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Li S, Zhai Q, Yang Y, Li H, Xu J, Zhang Y, Xuan J. Successful treatment of a case of super-high malignant esophago-tracheal fistula with Sigma fully covered esophageal stent placement: case report. Front Med (Lausanne) 2025; 12:1533538. [PMID: 40224625 PMCID: PMC11985799 DOI: 10.3389/fmed.2025.1533538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2024] [Accepted: 02/27/2025] [Indexed: 04/15/2025] Open
Abstract
Background Esophageal cancer, as one of the most frequently occurring malignancies globally, often leads to esophageal stenosis and fistulas post-surgery or radiotherapy, significantly impacting patients' quality of life and prognosis. In particular, super-high esophageal fistulas represent a clinically challenging issue that urgently needs to be addressed. Case summary This study reports on a 72-year-old female patient who developed anastomotic stenosis following esophageal cancer surgery. Endoscopic exploration revealed that the esophageal inlet was approximately 17 cm from the incisors, with the anastomotic site located 20 cm from the incisors and being stenotic, rendering endoscope passage impossible. An ultra-thin gastroscope was then used, showing the stenosis at 20-22 cm. Our center successfully managed the high anastomotic stenosis with a Sigma fully covered esophageal stent. Subsequently, the patient experienced anastomotic recurrence and multiple esophageal-tracheal fistulas, which were successfully sealed with the same type of stent. A stent replacement was performed one year later, successfully improving the patient's quality of life. Conclusion This study demonstrates the successful management of a super-high esophageal-tracheal fistula using a Sigma fully covered metallic stent.
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Affiliation(s)
- Shupei Li
- Department of Gastroenterology, Jinling Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Qi Zhai
- Department of Gastroenterology and Hepatology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Ya Yang
- Department of Gastroenterology and Hepatology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Huafei Li
- Department of Gastroenterology and Hepatology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Juan Xu
- Department of Gastroenterology and Hepatology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Ying Zhang
- Department of Pathology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Ji Xuan
- Department of Gastroenterology, Jinling Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
- Department of Gastroenterology and Hepatology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
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Paulson B, Darian SB, Kim Y, Oh J, Ghasemi M, Lee K, Kim JK. Spectral Multiplexing of Fluorescent Endoscopy for Simultaneous Imaging with Multiple Fluorophores and Multiple Fields of View. BIOSENSORS 2022; 13:33. [PMID: 36671868 PMCID: PMC9855833 DOI: 10.3390/bios13010033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/22/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
Complex clinical procedures and small-animal research procedures can benefit from dual-site imaging provided by multiple endoscopic devices. Here, an endoscopic system is proposed which enables multiple fluorescence microendoscopes to be spectrally multiplexed on a single microscope base, enabling light sources and optical relays to be shared between endoscopes. The presented system is characterized for resolution using USAF-1951 resolution test charts and for modulation transfer function using the slanted edge method. Imaging is demonstrated both directly and with microendoscopes attached. Imaging of phantoms was demonstrated by targeting USAF charts and fiber tissues dyed for FITC and Texas Red fluorescence. Afterwards, simultaneous liver and kidney imaging was demonstrated in mice expressing mitochondrial Dendra2 and injected with Texas Red-dextran. The results indicate that the system achieves high channel isolation and submicron and subcellular resolution, with resolution limited by the endoscopic probe and by physiological movement during endoscopic imaging. Multi-channel microendoscopy provides a potentially low-cost means of simultaneous multiple endoscopic imaging during biological experiments, resulting in reduced animal harm and potentially increasing insight into temporal connections between connected biological systems.
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Affiliation(s)
- Bjorn Paulson
- Biomedical Engineering Research Center, Asan Institute for Life Science, Asan Medical Center, Seoul 05505, Republic of Korea
| | - Saeed Bohlooli Darian
- Department of Convergence Medicine, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Youngkyu Kim
- Department of Convergence Medicine, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Jeongmin Oh
- Department of Convergence Medicine, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Marjan Ghasemi
- Department of Physics, Yonsei University, Seoul 03722, Republic of Korea
| | - Kwanhee Lee
- Department of Convergence Medicine, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Jun Ki Kim
- Biomedical Engineering Research Center, Asan Institute for Life Science, Asan Medical Center, Seoul 05505, Republic of Korea
- Department of Convergence Medicine, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
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Youness HA, Harris K, Awab A, Keddissi JI. Bronchoscopic advances in the management of aerodigestive fistulas. J Thorac Dis 2018; 10:5636-5647. [PMID: 30416814 DOI: 10.21037/jtd.2018.05.44] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Malignant aerodigestive fistula (ADF) is an uncommon condition complicating thoracic malignancies. It results in increased morbidity and mortality and warrants therapeutic intervention. The management approach depends on symptoms, configuration, location, and extent of the fistula. This article will discuss the therapeutic considerations in the management of ADF.
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Affiliation(s)
- Houssein A Youness
- Oklahoma City VA Health Care system, Oklahoma City, OK, USA.,University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Kassem Harris
- Interventional Pulmonary Section, Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
| | - Ahmed Awab
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Jean I Keddissi
- Oklahoma City VA Health Care system, Oklahoma City, OK, USA.,University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Kim KY, Tsauo J, Song HY, Kim PH, Park JH. Self-Expandable Metallic Stent Placement for the Palliation of Esophageal Cancer. J Korean Med Sci 2017; 32:1062-1071. [PMID: 28581260 PMCID: PMC5461307 DOI: 10.3346/jkms.2017.32.7.1062] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 04/10/2017] [Indexed: 12/20/2022] Open
Abstract
Esophageal stents have been used to palliate patients with dysphagia caused by esophageal cancer. Early rigid plastic prostheses have been associated with a high risk of complications. However, with the development of self-expanding stents, it has developed into a widely accepted method for treating malignant esophageal strictures and esophagorespiratory fistulas (ERFs). The present review covers various aspects of self-expanding metallic stent placement for palliating esophageal cancer, including its types, placement procedures, indications, contraindications, complications, and some of innovations that will become available in the future.
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Affiliation(s)
- Kun Yung Kim
- Department of Radiology and Research Institute of Radiology, Asan Institute for Life Sciences, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jiaywei Tsauo
- Department of Radiology and Research Institute of Radiology, Asan Institute for Life Sciences, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ho Young Song
- Department of Radiology and Research Institute of Radiology, Asan Institute for Life Sciences, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Pyeong Hwa Kim
- Department of Radiology and Research Institute of Radiology, Asan Institute for Life Sciences, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jung Hoon Park
- Department of Radiology and Research Institute of Radiology, Asan Institute for Life Sciences, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
- Biomedical Engineering Center, Asan Institute for Life Sciences, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Silon B, Siddiqui AA, Taylor LJ, Arastu S, Soomro A, Adler DG. Endoscopic Management of Esophagorespiratory Fistulas: A Multicenter Retrospective Study of Techniques and Outcomes. Dig Dis Sci 2017; 62:424-431. [PMID: 28012101 DOI: 10.1007/s10620-016-4390-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 11/22/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS Esophagorespiratory fistulas (ERF) are a devastating complication of benign and malignant etiologies. ERF are associated with high mortality, short survival, and poor quality of life. We performed a multicenter analysis of patients with ERF undergoing endoscopic treatment. METHODS Multicentre retrospective study. RESULTS We analyzed 25 patients undergoing 35 procedures over an 8-year period. Our data showed high technical success rates (97.1% of procedures) and with good, but not ideal, clinical success rates (60% of procedures, 80% of patients), which were defined as fistula closure confirmed by radiographic or repeat endoscopic evaluation and/or a lack of recurrent episodes of clinical aspiration to focus on durable ERF closure as opposed to only initial success. Proximal ERF were the most difficult to manage with the lowest overall clinical success rates, highest rates of recurrent aspiration despite endoscopic therapy, highest adverse events, and shortest survival times. Adverse events occurred in 40.0% of our patients and were all minor. Treatment allowed for diet advancement in 75% of patients. CONCLUSION This represents the largest recent collection of US data and the first multicenter study evaluating the clinical success of multiple treatment modalities while stratifying data by fistula etiology and esophageal location. The endoscopic approaches detailed in this study offer a minimally invasive and safe choice for intervention with the potential to improve quality of life despite overall suboptimal clinical success and survivorship rates for in with ERF.
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Affiliation(s)
- Bryan Silon
- Gastroenterology and Hepatology, Huntsman Cancer Center, University of Utah School of Medicine, 30N 1900E 4R118, Salt Lake City, UT, 84132, USA
| | - Ali A Siddiqui
- Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, PA, USA
| | - Linda Jo Taylor
- Gastroenterology and Hepatology, Huntsman Cancer Center, University of Utah School of Medicine, 30N 1900E 4R118, Salt Lake City, UT, 84132, USA
| | - Sanaa Arastu
- Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, PA, USA
| | - Ammara Soomro
- Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, PA, USA
| | - Douglas G Adler
- Gastroenterology and Hepatology, Huntsman Cancer Center, University of Utah School of Medicine, 30N 1900E 4R118, Salt Lake City, UT, 84132, USA.
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