17:1369-77. [PMID: 16292092 DOI: 10.1097/00042737-200512000-00017] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE To relieve dysphagia is the main goal in palliative treatment of patients with incurable cancer of the oesophagus or the gastro-oesophageal junction. The aim of this prospective, randomized multicentre study was to compare stent placement and brachytherapy regarding health economy and clinical outcomes. METHODS Patients with incurable cancer of the oesophagus or gastro-oesophageal junction were randomized to receive a self-expandable metallic stent or 3 x 7 Gy brachytherapy. At clinical follow-up visits, dysphagia was scored and health care consumptions were recorded. Costs were based on hospital debits. Total lifetime healthcare consumption costs and costs for the initial treatments were calculated and a sensitivity analysis was conducted. RESULTS Thirty patients were randomized to each treatment group. There was no difference in survival or complication rates between the two treatment strategies. There was a significant difference in the change of dysphagia scores between the time of inclusion and the 1-month follow-up visit, in favour of the stented group (P = 0.03). This difference had disappeared at 3 months. Median total lifetime costs were 17,690 for the stented group compared with 33 171 for the brachytherapy group (P = 0.005). This difference was due to higher costs for the initial treatment (4615 versus 23 857, P < 0.0001). Sensitivity analyses showed that the charges for a brachytherapy session had to be reduced from 6092 to 4222 (31%) to make this therapeutic concept cost-competitive. CONCLUSION Stenting is currently more cost-effective compared with fractionated 3 x 7 Gy brachytherapy for patients with incurable cancer of the oesophagus and gastro-oesophageal junction.
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Affiliation(s)
- Urs Wenger
- Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
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Hayashi K, Okayama Y, Gotoh K, Ohara H, Sano H, Nakazawa T, Nakao H, Joh T, Itoh M. CLINICAL EVALUATION OF METALLIC STENTING FOR MALIGNANT DUODENAL OBSTRUCTION USING COVERED SELF-EXPANDABLE METALLIC STENT. Dig Endosc 2005. [DOI: 10.1111/j.1443-1661.2005.00509.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Abstract
Endoluminal palliation involves the application of endoscopic techniques or devices to relieve the symptoms of malignant gastrointestinal obstruction. This is most often achieved with the use of self-expandable metal stents (SEMS). SEMS can be deployed as far distally or proximally in the gastrointestinal tract as the reach of an adult colonoscope. This article outlines the use of endoscopic techniques to provide endoluminal palliation.
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Affiliation(s)
- Dia T Simmons
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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Pazurek M, Malecka-Panas E. Photodynamic therapy in the palliative treatment of esophageal cancer. Photodiagnosis Photodyn Ther 2005; 2:73-7. [DOI: 10.1016/s1572-1000(05)00013-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2004] [Revised: 02/28/2005] [Accepted: 02/28/2005] [Indexed: 10/25/2022]
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Zhang PB, Zhao XY, Li YH, Da SP. Self-expandable metal stents for dysphagia in 26 patients with advanced esophageal cancer. Shijie Huaren Xiaohua Zazhi 2003; 11:1528-1530. [DOI: 10.11569/wcjd.v11.i10.1528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the therapeutic effect of self-expandable metal stents for dysphagia in 26 patients with advanced esophageal cancer.
METHODS Twenty-six patients with inoperable esophageal cancer had dysphagia and were treated with self-expandable stents. After esophageal dilation, a covered self-expandable metal stent was inserted and released on the site of stenosis.
RESULTS The stent was placed successfully in all of the 26 patients. Immediate relief of dysphagia was observed, the dysphagia score decreased from 3.08 to 1.38 (P<0.01).The main complications of this procedure were chest pain, gastroesophageal reflux and obstruction of the stent.
CONCLUSION Self-expandable mental stent is a safe and effective method to palliate the dysphagia in inoperable esophageal cancer.
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Affiliation(s)
- Peng-Bin Zhang
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Xiao-Yan Zhao
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Yi-Hui Li
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Si-Ping Da
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
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Abstract
The interventional management of esophageal strictures remains, to date, an important clinical challenge. Stenting is probably the best palliation modality in patients with incurable esophagogastric carcinoma. Conversely, the use of esophageal stents is still relatively uncommon for the treatment of refractory benign strictures. In the last few years, several new stents have become available as a result of significant advances that have been made in terms of design and materials. This review focuses on the endoscopic use of esophageal stents in malignant and benign esophageal strictures, revisiting the different types of expandable stents presently available, the techniques, the results, and the complications of stent insertion and giving some practical advices. Future developments in the field of esophageal stenting are also discussed.
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Affiliation(s)
- L Petruzziello
- Digestive Endoscopy Unit, Department of Surgery, Catholic University, Rome, Italy.
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