AIM: To clarify the usefulness of the self-expanding metallic stents (SEMS) in the management of acute proximal colon obstruction due to colon carcinoma before curative surgery.METHODS: Eighty-one colon (proximal to s...AIM: To clarify the usefulness of the self-expanding metallic stents (SEMS) in the management of acute proximal colon obstruction due to colon carcinoma before curative surgery.METHODS: Eighty-one colon (proximal to spleen flex) carcinoma patients (47 males and 34 females,aged 18-94 years,mean = 66.2 years) treated between September 2004 and June 2010 for acute colon obstruction were enrolled to this study,and their clinical and radiological features were reviewed.After a cleaning enema was administered,urgent colonoscopy was performed.Subsequently,endoscopic decompression using SEMS placement was attempted.RESULTS: Endoscopic decompression using SEMS placement was technically successful in 78 (96.3%) of 81 patients.Three patients’ symptoms could not be relieved after SEMS placement and emergent operation was performed 1 d later.The site of obstruction was transverse colon in 18 patients,the hepatic flex in 42,and the ascending colon in 21.Following adequate cleansing of the colon,patients’ abdominal girth was decreased from 88 ± 3 cm before drainage to 72 ± 6 cm 7 d later,and one-stage surgery after 8 ± 1 d (range,7-10 d) was performed.No anastomotic leakage or postoperative stenosis occurred after operation.CONCLUSION: SEMS placement is effective and safe in the management of acute proximal colon obstruction due to colon carcinoma,and is considered as a bridged method before curative surgery.展开更多
AIM: To compare the efficacy of self-expanding metallic stents (SEMSs) for the long-term clinical treatment of achalasia. METHODS: Ninety achalasic patients were treated with a temporary SEMS with a diameter of 20 mm ...AIM: To compare the efficacy of self-expanding metallic stents (SEMSs) for the long-term clinical treatment of achalasia. METHODS: Ninety achalasic patients were treated with a temporary SEMS with a diameter of 20 mm (n = 30, group A), 25 mm (n = 30, group B) or 30 mm (n = 30, group C). Data on clinical symptoms, complications and treatment outcomes were collected, and follow-up was made at 6 mo and at 1, 3-5, 5-8, 8-10 and > 10 years, postoperatively.RESULTS: Stent placement was successful in all patients. Although chest pain occurrence was high, stent migration was less in group C than in groups A and B. The clinical remission rate at 5-8, 8-10 and > 10 years in group C was higher than that in the other two groups. The treatment failure rate was lower in group C (13%) than in groups A (53%) and B (27%). SEMSs in group C resulted in reduced dysphagia scores and lowered esophageal sphincter pressures, as well as normal levels of barium height and width during all the follow-up time periods. Conversely, these parameters increased over time in groups A and B. The primary patency in group C was longer than in groups A and B. CONCLUSION: A temporary SEMS with a diameter of 30 mm is associated with a superior long-term clinical efficacy in the treatment of achalasia compared with a SEMS with a diameter of 20 mm or 25 mm.展开更多
AIM:To investigate the clinical safety and efficacy of a temporary self-expanding metallic stent(SEMS) for malignant colorectal obstruction.METHODS:From September 2007 to June 2012,33 patients with malignant colorecta...AIM:To investigate the clinical safety and efficacy of a temporary self-expanding metallic stent(SEMS) for malignant colorectal obstruction.METHODS:From September 2007 to June 2012,33 patients with malignant colorectal obstruction were treated with a temporary SEMS.The stent had a tubular configuration with a retrieval lasso attached inside the proximal end of the stent to facilitate its removal.The SEMS was removed one week after placement.Clinical examination,abdominal X-ray and a contrast study were prospectively performed and both initial and follow-up data before and at 1 d,1 wk,and 1 mo,3 mo,6 mo and 12 mo after stent placement were obtained.Data collected on the technical and clinical success of the procedures,complications,need for reinsertion and survival were analyzed.RESULTS:Stent placement and removal were technically successful in all patients with no procedurerelated complications.Post-procedural complications included stent migration(n = 2) and anal pain(n = 2).Clinical success was achieved in 31(93.9%) of 33 patients with resolution of bowel obstruction within 3 d of stent removal.Eleven of the 33 patients died 73.81 ± 23.66 d(range 42-121 d) after removal of the stent without colonic re-obstruction.Clinical success was achieved in another 8 patients without symptoms of obstruction during the follow-up period.Reinsertion of the stent was performed in the remaining 12 patients with re-obstruction after 84.33 ± 51.80 d of follow-up.The mean and median periods of relief of obstructive symptoms were 97.25 ± 9.56 d and 105 ± 17.43 d,respectively,using Kaplan-Meier analysis.CONCLUSION:Temporary SEMS is a safe and effective approach in patients with malignant colorectal obstruction due to low complication rates and good medium-term outcomes.展开更多
BACKGROUND The treatment of difficult common bile duct stones(CBDS)remains a big challenge around the world.Biliary stenting is a widely accepted rescue method in patients with failed stone extraction under endoscopic...BACKGROUND The treatment of difficult common bile duct stones(CBDS)remains a big challenge around the world.Biliary stenting is a widely accepted rescue method in patients with failed stone extraction under endoscopic retrograde cholangiopancreatography.Fully covered self-expanding metal stent(FCSEMS)has gained increasing attention in the management of difficult CBDS.AIM To manufacture a drug-eluting FCSEMS,which can achieve controlled release of stone-dissolving agents and speed up the dissolution of CBDS.METHODS Customized covered nitinol stents were adopted.Sodium cholate(SC)and disodium ethylene diamine tetraacetic acid(EDTA disodium,EDTA for short)were used as stone-dissolving agents.Three different types of drug-eluting stents were manufactured by dip coating(Stent I),coaxial electrospinning(Stent II),and dip coating combined with electrospinning(Stent III),respectively.The drugrelease behavior and stone-dissolving efficacy of these stents were evaluated in vitro to sort out the best manufacturing method.And the selected stonedissolving stents were further put into porcine CBD to evaluate their biosecurity.RESULTS Stent I and Stent II had obvious burst release of drugs in the first 5 d while Stent III presented controlled and sustainable drug release for 30 d.In still buffer,the final stone mass-loss rate of each group was 5.19%±0.69%for naked FCSEMS,20.37%±2.13%for Stent I,24.57%±1.45%for Stent II,and 33.72%±0.67%for Stent III.In flowing bile,the final stone mass-loss rate of each group was 5.87%±0.25%for naked FCSEMS,6.36%±0.48%for Stent I,6.38%±0.37%for Stent II,and 8.15%±0.27%for Stent III.Stent III caused the most stone mass-loss no matter in still buffer or in flowing bile,which was significantly higher than those of other groups(P<0.05).In vivo,Stent III made no difference from naked FCSEMS in serological analysis(P>0.05)and histopathological examination(P>0.05).CONCLUSION The novel SC and EDTA-eluting FCSEMS is efficient in diminishing CBDS in vitro.When conventional endoscopic techniques fail to remove difficult CBDS,SC and EDTA-eluting FCSEMS implantation may be considered a promising alternative.展开更多
AIM To evaluate the efficacy of self-expanding metal stents(SEMS) for the palliation of malignant gastric outlet obstruction in patients with and without peritoneal carcinomatosis(PC).METHODS We performed a retrospect...AIM To evaluate the efficacy of self-expanding metal stents(SEMS) for the palliation of malignant gastric outlet obstruction in patients with and without peritoneal carcinomatosis(PC).METHODS We performed a retrospective analysis of 62 patients who underwent SEMS placement for treatment of malignant gastroduodenal obstruction at our hospital over a six-year period. Stents were deployed through the scope under combined fluoroscopic and endoscopic guidance. Technical success was defined as successful stent placement and expansion. Clinical success was defined as an improvement in the obstructive symptoms and discharge from hospital without additional parenteral nutrition. According to carcinomatosis status, patients were assigned into groups with or without evidence of peritoneal disease.RESULTS In most cases, obstruction was caused by pancreatic(47%) or gastric cancer(23%). Technical success was achieved in 96.8%(60/62), clinical success in 79%(49/62) of all patients. Signs of carcinomatosis were identified in 27 patients(43.5%). The diagnosis was confirmed by pathology or previous operation in 7 patients(11.2%) and suspected by CT, MRI or ultrasound in 20 patients(32.2%). Presence of carcinomatosis was associated with a significantly lower clinical success rate compared to patients with no evidence of peritoneal disease(66.7% vs 88.6%, P = 0.036). There was no significant difference in overall survival between patients with or without PC(median 48 d vs 70 d, P = 0.21), but patients showed significantly longer survival after clinical success of SEMS placement compared to those experiencing clinical failure(median 14.5 d vs 75 d, P = 0.0003).CONCLUSION Given the limited therapeutic options and a clinical success rate of at least 66.7%, we believe that SEMS are a reasonable treatment option in patients with malignant gastric outlet obstruction with peritoneal carcinomatosis.展开更多
Biliary fully covered self-expanding metal stents (FCSEMS) are now being used to treat several benign biliary conditions. Advantages include small predeployment and large postexpansion diameters in addition to an easy...Biliary fully covered self-expanding metal stents (FCSEMS) are now being used to treat several benign biliary conditions. Advantages include small predeployment and large postexpansion diameters in addition to an easy insertion technique. Lack of imbedding of the metal into the bile duct wall enables removability. In benign biliary strictures that usually require multiple procedures, despite the substantially higher cost of FCSEMS compared with plastic stents, the use of FCSEMS is offset by the reduced number of endoscopic retrograde cholangiopancreatography interventions required to achieve stricture resolution. In the same way, FCSEMS have also been employed to treat complex bile leaks, perforation and bleeding after endoscopic biliary sphincterotomy and as an aid to maintain permanent drainage tracts obtained by means of Endoscopic Ultrasound-guided biliary drainage. Good success rates have been achieved in all these conditions with an acceptable number of complications. FCSEMS were successfully removed in all patients. Comparative studies of FCSEMS and plastic stents are needed to demonstrate efficacy and cost-effectiveness展开更多
BACKGROUND Endoscopic placement of a self-expandable metal stent(SEMS)is a minimally invasive treatment for use in malignant and benign colonic obstruction.However,their widespread use is still limited with a nationwi...BACKGROUND Endoscopic placement of a self-expandable metal stent(SEMS)is a minimally invasive treatment for use in malignant and benign colonic obstruction.However,their widespread use is still limited with a nationwide analysis showing only 5.4%of patients with colon obstruction undergoing stent placement.This underutilization could be due to perceived increase risk of complications with stent placement.AIM To review long-and short-term clinical success of SEMS use for colonic obstruction at our center.METHODS We retrospectively reviewed all the patients who underwent colonic SEMS placement over aeighteen year period (August 2004 through August 2022) at our academic center. Demographicsincluding age, gender, indication (malignant and benign), technical success, clinical success,complications (perforation, stent migration), mortality, and outcomes were recorded.RESULTSSixty three patients underwent colon SEMS over an 18-year period. Fifty-five cases were formalignant indications, 8 were for benign conditions. The benign strictures included diverticulardisease stricturing (n = 4), fistula closure (n = 2), extrinsic fibroid compression (n = 1), and ischemicstricture (n = 1). Forty-three of the malignant cases were due to intrinsic obstruction from primaryor recurrent colon cancer;12 were from extrinsic compression. Fifty-four strictures occurred on theleft side, 3 occurred on the right and the rest in transverse colon. The total malignant case (n = 55)procedural success rate was 95% vs 100% for benign cases (P = 1.0, NS). Overall complication ratewas significantly higher for benign group: Four complications were observed in the malignantgroup (stent migration, restenosis) vs 2 of 8 (25%) for benign obstruction (1-perforation, 1-stentmigration) (P = 0.02). When stratifying complications of perforation and stent migration there wasno significant difference between the two groups (P = 0.14, NS).CONCLUSIONColon SEMS remains a worthwhile option for colonic obstruction related to malignancy and has ahigh procedural and clinical success rate. Benign indications for SEMS placement appear to havesimilar success to malignant. While there appears to be a higher overall complication rate inbenign cases, our study is limited by sample size. When evaluating for perforation alone theredoes not appear to be any significant difference between the two groups. SEMS placement may bea practical option for indications other that malignant obstruction. Interventional endoscopistsshould be aware and discuss the risk for complications in setting of benign conditions. Indicationsin these cases should be discussed in a multi-disciplinary fashion with colorectal surgery.展开更多
We agree that the covered self-expanding metal stents (SEMSs) fare better than the uncovered stents as recurrent dysphagia due to tumor ingrowth is common with uncovered stent. Recent American College of Gastroenterol...We agree that the covered self-expanding metal stents (SEMSs) fare better than the uncovered stents as recurrent dysphagia due to tumor ingrowth is common with uncovered stent. Recent American College of Gastroenterology Practice Guideline on the Role of Esophageal Stents in Benign and Malignant Diseases concludes that SEMSs cannot be routinely recommended in conjunction with chemo-radiation. The comparison of ultraflex and choostent in the Italian study found no difference in the palliation of dysphagia, rate of complications and survival rate.展开更多
Background: Occlusion of self-expanding metal stents(SEMS) in malignant biliary obstruction occurs in up to 40% of patients. This study aimed to compare the different techniques to resolve stent occlusion in our colle...Background: Occlusion of self-expanding metal stents(SEMS) in malignant biliary obstruction occurs in up to 40% of patients. This study aimed to compare the different techniques to resolve stent occlusion in our collective of patients.Methods: Patients with malignant biliary obstruction and occlusion of biliary metal stent at a tertiary referral endoscopic center were retrospectively identified between April 1, 1994 and May 31, 2014. The clinical records were further analyzed regarding the characteristics of patients, malignant strictures, SEMS,management strategies, stent patency, subsequent interventions, survival time and case charges.Results: A total of 108 patients with biliary metal stent occlusion were identified. Seventy-nine of these patients were eligible for further analysis. Favored management was plastic stent insertion in 73.4% patients. Second SEMS were inserted in 12.7% patients. Percutaneous transhepatic biliary drainage and mechanical cleansing were conducted in a minority of patients. Further analysis showed no statistically significant difference in median overall secondary stent patency(88 vs. 143 days, P = 0.069), median survival time(95 vs. 192 days, P = 0.116), median subsequent intervention rate(53.4% vs. 40.0%, P = 0.501)and median case charge(€5145 vs. €3473, P = 0.803) for the treatment with a second metal stent insertion compared to plastic stent insertion. In patients with survival time of more than three months,significantly more patients treated with plastic stents needed re-interventions than patients treated with second SEMS(93.3% vs. 57.1%, P = 0.037).Conclusions: In malignant biliary strictures, both plastic and metal stent insertions are feasible strategies for the treatment of occluded SEMS. Our data suggest that in palliative biliary stenting, patients especially those with longer expected survival might benefit from second SEMS insertion. Careful patient selection is important to ensure a proper decision for either management strategy.展开更多
BACKGROUND There are few reports of a fractured esophageal self-expanding metallic stent(SEMS)and the lasso retrieval technique,forming a guidewire loop by directing the guidewire back up the external stent for retrie...BACKGROUND There are few reports of a fractured esophageal self-expanding metallic stent(SEMS)and the lasso retrieval technique,forming a guidewire loop by directing the guidewire back up the external stent for retrieval.CASE SUMMARY A 74-year-old man complained of dysphagia approximately 6 mo after radical resection of esophageal cancer.Benign anastomotic stenosis was diagnosed,and a 20 mm in diameter and 60 mm in length esophageal covered SEMS was inserted after repeated balloon dilatation.About 13.5 mo after stenting,dysphagia recurred and esophagography showed severe stenosis above the proximal stent and stent removal was performed.One-third of the stent was removed and the fractured stent remained in the proximal esophagus.A suction tube was introduced through the guidewire and then the guidewire was grabbed,acting like a“lasso”on tightening.The remaining fractured stent was successfully removed by slowly pulling back the guidewire,with no fragments of stent wires retained.CONCLUSION The guidewire lasso technique is a simple,effective method of removing esophageal SEMS in rare cases of stent fracture.展开更多
Background: Self-expanding metal stents (SEMS) have been used in the management of malignant colorectal obstruction for palliation or as a bridging tool to single-stage surgery. We present the clinical results of a se...Background: Self-expanding metal stents (SEMS) have been used in the management of malignant colorectal obstruction for palliation or as a bridging tool to single-stage surgery. We present the clinical results of a series of patients with colonic cancer in whom SEMS were inserted endoscopically under radiological guidance. Methods: Between September 2007 and January 2010, prospectively collected data from 21 patients who underwent SEMS insertion was analysed. This data includes demographics, indication for stenting, stent size, technical success, clinical success, complications, survival and duration of hospitalisation. Results: 14 male and 7 female patients with malignant colonic obstruction underwent SEMS insertion: 19 requiring palliation and 2 bridging to surgery. The rate of technical success was 100% and of initial clinical success was 100%. In 16/19 (84.2%) of the palliation group, clinical success was maintained at mean follow up of 3.4 months (1-6 months), while 3/19 (15.8%) died, two with functioning stents and one with stent occlusion. The two patients with operable tumours were successfully bridged to one-stage elective surgery at 1 month and 4 months following stenting. Post-procedure complications occurred in 5 patients: 1 perforation, 2 pain, 1 migration and 1 stent occlusion. All patients were discharged alive and the median hospital stay was 1 day (range: 1 to 13 days). Conclusion: SEMS provides an effective and safe option in the palliation of malignant colorectal obstruction. In operable patients, it provides a useful option to avoid colostomy, by facilitating safer single-stage surgery. In this prospective study of SEMS insertion, high rates of technical and initial clinical success were achieved. This could be attributed to performing the procedure under combined endoscopic and radiological guidance.展开更多
In the report,we describe a case of refractory benign esophageal strictures from esophageal cancer after an operation for the placement of three partially covered self-expanding metal stents (SEMSs),which were all emb...In the report,we describe a case of refractory benign esophageal strictures from esophageal cancer after an operation for the placement of three partially covered self-expanding metal stents (SEMSs),which were all embedded in the esophageal wall.Using the stentin-stent technique,the three embedded SEMSs were successfully removed without significant complications.To the best of our knowledge,few cases of the successful removal of multiple embedded esophageal SEMSs have been reported in the literature.This case also highlights that the stent-in-stent technique is effective for removing multiple embedded esophageal SEMSs.展开更多
Self-expanding metal stent (SEMS) placement offers safe and effective palliation in patients with upper gastrointestinal obstruction due to a malignancy. Well described complications of SEMS placement include tumor gr...Self-expanding metal stent (SEMS) placement offers safe and effective palliation in patients with upper gastrointestinal obstruction due to a malignancy. Well described complications of SEMS placement include tumor growth, obstruction, and stent migration. SEMS occlusions are treated by SEMS redeployment, argon plasma coagulation application, balloon dilation, and surgical bypass. At our center, we usually place the second SEMS into the first SEMS if there is complete occlusion by the tumor. We discovered an unusual complication during SEMS redeployment. The guide-wire passed through the mesh of the first SEMS and caused the second SEMS to become entangled with the first SEMS. This led to the distortion and malfunction of the second SEMS, which worsened the gastric outlet obstruction. For lowering the risk of entanglement, we studied stone extraction balloon-guided repeat SEMS placement. This is the first report of a SEMS entangled by the mesh of the first SEMS and stone extraction balloon-guided repeat SEMS placement for lowering the risk of this complication.展开更多
Self-expanding metallic stents are sometimes placed for the management of obstructing airway lesions or conditions such as airway wall malacia or tracheal stenosis. However, endoscopic removal of these devices from th...Self-expanding metallic stents are sometimes placed for the management of obstructing airway lesions or conditions such as airway wall malacia or tracheal stenosis. However, endoscopic removal of these devices from the airway can pose extreme challenges for both clinical airway management as well as for the administration of general anesthesia. We report on a 61-yearold man with a complex cardiac history presenting for endoscopic stent removal necessitated by the formation of extensive granulation tissue. Comorbidities included a history of myocardial infarction, an ischemic cardiomyopathy with severe left heart failure(ejection fraction of 25%), mild right heart failure, 2+ tricuspid regurgitation status post tricuspid valve repair, and atrial fibrillation. An automatic external(wearable) cardiac defibrillator(Zoll Life Vest) was also in place. Induction of anesthesia was carried out using etomidate, with maintenance of anesthesia carried out with a propofol infusion(total intravenous anesthesia). Rocuronium was used for neuromuscular blockade. A size 4 i Gel supraglottic airway and, later, rigid bronchoscopy formed the basis for airway management. Stable conditions were met through the 2-h procedure, and the patient recovered uneventfully. Our successful experience in this case leads us to propose further use of a supraglottic airway in conjunction with total intravenous anesthesia for these procedures.展开更多
Objective To compare the outcomes after self-expanding metallic stent (SEMS) or transanal drainage tube (TDT) placement in patients with malignant large-bowel obstruction (MLBO). Methods Seventy-three patients with ML...Objective To compare the outcomes after self-expanding metallic stent (SEMS) or transanal drainage tube (TDT) placement in patients with malignant large-bowel obstruction (MLBO). Methods Seventy-three patients with MLBO from the clinical unit underwent SEMS (n = 51) or TDT (n = 22) placement from 2012 to 2017. The success rates of placement, clinical outcomes after decompression, complications, the time to resuming enteral nutrition (EN), Karnofsky performance status (KPS) scoring and the following-up therapeutic options were investigated. Results Technical success were achieved in 100% of patients in both groups. The clinical success rates were 98.0%(50/51) for SEMS and 95.5%(21/22) for TDT. No perforation was found in any group, while 3.9%(2/51) in the SEMS and 18.2%(4/22) in TDT group experienced displacement (P = 0.26). It took 2.1 IQR (0~2) days and 3 IQR (2~5) days to resume EN in the SEMS and TDT groups, respectively (P < 0.001). The KPS scores were significantly higher in patients implanted with SEMS (70, IQR 50~80) than in those with TDT (35, IQR 30~50)(P < 0.001). In the SEMS group, 37.3%(19/51) of patients underwent stenting as a bridge to surgery, 9.8%(5/51) for chemotherapy only and 52.9%(27/51) for palliation, while 40.9%(9/22), 0 and 59.1%(13/22) underwent placement for these reasons in the TDT group, respectively. The majority (6/9) of the patients who underwent TDT placement as a bridge to surgery required stoma creation, while only 31.6%(6/19) of those in the SEMS group needed a stoma (P = 0.080). In addition, anastomotic leakage was only found in the TDT group (2/9)(P = 0.10). Conclusion Both SEMS and TDT placement could provide clinical relief for MLBO. However, SEMS placement is associated with earlier EN, fewer complications, and benefits for the postoperative quality-of-life.展开更多
AIM:To investigate the clinical advantages of the stent-laparoscopy approach to treat colorectal cancer(CRC)patients with acute colorectal obstruction(ACO).METHODS:From April 2008 to April 2012,surgeryrelated paramete...AIM:To investigate the clinical advantages of the stent-laparoscopy approach to treat colorectal cancer(CRC)patients with acute colorectal obstruction(ACO).METHODS:From April 2008 to April 2012,surgeryrelated parameters,complications,overall survival(OS),and disease-free survival(DFS)of 74 consecutive patients with left-sided CRC presented with ACO who underwent self-expandable metallic stent(SEMS)placement followed by one-stage open(n=58)or laparoscopic resection(n=16)were evaluated retrospectively.The stent-laparoscopy group was also compared with a control group of 96 CRC patients who underwent regular laparoscopy without ACO between January 2010 and December 2011 to explore whether SEMS placement influenced the laparoscopic procedure or reduced long-term survival by influencing CRC oncological characteristics.RESULTS:The characteristics of patients among these groups were comparable.The rate of conversion to open surgery was 12.5%in the stent-laparoscopy group.Bowel function recovery and postoperative hospital stay were significantly shorter(3.3±0.9 d vs 4.2±1.5 d and 6.7±1.1 d vs 9.5±6.7 d,P=0.016 and P=0.005),and surgical time was significantly longer(152.1±44.4 min vs 127.4±38.4 min,P=0.045)in the stent-laparoscopy group than in the stent-open group.Surgery-related complications and the rate of admission to the intensive care unit were lower in the stent-laparoscopy group.There were no significant differences in the interval between stenting and surgery,intraoperative blood loss,OS,and DFS between the two stent groups.Compared with those in the stentlaparoscopy group,all surgery-related parameters,complications,OS,and DFS in the control group were comparable.CONCLUSION:The stent-laparoscopy approach is a feasible,rapid,and minimally invasive option for patients with ACO caused by left-sided CRC and can achieve a favorable long-term prognosis.展开更多
Malignant gastroduodenal obstruction can occur in up to 20%of patients with primary pancreatic,gastric or duodenal carcinomas.Presenting symptoms include nausea,vomiting,abdominal distention,pain and decreased oral in...Malignant gastroduodenal obstruction can occur in up to 20%of patients with primary pancreatic,gastric or duodenal carcinomas.Presenting symptoms include nausea,vomiting,abdominal distention,pain and decreased oral intake which can lead to dehydration, malnutrition,and poor quality of life.Endoscopic stent placement has become the primary therapeutic modality because it is safe,minimally invasive,and a cost-effective option for palliation.Stents can be successfully deployed in the majority of patients. Stent placement appears to lead to a shorter time to symptomatic improvement,shorter time to resumption of an oral diet,and shorter hospital stays as compared with surgical options.Recurrence of the obstructive symptoms resulting from stent occlusion,due to tumor ingrowth or overgrowth,can be successfully treated with repeat endoscopic stent placement in the majority of the cases.Both endoscopic stenting and surgical bypass are considered palliative treatments and,to date,no improvement in survival with either modality has been demonstrated.A tailored therapeutic approach,taking into consideration patient preferences and involving a multidisciplinary team including the therapeutic endoscopist,surgeon,medical oncologist, radiation therapist,and interventional radiologist, should be considered in all cases.展开更多
AIM: To ascertain clinical outcome and complications of self-expandable metal stents for endoscopic palliation of patients with malignant obstruction of the gastrointestinal (GI) tract. METHODS: A retrospective review...AIM: To ascertain clinical outcome and complications of self-expandable metal stents for endoscopic palliation of patients with malignant obstruction of the gastrointestinal (GI) tract. METHODS: A retrospective review was performed throughout August 2000 to June 2005 of 53 patients with gastric outlet obstruction caused by stomach cancer. All patients had symptomatic obstruction including nausea, vomiting, and decreased oral intake. All received self-expandable metallic stents. RESULTS: Stent implantation was successful in all 53 (100%) patients. Relief of obstructive symptoms was achieved in 43 (81.1%) patients. No immediate stent-related complications were noted. Seventeen patients had recurrent obstruction (tumor ingrowth in 14 patients, tumor overgrowth in 1 patient, and partial distal stent migration in 2 patients). The mean survival was 145 d. Median stent patency time was 187 d. CONCLUSION: Endoscopic placement of self-expandable metallic stents is a safe and effective treatment for the palliation of patients with inoperable malignant gastric outlet obstruction caused by stomach cancer.展开更多
To evaluate the safety and efficacy of limited endoscopic sphincterotomy (ES) before placement of self-expandable metal stent (SEMS).METHODSThis was a retrospective analysis of 244 consecutive patients with unresectab...To evaluate the safety and efficacy of limited endoscopic sphincterotomy (ES) before placement of self-expandable metal stent (SEMS).METHODSThis was a retrospective analysis of 244 consecutive patients with unresectable malignant biliary obstruction, who underwent placement of SEMSs following limited ES from December 2008 to February 2015. The diagnosis of malignant biliary obstruction and assessment of patient eligibility for the study was established by a combination of clinical findings, laboratory investigations, imaging and pathological results. All patients were monitored in the hospital for at least 24 h following endoscopic retrograde cholangio pancreatography (ERCP). The incidence of immediate or early post-ERCP complications such as post-ERCP pancreatitis (PEP) and bleeding related to limited ES were considered as primary outcomes. Also, characteristics and complications according to the cancer type were classified.RESULTSAmong the 244 patients included, the underlying diagnosis was cholangiocarcinoma in 118 patients, pancreatic cancer in 79, and non-pancreatic or non-biliary malignancies in the remaining 47 patients. Early post-ERCP complications occurred in 9 patients (3.7%), with PEP in 7 patients (2.9%; mild, 6; moderate, 1) and mild bleeding in 2 patients (0.8%). There was no significant association between the incidence of post-ERCP complications and the type of malignancy (cholangiocarcinoma vs pancreatic cancer vs others, P = 0.696) or the type of SEMS used (uncovered vs covered, P = 1.000). Patients who had more than one SEMS placed at the first instance were at a significantly higher risk of post-ERCP complications (one SEMS vs two SEMS, P = 0.031). No other factors were predictive of post-ERCP complications.CONCLUSIONLimited ES is feasible and safe, and effectively facilitates the placement of SEMS, without any significant risk of PEP or severe bleeding.展开更多
AIM:To present a series of covered self-expandable metal stents(CSEMS) placed for different indications and to evaluate the effectiveness,complications and extractability of these devices.METHODS:We therefore retrospe...AIM:To present a series of covered self-expandable metal stents(CSEMS) placed for different indications and to evaluate the effectiveness,complications and extractability of these devices.METHODS:We therefore retrospectively reviewed the courses of patients who received CSEMS due to malignant as well as benign biliary strictures and postsphincterotomy bleeding in our endoscopic unit between January 2010 and October 2011.RESULTS:Twenty-six patients received 28 stents due to different indications(20 stents due to malignant biliary strictures,six stents due to benign biliary strictures and two stents due to post-sphincterotomy bleeding).Biliary obstruction was relieved in all cases,regardless of the underlying cause.Hemostasis could be achieved in the two patients who received the stents for this purpose.Complications occurred in five patients(18%).Two patients(7%) developed cholecystitis,stents dislocated/migrated in other two patients(7%),and in one patient(3.6%) stent occlusion was documented during the study period.Seven stents were extracted endoscopically.Removal of stents was easily possible in all cases in which it was desired using standard forceps.Twelve patients underwent surgery with pylorus preserving duodenopancreatectomy.In all patients stents could be removed during the operation without difficulties.CONCLUSION:Despite the higher costs of these devices,fully covered self-expanding metal stents may be suitable to relief biliary obstruction due to bile duct stenosis,regardless of the underlying cause.CSEMS may also represent an effective treatment strategy of severe post-sphincterotomy bleeding,not controlled by other measures.展开更多
基金Supported by Shanghai Science and Technology Committee,No.09411967100Shanghai Municipal Health Bureau,No.2007Y38
文摘AIM: To clarify the usefulness of the self-expanding metallic stents (SEMS) in the management of acute proximal colon obstruction due to colon carcinoma before curative surgery.METHODS: Eighty-one colon (proximal to spleen flex) carcinoma patients (47 males and 34 females,aged 18-94 years,mean = 66.2 years) treated between September 2004 and June 2010 for acute colon obstruction were enrolled to this study,and their clinical and radiological features were reviewed.After a cleaning enema was administered,urgent colonoscopy was performed.Subsequently,endoscopic decompression using SEMS placement was attempted.RESULTS: Endoscopic decompression using SEMS placement was technically successful in 78 (96.3%) of 81 patients.Three patients’ symptoms could not be relieved after SEMS placement and emergent operation was performed 1 d later.The site of obstruction was transverse colon in 18 patients,the hepatic flex in 42,and the ascending colon in 21.Following adequate cleansing of the colon,patients’ abdominal girth was decreased from 88 ± 3 cm before drainage to 72 ± 6 cm 7 d later,and one-stage surgery after 8 ± 1 d (range,7-10 d) was performed.No anastomotic leakage or postoperative stenosis occurred after operation.CONCLUSION: SEMS placement is effective and safe in the management of acute proximal colon obstruction due to colon carcinoma,and is considered as a bridged method before curative surgery.
基金Supported by The National 9th Five-Year Plan Key Medical Research and Development Program of China, No. 96-907-03-04Shanghai Natural Science Funds, No. 02Z1314073+1 种基金Shanghai Medical Development Funds, No. 00419the National Natural Science Foundation of China, No. 30670614 and 30970817
文摘AIM: To compare the efficacy of self-expanding metallic stents (SEMSs) for the long-term clinical treatment of achalasia. METHODS: Ninety achalasic patients were treated with a temporary SEMS with a diameter of 20 mm (n = 30, group A), 25 mm (n = 30, group B) or 30 mm (n = 30, group C). Data on clinical symptoms, complications and treatment outcomes were collected, and follow-up was made at 6 mo and at 1, 3-5, 5-8, 8-10 and > 10 years, postoperatively.RESULTS: Stent placement was successful in all patients. Although chest pain occurrence was high, stent migration was less in group C than in groups A and B. The clinical remission rate at 5-8, 8-10 and > 10 years in group C was higher than that in the other two groups. The treatment failure rate was lower in group C (13%) than in groups A (53%) and B (27%). SEMSs in group C resulted in reduced dysphagia scores and lowered esophageal sphincter pressures, as well as normal levels of barium height and width during all the follow-up time periods. Conversely, these parameters increased over time in groups A and B. The primary patency in group C was longer than in groups A and B. CONCLUSION: A temporary SEMS with a diameter of 30 mm is associated with a superior long-term clinical efficacy in the treatment of achalasia compared with a SEMS with a diameter of 20 mm or 25 mm.
文摘AIM:To investigate the clinical safety and efficacy of a temporary self-expanding metallic stent(SEMS) for malignant colorectal obstruction.METHODS:From September 2007 to June 2012,33 patients with malignant colorectal obstruction were treated with a temporary SEMS.The stent had a tubular configuration with a retrieval lasso attached inside the proximal end of the stent to facilitate its removal.The SEMS was removed one week after placement.Clinical examination,abdominal X-ray and a contrast study were prospectively performed and both initial and follow-up data before and at 1 d,1 wk,and 1 mo,3 mo,6 mo and 12 mo after stent placement were obtained.Data collected on the technical and clinical success of the procedures,complications,need for reinsertion and survival were analyzed.RESULTS:Stent placement and removal were technically successful in all patients with no procedurerelated complications.Post-procedural complications included stent migration(n = 2) and anal pain(n = 2).Clinical success was achieved in 31(93.9%) of 33 patients with resolution of bowel obstruction within 3 d of stent removal.Eleven of the 33 patients died 73.81 ± 23.66 d(range 42-121 d) after removal of the stent without colonic re-obstruction.Clinical success was achieved in another 8 patients without symptoms of obstruction during the follow-up period.Reinsertion of the stent was performed in the remaining 12 patients with re-obstruction after 84.33 ± 51.80 d of follow-up.The mean and median periods of relief of obstructive symptoms were 97.25 ± 9.56 d and 105 ± 17.43 d,respectively,using Kaplan-Meier analysis.CONCLUSION:Temporary SEMS is a safe and effective approach in patients with malignant colorectal obstruction due to low complication rates and good medium-term outcomes.
基金the National Natural Science Foundation of China,No.81470904and Shanghai Committee of Science and Technology,No.14411963000
文摘BACKGROUND The treatment of difficult common bile duct stones(CBDS)remains a big challenge around the world.Biliary stenting is a widely accepted rescue method in patients with failed stone extraction under endoscopic retrograde cholangiopancreatography.Fully covered self-expanding metal stent(FCSEMS)has gained increasing attention in the management of difficult CBDS.AIM To manufacture a drug-eluting FCSEMS,which can achieve controlled release of stone-dissolving agents and speed up the dissolution of CBDS.METHODS Customized covered nitinol stents were adopted.Sodium cholate(SC)and disodium ethylene diamine tetraacetic acid(EDTA disodium,EDTA for short)were used as stone-dissolving agents.Three different types of drug-eluting stents were manufactured by dip coating(Stent I),coaxial electrospinning(Stent II),and dip coating combined with electrospinning(Stent III),respectively.The drugrelease behavior and stone-dissolving efficacy of these stents were evaluated in vitro to sort out the best manufacturing method.And the selected stonedissolving stents were further put into porcine CBD to evaluate their biosecurity.RESULTS Stent I and Stent II had obvious burst release of drugs in the first 5 d while Stent III presented controlled and sustainable drug release for 30 d.In still buffer,the final stone mass-loss rate of each group was 5.19%±0.69%for naked FCSEMS,20.37%±2.13%for Stent I,24.57%±1.45%for Stent II,and 33.72%±0.67%for Stent III.In flowing bile,the final stone mass-loss rate of each group was 5.87%±0.25%for naked FCSEMS,6.36%±0.48%for Stent I,6.38%±0.37%for Stent II,and 8.15%±0.27%for Stent III.Stent III caused the most stone mass-loss no matter in still buffer or in flowing bile,which was significantly higher than those of other groups(P<0.05).In vivo,Stent III made no difference from naked FCSEMS in serological analysis(P>0.05)and histopathological examination(P>0.05).CONCLUSION The novel SC and EDTA-eluting FCSEMS is efficient in diminishing CBDS in vitro.When conventional endoscopic techniques fail to remove difficult CBDS,SC and EDTA-eluting FCSEMS implantation may be considered a promising alternative.
文摘AIM To evaluate the efficacy of self-expanding metal stents(SEMS) for the palliation of malignant gastric outlet obstruction in patients with and without peritoneal carcinomatosis(PC).METHODS We performed a retrospective analysis of 62 patients who underwent SEMS placement for treatment of malignant gastroduodenal obstruction at our hospital over a six-year period. Stents were deployed through the scope under combined fluoroscopic and endoscopic guidance. Technical success was defined as successful stent placement and expansion. Clinical success was defined as an improvement in the obstructive symptoms and discharge from hospital without additional parenteral nutrition. According to carcinomatosis status, patients were assigned into groups with or without evidence of peritoneal disease.RESULTS In most cases, obstruction was caused by pancreatic(47%) or gastric cancer(23%). Technical success was achieved in 96.8%(60/62), clinical success in 79%(49/62) of all patients. Signs of carcinomatosis were identified in 27 patients(43.5%). The diagnosis was confirmed by pathology or previous operation in 7 patients(11.2%) and suspected by CT, MRI or ultrasound in 20 patients(32.2%). Presence of carcinomatosis was associated with a significantly lower clinical success rate compared to patients with no evidence of peritoneal disease(66.7% vs 88.6%, P = 0.036). There was no significant difference in overall survival between patients with or without PC(median 48 d vs 70 d, P = 0.21), but patients showed significantly longer survival after clinical success of SEMS placement compared to those experiencing clinical failure(median 14.5 d vs 75 d, P = 0.0003).CONCLUSION Given the limited therapeutic options and a clinical success rate of at least 66.7%, we believe that SEMS are a reasonable treatment option in patients with malignant gastric outlet obstruction with peritoneal carcinomatosis.
文摘Biliary fully covered self-expanding metal stents (FCSEMS) are now being used to treat several benign biliary conditions. Advantages include small predeployment and large postexpansion diameters in addition to an easy insertion technique. Lack of imbedding of the metal into the bile duct wall enables removability. In benign biliary strictures that usually require multiple procedures, despite the substantially higher cost of FCSEMS compared with plastic stents, the use of FCSEMS is offset by the reduced number of endoscopic retrograde cholangiopancreatography interventions required to achieve stricture resolution. In the same way, FCSEMS have also been employed to treat complex bile leaks, perforation and bleeding after endoscopic biliary sphincterotomy and as an aid to maintain permanent drainage tracts obtained by means of Endoscopic Ultrasound-guided biliary drainage. Good success rates have been achieved in all these conditions with an acceptable number of complications. FCSEMS were successfully removed in all patients. Comparative studies of FCSEMS and plastic stents are needed to demonstrate efficacy and cost-effectiveness
文摘BACKGROUND Endoscopic placement of a self-expandable metal stent(SEMS)is a minimally invasive treatment for use in malignant and benign colonic obstruction.However,their widespread use is still limited with a nationwide analysis showing only 5.4%of patients with colon obstruction undergoing stent placement.This underutilization could be due to perceived increase risk of complications with stent placement.AIM To review long-and short-term clinical success of SEMS use for colonic obstruction at our center.METHODS We retrospectively reviewed all the patients who underwent colonic SEMS placement over aeighteen year period (August 2004 through August 2022) at our academic center. Demographicsincluding age, gender, indication (malignant and benign), technical success, clinical success,complications (perforation, stent migration), mortality, and outcomes were recorded.RESULTSSixty three patients underwent colon SEMS over an 18-year period. Fifty-five cases were formalignant indications, 8 were for benign conditions. The benign strictures included diverticulardisease stricturing (n = 4), fistula closure (n = 2), extrinsic fibroid compression (n = 1), and ischemicstricture (n = 1). Forty-three of the malignant cases were due to intrinsic obstruction from primaryor recurrent colon cancer;12 were from extrinsic compression. Fifty-four strictures occurred on theleft side, 3 occurred on the right and the rest in transverse colon. The total malignant case (n = 55)procedural success rate was 95% vs 100% for benign cases (P = 1.0, NS). Overall complication ratewas significantly higher for benign group: Four complications were observed in the malignantgroup (stent migration, restenosis) vs 2 of 8 (25%) for benign obstruction (1-perforation, 1-stentmigration) (P = 0.02). When stratifying complications of perforation and stent migration there wasno significant difference between the two groups (P = 0.14, NS).CONCLUSIONColon SEMS remains a worthwhile option for colonic obstruction related to malignancy and has ahigh procedural and clinical success rate. Benign indications for SEMS placement appear to havesimilar success to malignant. While there appears to be a higher overall complication rate inbenign cases, our study is limited by sample size. When evaluating for perforation alone theredoes not appear to be any significant difference between the two groups. SEMS placement may bea practical option for indications other that malignant obstruction. Interventional endoscopistsshould be aware and discuss the risk for complications in setting of benign conditions. Indicationsin these cases should be discussed in a multi-disciplinary fashion with colorectal surgery.
文摘We agree that the covered self-expanding metal stents (SEMSs) fare better than the uncovered stents as recurrent dysphagia due to tumor ingrowth is common with uncovered stent. Recent American College of Gastroenterology Practice Guideline on the Role of Esophageal Stents in Benign and Malignant Diseases concludes that SEMSs cannot be routinely recommended in conjunction with chemo-radiation. The comparison of ultraflex and choostent in the Italian study found no difference in the palliation of dysphagia, rate of complications and survival rate.
文摘Background: Occlusion of self-expanding metal stents(SEMS) in malignant biliary obstruction occurs in up to 40% of patients. This study aimed to compare the different techniques to resolve stent occlusion in our collective of patients.Methods: Patients with malignant biliary obstruction and occlusion of biliary metal stent at a tertiary referral endoscopic center were retrospectively identified between April 1, 1994 and May 31, 2014. The clinical records were further analyzed regarding the characteristics of patients, malignant strictures, SEMS,management strategies, stent patency, subsequent interventions, survival time and case charges.Results: A total of 108 patients with biliary metal stent occlusion were identified. Seventy-nine of these patients were eligible for further analysis. Favored management was plastic stent insertion in 73.4% patients. Second SEMS were inserted in 12.7% patients. Percutaneous transhepatic biliary drainage and mechanical cleansing were conducted in a minority of patients. Further analysis showed no statistically significant difference in median overall secondary stent patency(88 vs. 143 days, P = 0.069), median survival time(95 vs. 192 days, P = 0.116), median subsequent intervention rate(53.4% vs. 40.0%, P = 0.501)and median case charge(€5145 vs. €3473, P = 0.803) for the treatment with a second metal stent insertion compared to plastic stent insertion. In patients with survival time of more than three months,significantly more patients treated with plastic stents needed re-interventions than patients treated with second SEMS(93.3% vs. 57.1%, P = 0.037).Conclusions: In malignant biliary strictures, both plastic and metal stent insertions are feasible strategies for the treatment of occluded SEMS. Our data suggest that in palliative biliary stenting, patients especially those with longer expected survival might benefit from second SEMS insertion. Careful patient selection is important to ensure a proper decision for either management strategy.
文摘BACKGROUND There are few reports of a fractured esophageal self-expanding metallic stent(SEMS)and the lasso retrieval technique,forming a guidewire loop by directing the guidewire back up the external stent for retrieval.CASE SUMMARY A 74-year-old man complained of dysphagia approximately 6 mo after radical resection of esophageal cancer.Benign anastomotic stenosis was diagnosed,and a 20 mm in diameter and 60 mm in length esophageal covered SEMS was inserted after repeated balloon dilatation.About 13.5 mo after stenting,dysphagia recurred and esophagography showed severe stenosis above the proximal stent and stent removal was performed.One-third of the stent was removed and the fractured stent remained in the proximal esophagus.A suction tube was introduced through the guidewire and then the guidewire was grabbed,acting like a“lasso”on tightening.The remaining fractured stent was successfully removed by slowly pulling back the guidewire,with no fragments of stent wires retained.CONCLUSION The guidewire lasso technique is a simple,effective method of removing esophageal SEMS in rare cases of stent fracture.
文摘Background: Self-expanding metal stents (SEMS) have been used in the management of malignant colorectal obstruction for palliation or as a bridging tool to single-stage surgery. We present the clinical results of a series of patients with colonic cancer in whom SEMS were inserted endoscopically under radiological guidance. Methods: Between September 2007 and January 2010, prospectively collected data from 21 patients who underwent SEMS insertion was analysed. This data includes demographics, indication for stenting, stent size, technical success, clinical success, complications, survival and duration of hospitalisation. Results: 14 male and 7 female patients with malignant colonic obstruction underwent SEMS insertion: 19 requiring palliation and 2 bridging to surgery. The rate of technical success was 100% and of initial clinical success was 100%. In 16/19 (84.2%) of the palliation group, clinical success was maintained at mean follow up of 3.4 months (1-6 months), while 3/19 (15.8%) died, two with functioning stents and one with stent occlusion. The two patients with operable tumours were successfully bridged to one-stage elective surgery at 1 month and 4 months following stenting. Post-procedure complications occurred in 5 patients: 1 perforation, 2 pain, 1 migration and 1 stent occlusion. All patients were discharged alive and the median hospital stay was 1 day (range: 1 to 13 days). Conclusion: SEMS provides an effective and safe option in the palliation of malignant colorectal obstruction. In operable patients, it provides a useful option to avoid colostomy, by facilitating safer single-stage surgery. In this prospective study of SEMS insertion, high rates of technical and initial clinical success were achieved. This could be attributed to performing the procedure under combined endoscopic and radiological guidance.
基金Supported by Shandong Provincial Science and Technology Committee of China,No.2014GGH218034
文摘In the report,we describe a case of refractory benign esophageal strictures from esophageal cancer after an operation for the placement of three partially covered self-expanding metal stents (SEMSs),which were all embedded in the esophageal wall.Using the stentin-stent technique,the three embedded SEMSs were successfully removed without significant complications.To the best of our knowledge,few cases of the successful removal of multiple embedded esophageal SEMSs have been reported in the literature.This case also highlights that the stent-in-stent technique is effective for removing multiple embedded esophageal SEMSs.
文摘Self-expanding metal stent (SEMS) placement offers safe and effective palliation in patients with upper gastrointestinal obstruction due to a malignancy. Well described complications of SEMS placement include tumor growth, obstruction, and stent migration. SEMS occlusions are treated by SEMS redeployment, argon plasma coagulation application, balloon dilation, and surgical bypass. At our center, we usually place the second SEMS into the first SEMS if there is complete occlusion by the tumor. We discovered an unusual complication during SEMS redeployment. The guide-wire passed through the mesh of the first SEMS and caused the second SEMS to become entangled with the first SEMS. This led to the distortion and malfunction of the second SEMS, which worsened the gastric outlet obstruction. For lowering the risk of entanglement, we studied stone extraction balloon-guided repeat SEMS placement. This is the first report of a SEMS entangled by the mesh of the first SEMS and stone extraction balloon-guided repeat SEMS placement for lowering the risk of this complication.
文摘Self-expanding metallic stents are sometimes placed for the management of obstructing airway lesions or conditions such as airway wall malacia or tracheal stenosis. However, endoscopic removal of these devices from the airway can pose extreme challenges for both clinical airway management as well as for the administration of general anesthesia. We report on a 61-yearold man with a complex cardiac history presenting for endoscopic stent removal necessitated by the formation of extensive granulation tissue. Comorbidities included a history of myocardial infarction, an ischemic cardiomyopathy with severe left heart failure(ejection fraction of 25%), mild right heart failure, 2+ tricuspid regurgitation status post tricuspid valve repair, and atrial fibrillation. An automatic external(wearable) cardiac defibrillator(Zoll Life Vest) was also in place. Induction of anesthesia was carried out using etomidate, with maintenance of anesthesia carried out with a propofol infusion(total intravenous anesthesia). Rocuronium was used for neuromuscular blockade. A size 4 i Gel supraglottic airway and, later, rigid bronchoscopy formed the basis for airway management. Stable conditions were met through the 2-h procedure, and the patient recovered uneventfully. Our successful experience in this case leads us to propose further use of a supraglottic airway in conjunction with total intravenous anesthesia for these procedures.
文摘Objective To compare the outcomes after self-expanding metallic stent (SEMS) or transanal drainage tube (TDT) placement in patients with malignant large-bowel obstruction (MLBO). Methods Seventy-three patients with MLBO from the clinical unit underwent SEMS (n = 51) or TDT (n = 22) placement from 2012 to 2017. The success rates of placement, clinical outcomes after decompression, complications, the time to resuming enteral nutrition (EN), Karnofsky performance status (KPS) scoring and the following-up therapeutic options were investigated. Results Technical success were achieved in 100% of patients in both groups. The clinical success rates were 98.0%(50/51) for SEMS and 95.5%(21/22) for TDT. No perforation was found in any group, while 3.9%(2/51) in the SEMS and 18.2%(4/22) in TDT group experienced displacement (P = 0.26). It took 2.1 IQR (0~2) days and 3 IQR (2~5) days to resume EN in the SEMS and TDT groups, respectively (P < 0.001). The KPS scores were significantly higher in patients implanted with SEMS (70, IQR 50~80) than in those with TDT (35, IQR 30~50)(P < 0.001). In the SEMS group, 37.3%(19/51) of patients underwent stenting as a bridge to surgery, 9.8%(5/51) for chemotherapy only and 52.9%(27/51) for palliation, while 40.9%(9/22), 0 and 59.1%(13/22) underwent placement for these reasons in the TDT group, respectively. The majority (6/9) of the patients who underwent TDT placement as a bridge to surgery required stoma creation, while only 31.6%(6/19) of those in the SEMS group needed a stoma (P = 0.080). In addition, anastomotic leakage was only found in the TDT group (2/9)(P = 0.10). Conclusion Both SEMS and TDT placement could provide clinical relief for MLBO. However, SEMS placement is associated with earlier EN, fewer complications, and benefits for the postoperative quality-of-life.
基金Supported by National Natural Science Funds of ChinaNo.81101566+4 种基金Scientific Funds of Shanghai Government11DZ228040012QA1400600XYQ201101711411950500
文摘AIM:To investigate the clinical advantages of the stent-laparoscopy approach to treat colorectal cancer(CRC)patients with acute colorectal obstruction(ACO).METHODS:From April 2008 to April 2012,surgeryrelated parameters,complications,overall survival(OS),and disease-free survival(DFS)of 74 consecutive patients with left-sided CRC presented with ACO who underwent self-expandable metallic stent(SEMS)placement followed by one-stage open(n=58)or laparoscopic resection(n=16)were evaluated retrospectively.The stent-laparoscopy group was also compared with a control group of 96 CRC patients who underwent regular laparoscopy without ACO between January 2010 and December 2011 to explore whether SEMS placement influenced the laparoscopic procedure or reduced long-term survival by influencing CRC oncological characteristics.RESULTS:The characteristics of patients among these groups were comparable.The rate of conversion to open surgery was 12.5%in the stent-laparoscopy group.Bowel function recovery and postoperative hospital stay were significantly shorter(3.3±0.9 d vs 4.2±1.5 d and 6.7±1.1 d vs 9.5±6.7 d,P=0.016 and P=0.005),and surgical time was significantly longer(152.1±44.4 min vs 127.4±38.4 min,P=0.045)in the stent-laparoscopy group than in the stent-open group.Surgery-related complications and the rate of admission to the intensive care unit were lower in the stent-laparoscopy group.There were no significant differences in the interval between stenting and surgery,intraoperative blood loss,OS,and DFS between the two stent groups.Compared with those in the stentlaparoscopy group,all surgery-related parameters,complications,OS,and DFS in the control group were comparable.CONCLUSION:The stent-laparoscopy approach is a feasible,rapid,and minimally invasive option for patients with ACO caused by left-sided CRC and can achieve a favorable long-term prognosis.
文摘Malignant gastroduodenal obstruction can occur in up to 20%of patients with primary pancreatic,gastric or duodenal carcinomas.Presenting symptoms include nausea,vomiting,abdominal distention,pain and decreased oral intake which can lead to dehydration, malnutrition,and poor quality of life.Endoscopic stent placement has become the primary therapeutic modality because it is safe,minimally invasive,and a cost-effective option for palliation.Stents can be successfully deployed in the majority of patients. Stent placement appears to lead to a shorter time to symptomatic improvement,shorter time to resumption of an oral diet,and shorter hospital stays as compared with surgical options.Recurrence of the obstructive symptoms resulting from stent occlusion,due to tumor ingrowth or overgrowth,can be successfully treated with repeat endoscopic stent placement in the majority of the cases.Both endoscopic stenting and surgical bypass are considered palliative treatments and,to date,no improvement in survival with either modality has been demonstrated.A tailored therapeutic approach,taking into consideration patient preferences and involving a multidisciplinary team including the therapeutic endoscopist,surgeon,medical oncologist, radiation therapist,and interventional radiologist, should be considered in all cases.
文摘AIM: To ascertain clinical outcome and complications of self-expandable metal stents for endoscopic palliation of patients with malignant obstruction of the gastrointestinal (GI) tract. METHODS: A retrospective review was performed throughout August 2000 to June 2005 of 53 patients with gastric outlet obstruction caused by stomach cancer. All patients had symptomatic obstruction including nausea, vomiting, and decreased oral intake. All received self-expandable metallic stents. RESULTS: Stent implantation was successful in all 53 (100%) patients. Relief of obstructive symptoms was achieved in 43 (81.1%) patients. No immediate stent-related complications were noted. Seventeen patients had recurrent obstruction (tumor ingrowth in 14 patients, tumor overgrowth in 1 patient, and partial distal stent migration in 2 patients). The mean survival was 145 d. Median stent patency time was 187 d. CONCLUSION: Endoscopic placement of self-expandable metallic stents is a safe and effective treatment for the palliation of patients with inoperable malignant gastric outlet obstruction caused by stomach cancer.
文摘To evaluate the safety and efficacy of limited endoscopic sphincterotomy (ES) before placement of self-expandable metal stent (SEMS).METHODSThis was a retrospective analysis of 244 consecutive patients with unresectable malignant biliary obstruction, who underwent placement of SEMSs following limited ES from December 2008 to February 2015. The diagnosis of malignant biliary obstruction and assessment of patient eligibility for the study was established by a combination of clinical findings, laboratory investigations, imaging and pathological results. All patients were monitored in the hospital for at least 24 h following endoscopic retrograde cholangio pancreatography (ERCP). The incidence of immediate or early post-ERCP complications such as post-ERCP pancreatitis (PEP) and bleeding related to limited ES were considered as primary outcomes. Also, characteristics and complications according to the cancer type were classified.RESULTSAmong the 244 patients included, the underlying diagnosis was cholangiocarcinoma in 118 patients, pancreatic cancer in 79, and non-pancreatic or non-biliary malignancies in the remaining 47 patients. Early post-ERCP complications occurred in 9 patients (3.7%), with PEP in 7 patients (2.9%; mild, 6; moderate, 1) and mild bleeding in 2 patients (0.8%). There was no significant association between the incidence of post-ERCP complications and the type of malignancy (cholangiocarcinoma vs pancreatic cancer vs others, P = 0.696) or the type of SEMS used (uncovered vs covered, P = 1.000). Patients who had more than one SEMS placed at the first instance were at a significantly higher risk of post-ERCP complications (one SEMS vs two SEMS, P = 0.031). No other factors were predictive of post-ERCP complications.CONCLUSIONLimited ES is feasible and safe, and effectively facilitates the placement of SEMS, without any significant risk of PEP or severe bleeding.
文摘AIM:To present a series of covered self-expandable metal stents(CSEMS) placed for different indications and to evaluate the effectiveness,complications and extractability of these devices.METHODS:We therefore retrospectively reviewed the courses of patients who received CSEMS due to malignant as well as benign biliary strictures and postsphincterotomy bleeding in our endoscopic unit between January 2010 and October 2011.RESULTS:Twenty-six patients received 28 stents due to different indications(20 stents due to malignant biliary strictures,six stents due to benign biliary strictures and two stents due to post-sphincterotomy bleeding).Biliary obstruction was relieved in all cases,regardless of the underlying cause.Hemostasis could be achieved in the two patients who received the stents for this purpose.Complications occurred in five patients(18%).Two patients(7%) developed cholecystitis,stents dislocated/migrated in other two patients(7%),and in one patient(3.6%) stent occlusion was documented during the study period.Seven stents were extracted endoscopically.Removal of stents was easily possible in all cases in which it was desired using standard forceps.Twelve patients underwent surgery with pylorus preserving duodenopancreatectomy.In all patients stents could be removed during the operation without difficulties.CONCLUSION:Despite the higher costs of these devices,fully covered self-expanding metal stents may be suitable to relief biliary obstruction due to bile duct stenosis,regardless of the underlying cause.CSEMS may also represent an effective treatment strategy of severe post-sphincterotomy bleeding,not controlled by other measures.
