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Hatayama Y, Ishigami H, Kamezaki H, Murakami D, Shima Y, Ishikawa K, Sugiyama H, Nishino T, Arai M. Efficacy of palliative stenting in patients with esophageal obstruction attributable to malignancy. DEN OPEN 2025; 5:e70120. [PMID: 40271450 PMCID: PMC12014853 DOI: 10.1002/deo2.70120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2024] [Revised: 04/06/2025] [Accepted: 04/06/2025] [Indexed: 04/25/2025]
Abstract
BACKGROUND Self-expandable metallic stent (SEMS) placement is useful for patients with poor oral intake caused by esophageal stricture attributable to malignancy. In this study, we examined the usefulness of esophageal SEMS placement as a palliative treatment and evaluated the prognostic factors. MATERIALS AND METHODS Patients who underwent esophageal SEMS placement at three regional base hospitals from December 2007 to June 2023 were included in the study. RESULTS Of 73 patients, 57 patients who underwent palliative SEMS placement were evaluated after excluding 16 patients in whom postoperative treatment was possible after SEMS placement. Median survival after SEMS placement was 67 days (mean, 96 ± 16 days). Univariate analysis identified age (≤78 years vs. >78 years), performance status (3 or 4 vs. 1 or 2), the cancer location (other sites vs. gastrointestinal cancer), the resumption of oral intake (failure vs. success), and clinical stage (IVA/IVB vs. III) as prognostic factors after SEMS placement. On multivariate analysis, performance status 3 or 4 (odds ratio [OR] = 2.87, 95% confidence interval [CI] = 1.28-6.45), cancers other than gastrointestinal cancer (OR = 3.75, 95% CI = 1.14-12.3), and failure to resume oral intake (OR = 21.3, 95% CI = 3.40-133.0) were significantly associated with poor prognosis. CONCLUSIONS Palliative treatment with SEMS placement was safe, and a high percentage of patients resumed food intake. An inability to resume food intake, poor performance status, and cancer outside the gastrointestinal tract were poor prognostic factors.
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Affiliation(s)
- Yasuki Hatayama
- Department of GastroenterologyTokyo Women's Medical University Yachiyo Medical CenterChibaJapan
| | | | - Hidehiro Kamezaki
- Department of GastroenterologyEastern Chiba Medical CenterChibaJapan
| | - Daisuke Murakami
- Department of GastroenterologyTokyo Women's Medical University Yachiyo Medical CenterChibaJapan
| | - Yukiko Shima
- Department of GastroenterologyTokyo Women's Medical University Yachiyo Medical CenterChibaJapan
| | - Kentaro Ishikawa
- Department of GastroenterologyTokyo Women's Medical University Yachiyo Medical CenterChibaJapan
| | - Harutoshi Sugiyama
- Department of GastroenterologyTokyo Women's Medical University Yachiyo Medical CenterChibaJapan
| | - Takayoshi Nishino
- Department of GastroenterologyTokyo Women's Medical University Yachiyo Medical CenterChibaJapan
| | - Makoto Arai
- Department of GastroenterologyTokyo Women's Medical University Yachiyo Medical CenterChibaJapan
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Kubota Y, Nishiyama R, Sasaki M, Sakabe Y, Doi K, Kitagawa H, Kikuchi H, Kusano C. Fixation of an esophageal stent using a novel re-openable endoclip for a tracheoesophageal fistula. DEN OPEN 2024; 4:e342. [PMID: 38434147 PMCID: PMC10908370 DOI: 10.1002/deo2.342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 01/20/2024] [Accepted: 01/31/2024] [Indexed: 03/05/2024]
Abstract
Although esophageal stenting is one treatment option as a palliative treatment for tracheoesophageal fistulas, serious complications are associated with stent migration. Some reports have described stent fixation using various devices to prevent stent migration. However, these have yet to be sufficiently examined. We performed esophageal stent fixation using the MANTIS Clip (Boston Scientific), a novel re-openable endoclip. An 89-year-old man developed a tracheoesophageal fistula after radiotherapy for esophageal squamous cell carcinoma. Esophageal stenting was considered because the patient had difficulty with oral intake. However, the patient had a mild stenosis, which suggested stent migration. Therefore, we performed esophageal stent fixation by grasping the mouth side of the stent and the normal mucosa of the esophagus with the MANTIS Clip after placement of the stent. The esophageal stent closed the fistula, and the patient was able to take food orally. Upper gastrointestinal endoscopy performed 3 weeks after stenting showed residual MANTIS Clip and no evidence of stent migration. Esophageal stent fixation with MANTIS clips for tracheoesophageal fistulas may be an option to prevent stent migration.
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Affiliation(s)
- Yo Kubota
- Department of GastroenterologyHiratsuka Kyosai HospitalFederation of National Public Service Personnel Mutual Aid AssociationsKanagawaJapan
| | - Ryu Nishiyama
- Department of GastroenterologyHiratsuka Kyosai HospitalFederation of National Public Service Personnel Mutual Aid AssociationsKanagawaJapan
| | - Masaya Sasaki
- Department of GastroenterologyHiratsuka Kyosai HospitalFederation of National Public Service Personnel Mutual Aid AssociationsKanagawaJapan
| | - Yuta Sakabe
- Department of GastroenterologyHiratsuka Kyosai HospitalFederation of National Public Service Personnel Mutual Aid AssociationsKanagawaJapan
| | - Kusutaro Doi
- Department of GastroenterologyHiratsuka Kyosai HospitalFederation of National Public Service Personnel Mutual Aid AssociationsKanagawaJapan
| | - Hiroyuki Kitagawa
- Department of GastroenterologyHiratsuka Kyosai HospitalFederation of National Public Service Personnel Mutual Aid AssociationsKanagawaJapan
| | - Hidehiko Kikuchi
- Department of GastroenterologyHiratsuka Kyosai HospitalFederation of National Public Service Personnel Mutual Aid AssociationsKanagawaJapan
| | - Chika Kusano
- Department of GastroenterologyKitasato University School of MedicineKanagawaJapan
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Tokura J, Yoshio T, Hayashi S, Yamamoto M, Asai S, Yakushijin T, Ikezawa K, Nagaike K, Takagi T, Fujisawa T, Yamada T, Tsumura H, Maetani I, Hori Y, Ihara H, Matsunaga K, Kuwai T, Ito Y, Hasatani K, Komeda Y, Kurita A, Yamaguchi S, Maruyama H, Iwashita T, Takenaka M, Hosono M, Nishida T. Medical radiation exposure during gastrointestinal enteral metallic stent placement: Post hoc analysis of the REX-GI study. JGH Open 2023; 7:869-874. [PMID: 38162840 PMCID: PMC10757487 DOI: 10.1002/jgh3.12993] [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: 08/01/2023] [Accepted: 10/16/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND AND AIM Recently, the use of various endoscopic procedures performed under X-ray fluoroscopy guidance has increased. With the popularization of such procedures, diagnostic reference levels (DRLs) have been widely accepted as the global standard for various procedures with ionizing radiation. The Radiation Exposure from Gastrointestinal Fluoroscopic Procedures (REX-GI) study aimed to prospectively collect actual radiation exposure (RE) data and establish DRLs in gastrointestinal endoscopy units. In this post hoc analysis of the REX-GI study, we established DRLs for each disease site by analyzing cases of gastrointestinal enteral metallic stent placement. METHODS The REX-GI study was a multicenter, prospective observational study conducted to collect actual RE data during gastrointestinal enteral metallic stent placement. To establish DRL values for three disease sites, namely the esophagus, gastroduodenum, and colon, we examined fluoroscopy time (FT; min), number of X-ray images, air kerma at the patient entrance reference point (K a,r; mGy), and the air kerma-area product (P KA; Gy cm2) during enteral metallic stent placement. RESULTS Five-hundred and twenty-three stenting procedures were performed. The DRL values of FT (min) and the number of X-ray images for the esophagus/gastroduodenum/colon were 9/16/18 min and 9/15/11 min, respectively. Furthermore, the DRL values of K a,r and P KA for each disease site were 43.3/120/124 mGy and 10.3/36.6/48.4 Gy cm2, respectively. Among the procedures, esophageal stents were significantly associated with the lowest values (P < 0.001). CONCLUSION The characteristics of RE vary according to disease site among gastrointestinal enteral metallic stent placements. Thus, it is desirable to set DRL values based on the disease site.
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Affiliation(s)
- Junki Tokura
- Department of GastroenterologyCancer Institute Hospital, Japanese Foundation for Cancer ResearchTokyoJapan
| | - Toshiyuki Yoshio
- Department of GastroenterologyCancer Institute Hospital, Japanese Foundation for Cancer ResearchTokyoJapan
| | - Shiro Hayashi
- Department of Gastroenterology and Internal MedicineHayashi ClinicSuitaJapan
- Department of GastroenterologyToyonaka Municipal HospitalToyonakaJapan
| | - Masashi Yamamoto
- Department of GastroenterologyToyonaka Municipal HospitalToyonakaJapan
| | - Satoshi Asai
- Department of GastroenterologyTane General HospitalOsakaJapan
| | - Takayuki Yakushijin
- Department of Gastroenterology and HepatologyOsaka General Medical CenterOsakaJapan
| | - Kenji Ikezawa
- Department of Hepatobiliary and Pancreatic OncologyOsaka International Cancer InstituteOsakaJapan
| | - Koji Nagaike
- Department of Gastroenterology and HepatologySuita Municipal HospitalOsakaJapan
| | - Tadayuki Takagi
- Department of Gastroenterology, Fukushima Medical University School of MedicineFukushimaJapan
| | - Toshio Fujisawa
- Department of GastroenterologyGraduate School of Medicine, Juntendo UniversityTokyoJapan
| | - Takuya Yamada
- Department of Gastroenterology and HepatologyOsaka Rosai HospitalSakaiJapan
| | - Hidetaka Tsumura
- Department of Gastroenterological OncologyHyogo Cancer CenterAkashiJapan
| | - Iruru Maetani
- Division of Gastroenterology and Hepatology, Department of Internal MedicineToho University Ohashi Medical CenterTokyoJapan
| | - Yasuki Hori
- Department of Gastroenterology and MetabolismNagoya City University Graduate School of Medical SciencesNagoyaJapan
| | - Hideyuki Ihara
- Department of GastroenterologyTonan HospitalSapporoJapan
| | - Kazuhiro Matsunaga
- Department of GastroenterologyIshikawa Prefectural Central HospitalKanazawaJapan
| | - Toshio Kuwai
- Department of Gastroenterology, National Hospital OrganizationKure Medical Center and Chugoku Cancer CenterKureJapan
| | - Yukiko Ito
- Department of GastroenterologyJapanese Red Cross Medical CenterTokyoJapan
| | - Kenkei Hasatani
- Department of GastroenterologyFukui Prefectural HospitalFukuiJapan
| | - Yoriaki Komeda
- Department of Gastroenterology and Hepatology, Faculty of MedicineKindai UniversityŌsakasayamaJapan
| | - Akira Kurita
- Department of Gastroenterology and HepatologyDigestive Disease Center, Kitano Hospital, Tazuke Kofukai Medical Research InstituteOsakaJapan
| | - Shinjiro Yamaguchi
- Department of Gastroenterology and HepatologyKansai Rosai HospitalAmagasakiJapan
| | - Hirotsugu Maruyama
- Department of GastroenterologyOsaka City University Graduate School of MedicineOsakaJapan
| | - Takuji Iwashita
- First Department of Internal MedicineGifu University HospitalGifuJapan
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Faculty of MedicineKindai UniversityŌsakasayamaJapan
| | - Makoto Hosono
- Department of Gastroenterology and Hepatology, Faculty of MedicineKindai UniversityŌsakasayamaJapan
| | - Tsutomu Nishida
- Department of GastroenterologyToyonaka Municipal HospitalToyonakaJapan
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Izumi A, Yoshio T, Sasaki T, Ishioka M, Kizawa A, Ikenoyama Y, Namikawa K, Tokai Y, Yoshimizu S, Horiuchi Y, Ishiyama A, Hirasawa T, Chin K, Ogura M, Sasahira N, Fujisaki J. Efficacy and Safety of Self-Expandable Metallic Stent Placement for Malignant Esophageal Fistula. J Clin Med 2023; 12:5859. [PMID: 37762800 PMCID: PMC10532036 DOI: 10.3390/jcm12185859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/25/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Patients with malignant esophageal fistulas often experience dysphagia and infection, resulting in poor prognoses. Self-expandable metallic stent (SEMS) placement is a palliative treatment option; however, its efficacy and safety are unclear. We aimed to determine the efficacy and safety of SEMS placement for malignant esophageal fistulas. We retrospectively investigated patients who underwent SEMS placement for malignant esophageal fistulas between 2013 and 2022 at the Cancer Institute Hospital. Dysphagia scores (DSs) before and after SEMS placement, adverse events, and overall survival from SEMS placement until death were evaluated. A total of 17 patients underwent SEMS placement, including 12 and 5 patients with esophageal and lung cancers, respectively. Prior treatments included chemoradiotherapy (n = 11), radiotherapy (n = 4), and chemotherapy (n = 4); two patients underwent palliative radiotherapy after chemotherapy. All procedures were technically successful. After SEMS placement, 14 (82.4%) patients were able to consume semisolid or solid food (DS ≤ 2). Major adverse events were encountered in only one case. The median survival time after SEMS placement was 71 days (range 17-247 days). SEMS placement allowed most patients to resume oral intake with a low rate of major adverse events. SEMS placement is a reasonable palliative treatment option for patients with malignant fistulas who have poor prognoses.
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Affiliation(s)
- Atsuko Izumi
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (A.I.); (M.I.); (A.K.); (Y.I.); (K.N.); (Y.T.); (S.Y.); (Y.H.); (A.I.); (T.H.); (J.F.)
| | - Toshiyuki Yoshio
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (A.I.); (M.I.); (A.K.); (Y.I.); (K.N.); (Y.T.); (S.Y.); (Y.H.); (A.I.); (T.H.); (J.F.)
| | - Takashi Sasaki
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (T.S.); (N.S.)
| | - Mitsuaki Ishioka
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (A.I.); (M.I.); (A.K.); (Y.I.); (K.N.); (Y.T.); (S.Y.); (Y.H.); (A.I.); (T.H.); (J.F.)
- Shinagawa Gut Clinic, Tokyo 108-0074, Japan
| | - Atsuko Kizawa
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (A.I.); (M.I.); (A.K.); (Y.I.); (K.N.); (Y.T.); (S.Y.); (Y.H.); (A.I.); (T.H.); (J.F.)
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Yohei Ikenoyama
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (A.I.); (M.I.); (A.K.); (Y.I.); (K.N.); (Y.T.); (S.Y.); (Y.H.); (A.I.); (T.H.); (J.F.)
| | - Ken Namikawa
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (A.I.); (M.I.); (A.K.); (Y.I.); (K.N.); (Y.T.); (S.Y.); (Y.H.); (A.I.); (T.H.); (J.F.)
| | - Yoshitaka Tokai
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (A.I.); (M.I.); (A.K.); (Y.I.); (K.N.); (Y.T.); (S.Y.); (Y.H.); (A.I.); (T.H.); (J.F.)
| | - Shoichi Yoshimizu
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (A.I.); (M.I.); (A.K.); (Y.I.); (K.N.); (Y.T.); (S.Y.); (Y.H.); (A.I.); (T.H.); (J.F.)
| | - Yusuke Horiuchi
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (A.I.); (M.I.); (A.K.); (Y.I.); (K.N.); (Y.T.); (S.Y.); (Y.H.); (A.I.); (T.H.); (J.F.)
| | - Akiyoshi Ishiyama
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (A.I.); (M.I.); (A.K.); (Y.I.); (K.N.); (Y.T.); (S.Y.); (Y.H.); (A.I.); (T.H.); (J.F.)
| | - Toshiaki Hirasawa
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (A.I.); (M.I.); (A.K.); (Y.I.); (K.N.); (Y.T.); (S.Y.); (Y.H.); (A.I.); (T.H.); (J.F.)
| | - Keisho Chin
- Department of Gastroenterological Chemotherapy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (K.C.); (M.O.)
| | - Mariko Ogura
- Department of Gastroenterological Chemotherapy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (K.C.); (M.O.)
| | - Naoki Sasahira
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (T.S.); (N.S.)
| | - Junko Fujisaki
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (A.I.); (M.I.); (A.K.); (Y.I.); (K.N.); (Y.T.); (S.Y.); (Y.H.); (A.I.); (T.H.); (J.F.)
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