Self-expanding Metal Stents in Malignant Obstruction of the Esophagus: A 25-Year Multicentric Study

Background: Self-expanding metal prostheses improve dysphagia in patients with incurable esophageal cancer (EC). New stents have been introduced, and chemoradiotherapy has been implemented for EC, changing patients' risk profiles. It is unknown whether this has affected palliation with stents. Patients and methods: Retrospective study in three centers in Medellín-Colombia; patients undergoing placement of palliative esophageal prostheses for malignant dysphagia (1997-2022). Major and minor complications after implantation, the influence of oncological therapies, and survival were evaluated for 1997-2009 (n = 289) and 2010-2022 (n = 318). Results: 607 patients underwent esophageal prostheses; 296 (48.8%) became complicated. It was higher in the second period (52.5% vs. 48.1%), as were major complications (20.8% vs. 14.2%, p = 0.033), with no differences in minor complications (33.9% vs 31.8%, p = 0.765). Also, 190 (31.3%) patients presented with recurrent dysphagia, stable in both periods. Migration increased over time (from 13.1% to 18.2%, p = 0.09). The most common minor adverse event was pain, increasing over time (from 24.9% to 33.95%, p < 0.01), and associated factors were chemoradiotherapy, absence of fistula, and squamous cell carcinoma. Acid reflux decreased in the second group (p = 0.038). Twelve percent of patients required another intervention for feeding. Survival was not impacted by time and use of stents. Conclusions: Stents are an alternative in non-surgical malignant dysphagia, although recurrent dysphagia has not decreased over time. Minor stent-related complications are increasing in association with the implementation of chemoradiotherapy.

Antecedentes: Las prótesis metálicas autoexpandibles mejoran la disfagia en pacientes con cáncer esofágico (CE) incurable. En las últimas décadas se han introducido nuevos tipos de stents y se ha implementado la quimiorradioterapia para el CE, generando cambios en los perfiles de riesgo de los pacientes. Se desconoce si estos cambios han afectado la paliación con stents. Pacientes y métodos: Estudio retrospectivo en tres centros de Medellín-Colombia; pacientes sometidos a colocación de prótesis esofágicas paliativas para disfagia maligna (1997-2022). Se evaluaron en dos períodos: 1997-2009 (n = 289) y 2010-2022 (n = 318), complicaciones mayores y menores después del implante, la influencia de las terapias oncológicas y la sobrevida. Resultados: Se evaluaron 607 pacientes sometidos a prótesis esofágicas. 296 (48,8%) se complicaron, y fue mayor en el segundo periodo (52,5% frente a 48,1%), al igual que las complicaciones mayores (20,8% frente a 14,2%, p = 0,033), sin diferencias en complicaciones menores (33,9% frente a 31,8%, p = 0,765). 190 (31,3%) pacientes presentaron disfagia recurrente, estable en ambos períodos. La migración aumentó con el tiempo (de 13,1% a 18,2%, p = 0,09). El evento adverso menor más frecuente fue dolor, que aumentó con el tiempo (de 24,9% a 33,95%, p < 0,01), y los factores asociados fueron quimiorradioterapia, ausencia de fístula y carcinoma de células escamosas. El reflujo ácido disminuyó en el segundo grupo (p = 0,038). El 12% de pacientes requirieron otra intervención para alimentarse. No se impactó la sobrevida con el tiempo y uso de stents. Conclusiones: Los stents son una alternativa en la disfagia maligna no quirúrgica, aunque la disfagia recurrente no ha disminuido con el tiempo. Las complicaciones menores relacionadas con el stent van en aumento, asociadas a la implementación de la quimiorradioterapia.

The efficacy of the combination of radiofrequency ablation and endoscopic metal stent in the treatment of 44 patients with unresectable cholangiocarcinoma / 中华消化杂志

Objective:To explore the efficacy of the combination of radiofrequency ablation(RFA) and endoscopic metal stent in the treatment of patients with unresectable cholangiocarcinoma.Methods:From January 3, 2012 to June 30, 2019, at the Department of Endoscopic of the Third Affiliated Hospital of Naval Medical University, the clinical data of 44 patients with unresectable cholangiocarcinoma who were treated by the combination of RFA and endoscopic metal stent were retrospectively collected, which included age, gender, location of cholangiocarcinoma(hilar cholangiocarcinoma and distal cholangiocarcinoma), etc. Postoperative evaluation was conducted based on the follow-up, including clinical success rate, postoperative complication rate, time of stent patency and overall survival time (OS). The Kaplan-Meier method and log-rank test were used to analyze the difference of OS between patients with hilar cholangiocarcinoma and distal cholangiocarcinoma. Mann-Whitney U test was used for statistical analysis. Results:The age of the 44 patients with cholangiocarcinoma was (70.3±11.6) years old, with 20 males (45.5%). There were 22 patients (50.0%) with hilar cholangiocarcinoma and 22 patients (50.0%) with distal cholangiocarcinoma. The clinical success rate of 44 patients was 93.2%(41/44). A total of 5 patients(11.4%) had postoperative complications, which were all improved by appropriate treatment. The median time of follow-up of the 44 patient was 9.2 months(ranged from 3.1 to 57.6 months), the median time of stent patency was 7.0 months (ranged from 5.8 to 8.2 months). Thirty-two patients (72.7%) died during the follow-up, and the median OS was 10.9 months(ranged from 9.0 to 12.8 months). The median OS of patients with hilar cholangiocarcinoma was 7.8 months(ranged from 4.6 to 11.0 months) and that of patients with distal cholangiocarcinoma was 12.5 months(ranged from 5.7 to 19.4 months), and there was no statistically significant difference( P>0.05). Conclusion:RFA combined with endoscopic metal stent is safe and effective in the treatment of patients with unresectable cholangiocarcinoma.

Tratamento endovascular de aneurisma de artéria isquiática bilateral com stent recoberto autoexpansível Covera® - relato de caso / Endovascular repair of bilateral sciatic artery aneurysm with Covera® self expandable covered stents - case report

Resumo A persistência da artéria isquiática é um remanescente embriológico da artéria ilíaca interna que ocorre em 0,03% a 0,06% da população, podendo evoluir com degeneração aneurismática. A presença do aneurisma pode levar a embolização, com aumento de risco de perda do membro, principalmente se a artéria isquiática for seu principal suprimento arterial. O tratamento do aneurisma de artéria isquiática está indicado sempre que diagnosticado, devido ao alto risco de complicações. Entre as opções de tratamento, estão o tratamento aberto convencional, o tratamento endovascular e o tratamento híbrido. No presente estudo, será descrito o caso de um paciente apresentando persistência completa das artérias isquiáticas bilateralmente, com degeneração aneurismática de ambas, corrigida de forma endovascular com stent recoberto Covera® (Bard Medical, Geórgia, Estados Unidos).

Abstract A persistent sciatic artery is an embryological remnant of the internal iliac artery that occurs in 0.03% to 0.06% of the population and may develop aneurysmal degeneration. Aneurysms can lead to distal embolization with increased risk of limb loss, especially if the sciatic artery is the main arterial supply to the limb. A sciatic artery aneurysm must be treated whenever diagnosed, because of the high risk of complications. Treatment options include open, endovascular, or hybrid repair. This manuscript describes a patient with bilateral persistence of the sciatic arteries, both with aneurysmal degeneration, who underwent endovascular repair with Covera® (Bard Medical, Georgia-USA) covered stents.

Tratamiento endoscópico de una fístula aguda tras gastrectomía vertical laparoscópica / Endoscopic treatment of an acute fistula after laparoscopic sleeve gastrectomy / Tratamento endoscópico de uma fístula aguda após gastrectomia vertical laparoscópica

La fístula gástrica aguda es una de las principales complicaciones vinculadas a la gastrectomía vertical laparoscópica (GVL). Existen múltiples opciones terapéuticas para su resolución, siendo el tratamiento endoscópico mediante colocación de clips o stents uno de los más importantes. La aplicabilidad de cada método va a depender del tipo de fístula y del estado del paciente. Presentamos el caso de una mujer de 35 años, que desarrolla una fístula aguda posterior a una GVL. Se realiza tratamiento endoscópico con colocaciónn del sistema "over-the-scope clip" (Ovesco®) a nivel del orificio fistuloso, con posterior colocaciónn de stent metálico auto expandible.

Acute gastric fistula is one of the main complications associated with laparoscopic vertical gastrectomy (LVG). There are multiple therapeutic options for its resolution, being endoscopic treatment by placing clips or stents one of the most important. The applicability of each method will depend on the type of fistula and the patient's condition. We present the case of a 35-year-old woman who developed an acute fistula after LGV. Endoscopic treatment is performed with placement of the over-the-scope clip system (Ovesco®) at the level of the fistulous orifice, with subsequent placement of a self-expanding metal stent.

A fístula gástrica aguda é uma das principais complicações associadas à gastrectomia vertical laparoscópica (GVL). Existem múltiplas opções terapêuticas para a sua resolução, sendo o tratamento endoscópico com colocação de clipes ou stents uma das mais importantes. A aplicabilidade de cada método dependerá do tipo de fístula e do estado do paciente. Apresentamos o caso de uma mulher de 35 anos que apresentou uma fístula aguda após GVL. O tratamento endoscópico foi realizado com a colocação do sistema de clipe over-the-scope (Ovesco®) no nível do orifício fistuloso, com posterior colocação de stent metálico autoexpansível.

Long-term outcomes of fully covered self-expanding metal stent for benign refractory pancreatic stenosis (with video) / 中华消化内镜杂志

Objective:To investigate the safety and long-term outcomes of fully covered self-expanding metal stent (FCSEMS) placement in patients with benign refractory pancreatic stenosis.Methods:Data of 18 patients with benign refractory pancreatic stenosis who underwent endoscopic treatment with FCSEMS in Nanjing Drum Tower Hospital between March 2013 and July 2020 were collected. The technical success, clinical success, adverse events and long-term outcomes were analyzed.Results:FCSEMS placement was successful in all 18 patients, with technical success rate of 100.0% (18/18). After stenting, the visual analogue scale (VAS) significantly decreased [2.00 (1.75, 3.00) VS 6.00 (5.00, 7.00), Z=-3.572, P<0.001]. The VAS decreased by more than 50% in 15 cases, and the clinical success rate was 83.3% (15/18). Stent-related adverse events included intolerable pain in 3 patients, stented-induced de novo stricture in 2 patients, and distal migration of stent in 2 patients. The stents were successfully removed in all patients after 137.5 (59.0, 417.0) days. There was significant reduction in terms of decreased upstream ductal dilatation after stent removal [9.1 (6.7, 14.1) mm VS 11.0 (7.6, 16.2) mm, Z=10.508, P<0.001]. After stent removal, 10 of the 14 patients maintained the response to pancreatic stenting and 4 recurred during the follow-up of 37-1 246 days. Conclusion:FCSEMS placement appears to be safe and effective in the treatment of benign refractory pancreatic stenosis and can provide persistent improvement in the stricture.

Comparison of fully covered self-expanding metal stents and multiple plastic stents for benign biliary strictures / 中华消化内镜杂志

Objective:To compare the fully covered self-expanding metal stents (FCSEMS) and multiple plastic stents (MPS) in the effectiveness, safety and cost-effectiveness for benign bile duct strictures.Methods:A single-center retrospective study was conducted to analyze the clinical data of 107 patients with benign biliary strictures who underwent FCSEMS or MPS implantation through endoscopic retrograde cholangiopancreatography (ERCP) in Hangzhou First People's Hospital from January 2013 to June 2019.There were 54 cases in group FCSEMS and 53 cases in group MPS. Benign biliary stricture was confirmed by computed tomography (CT), magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasonography. The primary index was the rate of stricture remission, and the secondary indices were the incidence of stricture recurrence, ERCP-related complications, the rate of stent migration, hospital stay and charges.Results:The median follow-up times were 10.0 (6.5, 18.0) months and 12.0 (9.0, 20.0) months in group FCSEMS and in group MPS respectively ( P>0.05). The rates of stricture remission in the two groups were 87.0% (47/54) and 83.0% (44/53), the incidences of stricture recurrence were 14.6% (6/41) and 23.5% (8/34), and the incidences of ERCP-related complications were 14.8% (8/54) and 11.9% (13/109), respectively. And the differences were not statistically significant (all P>0.05). But the stent migration rates of the two groups were 22.9% (11/54) and 2.8% (3/109) with significant difference ( P<0.001). Cost-effectiveness analysis showed that the median numbers of ERCP intervention in the two groups were 2 (2,2) times and 3 (2,4) times ( P<0.001), and the median hospital stays were 6.0 (4.0,11.0) days and 9.0 (6.5,16.0) days respectively ( P=0.009). The median hospitalization expenses of the two groups were 44 646 yuan and 51 355 yuan without significant difference ( P>0.05). Conclusion:The effectiveness, safety and cost of FCSEMS for benign bile duct stenosis are similar to those of MPS, but it reduces ERCP intervention and treatment cycles. Even with a certain migration rate, it can still be a first-line treatment approach.

Stents metálicos autoexpandibles para el manejo endoscópico de las fístulas esofagogástricas / Self-expanding metal stents for endoscopic management of esophageal and gastric fistulas

Resumen Objetivos: mostrar la eficacia y seguridad de los stents metálicos autoexpandibles para el manejo endoscópico de las fístulas esofágicas. Materiales y métodos: se evalúo una serie de casos de manera retrospectiva entre el 2007 y el 2017, en los que se manejaron a 11 pacientes con un stent metálico autoexpandible para el manejo de fístula esofágica, en quienes se realizó el diagnóstico por clínica, endoscopia digestiva alta o estudios radiológicos en la unidad de gastroenterología del Hospital Universitario San Ignacio (HUSI) de Bogotá D. C., Colombia. Resultados: el principal síntoma inicial fue la disnea en 27,3 % de los casos, seguido por tos en un 18,2 %. El hallazgo más frecuentemente encontrado durante el seguimiento fue el derrame pleural en el 36,4 %, se realizó el diagnóstico de fístula en el 45,5 % con esofagograma y el tipo de lesión más reportada fue la fuga en la anastomosis esofagoentérica, con un 45,5 %, seguida de la esofagopleural, con un 36,4 %; y estos pacientes fueron manejados con un stent metálico autoexpandible. En el 100 % hubo éxito técnico y la resolución del defecto se evidenció en el 72,7 % de los casos. La única complicación reportada fue el desplazamiento del stent en el 27,3 %, y en un paciente se requirió el cambio del stent en 3 oportunidades. El promedio de estancia hospitalaria fue de 41,5 días. Conclusiones: el manejo endoscópico de las fístulas esofagogástricas con stents metálicos autoexpandibles es efectivo y seguro, con una baja tasa de complicaciones.

Abstract Objective: To demonstrate the efficacy and safety of self-expanding metal stents for endoscopic management of esophageal fistulas. Materials and methods: Retrospective case series between 2007 and 2017. A total of 11 patients were treated with self-expanding metal stents for esophageal fistula management, after being diagnosed based on symptoms, upper endoscopy, and/or radiological studies in the gastroenterology unit of the Hospital Universitario San Ignacio (HUSI) in Bogotá D.C, Colombia. Results: The most common initial symptom was dyspnea in 27.3% of cases, followed by cough in 18.2%. The most frequent finding during follow-up was pleural effusion in 36.4% of the cases, of which 45.5% received a diagnosis of fistula through esophagogram. The most reported lesion was esophagoenteric anastomotic leak with 45.5%, followed by esophagopleural injury with 36.4%; these patients were those who received self-expanding metal stent management. Technical success was achieved in 100% of the cases, and the defect was resolved in in 72.7% of them. The only complication reported was stent migration in 27.3%, requiring 3 changes in 1 patient. The average hospital stay was 41.5 days. Conclusions: Endoscopic management of esophagogastric fistulas with self-expanding metal stents is effective and safe, with a low complication rate.

Colecistogastrostomía guiada por ultrasonografía endoscópica en un paciente con cáncer pancreático: primer caso en Colombia (con video) / Endoscopic ultrasonography-guided cholecystogastrostomy in a patient with pancreatic cancer: the first case in Colombia (with video)

Resumen El tratamiento actual para la obstrucción biliar maligna es la derivación biliar no quirúrgica con propósito paliativo. La cirugía tiene indicaciones específicas en pacientes con patología maligna con propósito curativo. Sin embargo, la obstrucción duodenal y del conducto biliar intra o extrahepático no dilatado hace que esta cirugía y el procedimiento endoscópico guiado por ultrasonografía endoscópica (USE) sean difíciles de realizar. Presentamos nuestra experiencia con el primer caso en Colombia, un país latinoamericano del tercer mundo. Consistió en una colecistogastrostomía guiada por USE, a partir de la utilización de una endoprótesis luminal (Lumen-apposing metal stents, LAMS) (HOT AXIOS stent, Xlumena Inc.; Mountain View, CA, Estados Unidos) de 15 mm × 10 mm, en un paciente masculino con cáncer pancreático inoperable e invasión duodenal con conducto colédoco dilatado. La colecistogastrostomía guiada por USE podría ser considerada como una opción de más importancia para la descompresión biliar que el drenaje percutáneo, ya que es superior en términos de viabilidad técnica, seguridad y eficacia en casos específicos de estenosis ampular e invasión duodenal. Además, puede ser realizada en países del tercer mundo, cuando se cuenta con el entrenamiento y los instrumentos adecuados. La endoprótesis metálica totalmente recubierta, aplicada a luz (HOT AXIOS stent, Xlumena Inc.; Mountain View, CA, Estados Unidos), es ideal para la colecistogastrostomía guiada por USE, a fin de minimizar complicaciones como fugas biliares. Se necesitan estudios comparativos adicionales para validar los beneficios de esta técnica.

Abstract The current treatment of malignant biliary obstruction is non-surgical biliary diversion with palliative intent. The surgery having specific indications in patients with malignant pathology with curative intent. However, duodenal obstruction and non-dilated intra- or extrahepatic bile duct make these surgical and endoscopic procedures guided by EUS difficult. We present our experience with the first case in Colombia, a third-world country in Latin America, of a cholecystogastrostomy guided by endoscopic ultrasound (EUS) in a patient with unresectable pancreatic cancer and duodenal invasion with dilated common bile duct using a luminal stent (LAMS) (HOT AXIOS stent, Xlumena Inc.; Mountain View, CA, USA) 15 mm × 10 mm. EUS-guided cholecystogastrostomy should be considered as an option for biliary decompression of greater importance than percutaneous drainage since it is superior in terms of technical feasibility, safety and efficacy in specific cases of ampullary stenosis and duodenal invasion. In addition, it can be done in third world countries when it has the appropriate training and implements. The fully covered metal stent applied to light (HOT AXIOS stent, Xlumena Inc.; Mountain View, CA, USA) is ideal for EUS guided cholecystogastrostomy to minimize complications such as bile leakage. Additional comparative studies are needed to validate the benefits of this technique.

Design and manufacture of a coronary stent INC-1 and initial tests in experimental animal model / Diseño y fabricación del stent coronario INC-1y pruebas iniciales en animales de experimentación

Abstract In this paper, we describe our coronary stent (INC-1) design and development, the way that we found the specific characteristics needed for our device including biophysics aspects, design, finite element testing, manufacturing, and mechanic trials, we submitted and animal models experiences. The stent platform was cobalt-chromium L605 (Co-Cr), with struts thickness of 80 μm, balloon expandable. We placed the coronary stent INC-1 on a rabbit and dog models so we can evaluate efficacy and security of the device in relationship to its biomechanical properties including navigation capacity, traceability, symmetric expansion, and safety, as well as endothelial attachment, thrombogenicity, and lack of involvement of secondary branches in these models. We succeeded in efficacy and safety of the device after fluoroscopy-guided implant proving excellent capacity of release system, traceability, fluoroscopic visualization, symmetric expansion, and complete endothelial attach. Furthermore, we obtained a good post-implant balloon withdrawal, functional integrity, and no vascular complications. We observed adequate clinical evolution 3 weeks after the stent implantation.

Resumen En esta publicación se describen el diseño y el desarrollo de un stent coronario (INC-1), la forma en que se determinaron las características biofísicas deseadas, el diseño y las pruebas computacionales por elemento finito, su fabricación, así como las pruebas mecánicas a las que se sometió el prototipo y por último las primeras experiencias en modelos animales. La plataforma del stent desarrollado fue de cobalto y cromo L605 (Co-Cr), con struts de 80 μm de grosor, expandido por balón. La colocación del stent coronario INC-1 se realizó en un modelo de conejo y uno canino con el objetivo de evaluar el éxito técnico y de seguridad del stent en relación con las propiedades biomecánicas (capacidad de navegación, maniobrabilidad, expansión simétrica del stent) y de seguridad (fijación a la pared vascular y ausencia de compromiso de ramas secundarias y formación de trombos en el momento de la colocación del stent en el modelo animal). Se obtuvo éxito técnico y de seguridad del stent después del implante guiado por fluoroscopia, lo que demostró adecuada capacidad del sistema liberador, excelente maniobrabilidad, adecuada visualización fluoroscópica, expansión simétrica y fijación completa a la pared vascular, capacidad para retirar el balón desinflado después del implante, e integridad funcional y sin complicaciones vasculares. La evolución clínica fue favorable a tres semanas del seguimiento planeado.

Human pilot study of bare-metal stent: INC-01

ABSTRACT Background: The cost of performing a percutaneous coronary intervention is considerably high for the patient as well as for health systems, which have promoted the development of local technology to help meet the need for these devices. Methods: The INC-01 bare-metal stent was developed at the National Institute of Cardiology in Mexico City and was first implanted on porcine models with technical success in 100% of the evaluated parameters. Presentation of Cases: We present the first three cases of patients with ischemic heart disease, to whom the INC-01 bare-metal stent was implanted. Intracoronary ultrasonography was performed post-stent implantation, showing all the characteristics of implant success during evaluation and clinical follow-up. Conclusions: Angiography and intracoronary ultrasound were carried out demonstrating that the INC-01 bare-metal stent has physical, biological, and histological characteristics similar to those found in commercial metallic stents.

Study of efficacy and safety of drug eluting stent versus bare metal stent in ST elevation MI

Background: The present study was conducted with the aim of determining whether drug-elutingstents are superior to uncoated stents in the setting of primaryPCI in terms of occurrence of serious adverse cardiac events.Methods: In this prospective, single blind, randomized study, 20 to 80 years old patients with acute myocardial infarction with ST-segment elevation with >30 minutes of chest pain and at least 1 mm of ST-segment elevation in at least two standard leads or a new LBBB or 2 mm of ST-segment elevation in at least two contiguous leads were included. Patients were randomly assigned to receive either drug eluting stent (DES) (Everolimus Eluting stent, Endevour-Medtronics) or bare metal stent (BMS, Cordis-Dx sonic) in a 1:1 ratio. During follow ups at 30 days and 12 months, all serious adverse cardiac events like death from cardiac or non-cardiac cause, recurrent MI, revascularization of target vessel, coronary artery bypass grafting (CABG) or other intervention to target or non-target vessel etc. were recorded and compared between groups.Results: No significant differences were found between the two treatmentgroups for occurrence of adverse events during first 30 days after the intervention. At one year follow-up, trends were observed in favorof the DES group, none of the differences weresignificant.Conclusions: No significant benefit was observed with the use of Everolimus-eluting stents in primaryPCI for acute myocardial infarction with ST-segment elevation,in comparison with baremetal stents.

The efficacy of endoscopic stenting combined with laparoscopy in the treatment of left colon cancer with obstruction

Context: Endoscopic self-expandable metal stents (SEMSs) are the bridge of obstructive colorectal cancer surgery. The debate is still open on whether the procedure and effects can be the same between the SEMS combined obstructive colon cancer resection and nonobstructive colon cancer resection, both of which were under laparoscopic. Aims: This retrospective study was designed to compare whether the same effects could be achieved in both resections. Settings and Design: The retrospective analysis was from September 2016 to November 2017. In the observation group (OG), 20 patients hospitalized for obstruction of the left colon cancer were included, who received obstructive colon cancer laparoscopic resection (LR) combined with SEMS insertion. In control group (CG), 20 patients were randomly selected, who underwent nonobstructive colon cancer LR during this period. Subjects and Methods: The differences between the two groups were compared, including operation time, intraoperative blood loss, the number of removed lymph nodes, postoperative anal exhaust time, and hospital stay. Results: Both groups were comparable in the age, gender, weight, the distribution of tumor, lymph node metastasis, tumor, node, and metastasis staging, operation time, intraoperative blood loss, the number of removed lymph nodes, and postoperative anal exhaust time. The hospital stay was 15.2 ± 1.3 days and 14.2 ± 1.5 days in OG and CG, respectively, and it was longer in OG than that of in CG (P = 0.032). Conclusions: Obstructive colon cancer LR combined with SEMS insertion was a safe and feasible radical treatment strategy. The same level of procedure and effects could be achieved, compared to that of nonobstructive colon cancer LR.

Survival analysis pattern of patients treated with biliary metallic stent versus patients treated with surgical procedures for hepato-biliary malignancies in a rural tertiary care centre in South India

Background: Tumors of the biliary tract show spectrum ranging from benign to malignant lesions. Only 20% of tumors are resectable at the time of presentation. The operative mortality was approximately 5 to 20%. The morbidity rate associated with the surgery is approximately 65%. Options for palliative therapy of biliary tree obstruction include the surgical bypass, percutaneous external drainage/stenting and endoscopic stenting. The aim was to compare the survival pattern of patients treated with biliary Self Expandable Metallic Stents (SEMS) as a palliative procedure to that of patients treated by curative surgery.Methods: This was a retrospective study. 6-months survival pattern were analysed in 20 patients treated by SEMS and compared with that of 10 patients treated with plastic biliary stents followed by curative surgery.Results: Survival pattern analysis was done for all 20 patients with SEMS. 7 patients were in >1-year survival, 5 were in >6months survival, 6 expired within 6months, 2 patients were lost to follow up. Survival pattern was compared with 10 patients who had plastic stents followed by curative surgery. Only 1 patient had survival rate >1year post-surgery, 5 patients expired post-surgery in <6months, 2 patients expired few weeks after plastic stent deployment, 2 patients were lost to follow up.Conclusions: In patients with biliary malignancies with obstruction, biliary SEMS followed up by palliative chemotherapy had better survival rate than patients who had plastic stents followed up with curative surgical procedures.

Clinical research of the surgical timing for resectable colorectal cancer complicated with obstructions after implantation of SEMS / 中国实用外科杂志

OBJECTIVE: To compare the clinical outcomes of endoscopic intestinal stenting combined with elective surgery and emergency surgery at the same time for resectable left colon cancer or rectal cancer with intestinal obstruction and to explore the best time for reoperation after stent implantation. METHODS: The clinical data of 82 cases who underwent endoscopic intestinal stenting in the First Affiliated Hospital of China Medical University for the treatment of left colon cancer and rectal cancer with intestinal obstruction from March 2014 to September 2018 were analyzed retrospectively. Treatments were defined as effective only if primary anastomosis was received without a stoma,and those clinical outcomes were analyzed by receiver operator characteristic(ROC)curve. Another 44 patients diagnosed with colorectal cancer complicated with intestinal obstruction underwent emergency surgery during the same period were the control group. The differences in the first-stage surgical anastomosis rate,average operation time,total hospitalization time,total hospitalization expenses,and postoperative complications between two groups were compared.RESULTS: The area under the ROC curve(AUC)was 0.693 with a certain degree of accuracy(P<0.05). Compared to those within 8 days,the rate of primary anastomosis was significantly higher in those received elective surgery over 8 days,the average operation time was significantly decreased,and the ICU utilization rate was also significantly decreased(P<0.05).Compared with the emergency operation group,the stent group had a significantly higher rate of primary anastomosis,and the average operation time was significantly lower. The postoperative ICU utilization rate and the incidence of diarrhea were significantly lower,but the total hospitalization days and total hospitalization expenses were significantly increased(P <0.05).CONCLUSION: Endoscopic intestinal stenting combined with elective surgery for left colon cancer and rectal cancer intestinal obstruction is safe and feasible,and elective surgery should be implemented over 8 days for its security.

A Newly Designed, Fully Covered, Metal Stent with Wide Flanges for EUS-Guided Drainage and Access / 대한췌담도학회지

BACKGROUND/AIMS: Endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collections is a useful and effective procedure. One of the main limitations is the lack of devices tailored specifically for this technique. This study aims to evaluate a newly developed, fully covered, biflanged metal stent customized for EUS-guided transenteric drainage. METHODS: We enrolled one dog in an animal study and six patients with pancreatic fluid (five with pancreatic pseudocysts and one with pancreatic walled-off necrosis) in a clinical study. We performed EUS-guided drainage of the pancreatic fluid or gallbladder using a newly developed metal stent. Study outcomes were technical and clinical success, adverse events, and stent removability. RESULTS: In the animal study, the stent was placed successfully in the gallbladder via the EUS-guided transduodenal approach without complication. The cholecystoduodenal tract was intact on necropsy performed immediately after the procedure. The stents were inserted successfully and deployed in the six patients. There was no adverse event during or after the procedure. CONCLUSIONS: EUS-guided transenteric drainage using a new fully covered, biflanged metal stent was technically feasible and was not associated with any serious adverse event. The tailored design of the flange at the end of the stent facilitated the effectiveness of the procedure.

Incidence and etiology of stent associated respiratory tract infection caused by coated metal and silicone airway stents / 基础医学与临床

Objective To investigate the incidence and bacterial etiology of stent associated respiratory tract infec-tion (SARTI) caused by two types of airway stents.Methods Silicone and coated metal airway stent were placed into patients with central airway stenosis caused by varied pathologies. The incidence of stent related respiratory tract infection,bacteria etiology of SARTI and improved dyspnea score were compared between two groups receiving different airway stent.Results 1)Totally 171 patients received airway stents, and among them, 39 patients (22.81%) developed SARTI.2)The incidence of SARTI in metal stent group and silicone stent group was 29.21% (26/89) vs.15.85% (13/82),P<0.05;3)Bacterial spectrum of SARTI was different in metal and silicone stent groups:staphylococcus aureus was 38.46% vs. 69.23%,respectively;candida albicans was 23.08% vs. 0%,re-spectively;Singular proteus was 7.26% vs.0%,respectively;4)The narrowed lumen was improved from 74.27%± 7.13% to 17.64%±6.22%in the metal stent group,while the data was improved from 74.94%±9.18% to 12.68%± 8.32% in the silicone stent group (P<0.01). Accordingly, the dyspnea symptomscore was improvedfrom 2.85 ± 0.89 to 0.85±0.68 in metal stent group,and from 2.88±0.91 to 0±0.61 in the silicone stent group (P<0.05). Conclusions Compared with metal airway stents,silicone stents have a lower incidence of SARTI,which mightbe due to the projections in the silicon stent surface and wider expanded in the bronchial stenosis.

Management of Benign and Malignant Pancreatic Duct Strictures

The diagnosis and management of pancreatic strictures, whether malignant or benign, remain challenging. The last 2 decades have seen dramatic progress in terms of both advanced imaging and endoscopic therapy. While plastic stents remain the cornerstone of the treatment of benign strictures, the advent of fully covered metal stents has initiated a new wave of interest in calibrating the pancreatic duct with fewer sessions. In malignant disease, palliation remains the priority and further data are necessary before offering systematic pancreatic stenting.

Value of lumen-apposing metal stent in the treatment of 27 cases with peripancreatic fluid accumulation in acute pancreatitis / 中华消化杂志

Objective To assess the application value of lumen-apposing,fully covered,self-expandable metal stent (LAMS) in the treatment of peripancreatic fluid collection (PFC).Methods From July 2015 to July 2017,at Drum Tower Hospital Affiliated to Medical School of Nanjing University,the patients with PFC who received LAMS under endoscopic ultrasound were enrolled.The inclusion criteria was the first treatment,age ≥ 18 years old,PFC diameter ＞ 6 cm and clinical manifestations of compression,or increased diameter of PFC after continuous observation,or signs of infection,course ＞four weeks,and the distance between the cyst wall and the digestive gastrointestinal wall less than 1 cm;exclude other pancreatic cystic lesions,such as serous cystic neoplasm,mucinous cystic neoplasm and solid pseudopapillary neoplasm.The clinical data of enrolled patients were retrospectively analyzed,and the efficacy and postoperative complication were summarized.Results A total of 27 patients with PFC were enrolled.All patients were successfully punctured and placed with LAMS.The percentage of complete drainage rate of PFC was 96.3％ (26/27).The median LAMS maintenance time was 26 days,with a range of four to 135 days.Seventeen patients received debridement treatment through LAMS,and the number of debridement treatment was (2.5± 1.3) times.Two patients underwent endoscopic retrograde cholangiopancreatography (ERCP) and were placed with pancreatic stent,five patients received percutaneous drainage,and one patient underwent surgical drainage.Among 27 patients with PFC,eight patients (29.6％) coexisted with complications,including stent displacement in two cases,postoperative infection in three cases,perforation in two cases and bleeding in one case.They all improved after conservative treatment and none of them died.Conclusion LAMS is effective and relatively safe in the treatment of PFC,and may change the clinical treatment strategy of PFC.

Long-term effect of fully covered metal stents on benign bile duct stenosis / 中华消化内镜杂志

Objective To evaluate the long-term outcome of fully covered self-expandable metal stents(FCSEMS)for the treatment of benign biliary strictures(BBS). Methods Between June 2008 and September 2013, 68 patients with BBS receiving endoscopic retrograde cholangiopancreatography and FCSEMS placement were retrospectively enrolled. Data of endoscopic treatment, stricture resolution and recurrence were collected, and related risk factors were analyzed. Results FCSEMSs were successfully placed in all patients and removed in 93.4%(57/61). The median stent duration was 9.0(range 0.2-37.1)months. Stricture resolution occurred in 74.2%(46/62)patients. During median follow-up of 54.0 (range 2.5-96.0)months,stricture recurrences were seen in 16.7%(6/36)patients. Multivariate analysis revealed that distance between stricture and hepatic bifurcation of less than 1.5 cm(P=0.034,OR=6.395, 95%CI:1.153-35.464), and stent migration(P= 0.024, OR= 0.153, 95%CI:0.030-0.782)were significant risk factors for stricture resolution. Meanwhile, the stricture length longer than 1.0 cm(P=0.028, HR = 6.766, 95% CI:1.233-37.122)was a significant risk factor for stricture recurrence. Conclusion Endoscopic treatment combined with FCSEMS can achieve excellent efficacy in resolving BBS with low recurrence rate. However, location and length of BBS, as well as stent migration may impair its effectiveness.

Pancreatic stent in prevention of postoperative acute pancreatitis in patients with benign biliary stricture treated by full-covered self-expanding removable metal stents / 中华普通外科杂志

Objective To investigate the clinical value,safety and efficacy of pancreatic stent in prevention of postoperative acute pancreatitis in patients with benign biliary stricture (BBS) treated by fullcovered self-expanding removable metal stents (FCSERMSs).Methods From Jan 2011 to Dec 2017,92 BBS patients who met the inclusion criteria were admitted and divided into pancreatic stent (PS) group and control group.The acute pancreatitis (AP) and hyperamylase (HP) after FCSERMS implantation and removal was observed.Results 55 cases in PS group and 37 cases in control group underwent successful FCSERMS implantation.The incidences of postoperative elevated amylase and HP had no significant differences between the two groups (23.6％ vs.32.4％,3.6％ vs.10.8％,all P ＞0.05).The incidences of postoperative AP and moderately elevated amylase had significant differences (0 vs.13.5％,20.0％ vs.8.1％,all P ＜ 0.05).The average placement time of FCSERMSs was 7.84 ± 1.22 months.The incidence of elevated amylase,AP,HP and moderately elevated amylase after the FCSERMS and PS removed had no statistical differences (3.6％ vs.14.3％,0vs.2.9％,0 vs.2.9％,3.6％vs.8.6％,all P＞0.05).Conclusion The placement of pancreatic stents in the treatment of BBS with FCSERMS is a simple,safe and effective method for the prevention of post-ERCP pancreatitis.