ABSTRACT
Background: Esophageal cancer causes disabling dysphagia and swallowing problems. Aim: To prospectively analyze the outcome of the insertion of a covered self-expanding metallic Choostent type prosthesis as a method of palliation of dysphagia, esophageal fistula or leak secondary to malignant disease of the esophagus or cardia. Material and Methods: A total of 30 consecutive patients aged 75 +/- 8.8 years (63 percent males) with malignant disease of the esophagus or cardia were studied. Results: In 27 patients (90 percent) the stenosis was located in the esophagus, in two (6.7 percent) at the gastroesophageal junction and in one (3.3 percent) at the esophago - jejunal anastomosis due to tumor recurrence. In 24 cases (80 percent), the indication of the prosthesis was dysphagia, in three (10 percent) the presence of a tracheo-esophageal fistula and in the remaining three (10 percent), the suspicion of a perforation. Patients were followed until death. The prosthesis was inserted without incidents in 29 patients (96.6 percent). One patient had a pneumomediastinum, which evolved favorably. Dysphagia subsided in all patients. Early evolution was satisfactory in 12 patients (66.7 percent). The most common early complication was a transient chest pain in 3 cases (10 percent). Four patients (13.3 percent) died within 30 days post procedure. Of the remaining 26 patients, 14 (53.8 percent) had late complications (recurrence of dysphagia in 42 percent and hemorrhage in 11 percent). The mean interval between stent insertion and death was 169 +/- 142.5 days. Conclusions: The Choostent esophageal prosthesis improves dysphagia immediately and safely. However, its use is associated with a high rate of late complications, directly related to prosthetic dysfunction.
Objetivo: Analizar en forma prospectiva los resultados de la inserción de una prótesis metálica autoexpandible cubierta tipo Choostent como método de paliación de la disfagia, fístulas o fugas esofágicas secundarias a patología maligna del esófago o cardias. Material y Método: Se estudiaron un total de 30 pacientes consecutivos portadores de patología maligna del esófago o de cardias. La edad promedio fue de 75 +/- 8,8 años. 19 (63,3 por ciento) eran del género masculino. En 27 pacientes (90 por ciento) la estenosis comprometía el esófago, en 2 (6,7 por ciento) la unión gastroesofágica y en 1 (3,3 por ciento) la anastomosis esófago yeyunal por recidiva tumoral. En 24/30 casos (80 por ciento), la indicación de la prótesis fue la disfagia, en 3 (10 por ciento) la presencia de fístula esófago-traqueal y en los 3 restantes (10 por ciento), la sospecha de perforación. Los pacientes fueron controlados hasta su fallecimiento. Resultados: La prótesis se insertó sin incidentes en 29/30 pacientes (96,7 por ciento). Un caso (3 por ciento) presentó neumo-mediastino, que evolucionó favorablemente. La disfagia cedió en la totalidad de los enfermos. La evolución precoz fue satisfactoria en 12/30 pacientes (40 por ciento), siendo la complicación precoz más frecuente el dolor torácico transitorio en 3 casos (10 por ciento). Fallecieron precozmente 4 enfermos (13,3 por ciento). De los 26 restantes, en 14 (53,8 por ciento) se presentaron complicaciones tardías, siendo las más frecuentes la recidiva de la disfagia (42,3 por ciento) y la hemorragia (11,5 por ciento). Conclusión: Las prótesis Choostent mejoran la disfagia en forma inmediata y segura. Son efectivas en el manejo de las fístulas traqueo-esofágicas y perforaciones. Sin embargo, su uso se asocia a una alta tasa de morbilidad tardía directamente relacionada a la disfunción protésica.
Subject(s)
Humans , Male , Female , Middle Aged , Aged, 80 and over , Esophageal Neoplasms/complications , Stents , Deglutition Disorders/etiology , Deglutition Disorders/therapy , Palliative Care/methods , Esophageal Stenosis/etiology , Esophageal Stenosis/therapy , Esophageal Fistula/etiology , Esophageal Fistula/therapy , Prosthesis Implantation/methods , Esophageal Neoplasms/therapy , Prospective Studies , Prosthesis Failure , Severity of Illness IndexABSTRACT
Background: An early decompression of the biliary tract can be useful in biliary pancreatitis. This can be accomplished with an ERCP. Aim: To analyze prospectively the outcomes of ERCP and eventual endoscopic management among patients with mild acute biliary pancreatitis with gallbladder in situ. Material and methods: We studied 90 consecutive patients aged between 15 and 92 years (71 females) with mild acute pancreatitis and gallbladder in situ, that were subjected to an ERCP and eventual sphincterotomy. Forty nine patients (54 percent) had jaundice and 12 (13 percent) had cholangitis. Results: In 67 patients (74 percent), ERCP detected an abnormal ampulla. The bile duct was successfully cannulated in 89 cases (99 percent). Of these, 42 (47 percent) had a dilated bile duct and 36 (40 percent) had choledocholithiasis. In two patients (2 percent) ERCP was only diagnostic. In the remaining patients, it was therapeutic. Endoscopic treatment was successful in 86 patients (99 percent). No complications arising from the endoscopic procedure were recorded. Follow-up was completed in 84 patients (94 percent). Of these, 10 (12 percent) were not subjected to a cholecystectomy, in eight due to a high surgical risk and in two due to refusal. In the remaining 74 patients, a cholecystectomy was performed during the same hospitalization in 57 (77 percent) and on a deferred basis in 17 (23 percent). Conclusions: In patients with mild acute biliary pancreatitis and gallbladder in situ, ERCP is a safe and effective method.
Objetivo: Analizar en forma prospectiva los resultados de la Colangio Pancreatografía Retrógrada Endoscópica (CPRE) y eventual manejo endoscópico en pacientes portadores de pancreatitis aguda biliar (PAB) leve con vesícula in situ. Material y Método: Se estudiaron 90 pacientes consecutivos con PAB leve y vesícula in situ. La edad promedio fue de 49,5 +/- 18,6 años (78,9 por ciento mujeres y 21,1 por ciento hombres). Del total, 49 pacientes (54,4 por ciento) presentaron ictericia y 12 (13,3 por ciento) colangitis. Resultados: La CPRE pesquisó pato-logia de la ampolla en 67/90 pacientes (74,4 por ciento). La canulación selectiva de la vía biliar resultó exitosa en 89/90 casos (98,9 por ciento). En estos, se demostró una vía biliar dilatada en 42 (47,2 por ciento) y coledocolitiasis en 36 (40,4 por ciento). La CPRE fue diagnóstica en 2 enfermos (2,2 por ciento) y hubo indicación de procedimiento terapéutico en los 87 restantes (97,7 por ciento), este resultó exitoso en 86 (98,9 por ciento). No se presentaron complicaciones derivadas de la cirugía endoscópica. Se completó el seguimiento en 84/89 pacientes (94,4 por ciento). De estos, 10 (11,9 por ciento) no fueron colecistectomizados (8 debido al riesgo quirúrgico y 2 por rechazo a la intervención). De los 74 restantes, 57 (77 por ciento) fueron sometidos a una colecistectomía dentro de la misma hospitalización y 17 (23 por ciento en forma diferida. El 91,9 por ciento de ellas (68/74) mediante laparoscopia. Conclusión: En pacientes con PAB leve y vesícula in situ, la CPRE es un método seguro y efectivo. Además, permite efectuar una colecistectomía por vía laparoscópica, durante la misma hospitalización en la gran mayoría de los pacientes y constituye una alternativa a la colecistectomía en pacientes de alto riesgo quirúrgico.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged, 80 and over , Common Bile Duct/surgery , Common Bile Duct/pathology , Gallbladder , Pancreatitis/surgery , Pancreatitis/diagnosis , Cholangiopancreatography, Endoscopic Retrograde/methods , Acute Disease , Follow-Up Studies , Prospective StudiesABSTRACT
Background: Endoscopic extraction of biliary tract stones is safe and effective. When the procedure is not successful, the use of a temporary stent can be a solution. Aim: To prospectively analyze the usefulness of endoscopic biliary stents in the temporary management of biliary obstruction due to choledocholithiasis. Material and methods: Analysis of 51 consecutive patients (age range 21-88 years, 34 females) with common bile duct stones that, from January 1999 to December 2001, were subjected to an endoscopic insertion of a biliary stent. Results: The indications for stent placement were a large stone in 40 patients (78%), the insecurity of a complete biliary tract cleaning in eight (16%) and technical difficulties in three (6%). Twenty seven patients (52.9%) were jaundiced and 17 (33.3%) had cholangitis. The prostheses remained in place until definitive resolution of the choledocholithiasis in 47 patients (92%) and migrated in 4 (8%). Bilirubin levels became normal in all cases with jaundice and infection resolved in all those with cholangitis. The definitive treatment of choledocholithiasis was done endoscopically in 28 patients (58%) and surgically in 20 (42%). Three patients were lost from follow up. Of these, one patient (2%) died 14 months later due to a recurrent cholangitis. The remaining two patients were asymptomatic and with the prostheses still in place 522 and 560 days post stent placement. Conclusions: When the immediate endoscopic resolution of choledocholithiasis is not possible, temporary stenting is a simple and safe therapeutic alternative that allows patients to be free of obstructive complications until the definitive treatment is carried out.