The management of gastric outlet obstruction with expandable metallic stents is difficult and frequently is associated with late complications. A new, flexible, covered metal stent has been developed, which may be sui...The management of gastric outlet obstruction with expandable metallic stents is difficult and frequently is associated with late complications. A new, flexible, covered metal stent has been developed, which may be suitable for treatment of patients with recurrent malignant strictures after gastric surgery. The stainless-steel stent is covered by a polyethylene membrane. It has a proximal funnel attached to an expanded antimigratory segment 29 mm in diameter. The flexible covering membrane connects isolated distal segments that are 20 mm in diameter. The stent is preloaded in a 6.7-mm diameter introducer system. The structural features and the increased flexibility of this new prosthesis are intended to red uce the risk of migration and the frequency of late complications, and to broaden the range of applications. This stent was used to successfully treat two patie nts with recurrent tortuous malignant strictures after partial or complete gastr ectomy. This new flexible, polyethylene-covered stent potentially is a new alte rnative for the palliation of patients with recurrent, inoperable gastric malign ant strictures.展开更多
PURPOSE: This study involved a prospective evaluation of the results of the ba lloon catheter dilation of lower gastrointestinal stenoses. METHODS: First a gui de-wire was introduced into the stenosis followed under x...PURPOSE: This study involved a prospective evaluation of the results of the ba lloon catheter dilation of lower gastrointestinal stenoses. METHODS: First a gui de-wire was introduced into the stenosis followed under x-ray control by a dou ble-lumen balloon catheter, or directly through the endoscope a balloon cathete r, with progressive dilation under pressures of 1.5 to 3 atm. The result was ass essed via the decreased indentation of the balloon and the increased diameter of the stenosis. RESULTS:Between January 1985 and November 2002, 133 dilations wer e performed on 57 patients. The cause of the stenosis was postoperative stenosis in 44 patients, Crohn’s disease in 6, ulcerative colitis in 2, postirradiative stenosis in 1, ischemic stenosis in 1, and scarring of the anus in 3 patients. Four of the st enoses were localized to the anus, 45 to the rectum, 7 to the colon, and 1 to th e terminal ileum. The average diameter of the stenosis was increased from 7.2 (r ange, 1-14) mm to 19.7 (range, 14-25) mm. Colostomies were closed in 11 of 17 cases. In five patients, the ileus state ceased, and the three colocutaneous fis tulas healed rapidly. In 17 of 57 patients, reoperation was proposed. In one pat ient, fever as a complication was treated with antibiotics. CONCLUSIONS: The dil ation of benign stenoses of the lower gastrointestinal tract with a balloon cath eter is an effective and safe method, which in most cases (70 percent) results i n long-term elimination of the obstructive symptoms, so that surgery can be avo ided.展开更多
文摘The management of gastric outlet obstruction with expandable metallic stents is difficult and frequently is associated with late complications. A new, flexible, covered metal stent has been developed, which may be suitable for treatment of patients with recurrent malignant strictures after gastric surgery. The stainless-steel stent is covered by a polyethylene membrane. It has a proximal funnel attached to an expanded antimigratory segment 29 mm in diameter. The flexible covering membrane connects isolated distal segments that are 20 mm in diameter. The stent is preloaded in a 6.7-mm diameter introducer system. The structural features and the increased flexibility of this new prosthesis are intended to red uce the risk of migration and the frequency of late complications, and to broaden the range of applications. This stent was used to successfully treat two patie nts with recurrent tortuous malignant strictures after partial or complete gastr ectomy. This new flexible, polyethylene-covered stent potentially is a new alte rnative for the palliation of patients with recurrent, inoperable gastric malign ant strictures.
文摘PURPOSE: This study involved a prospective evaluation of the results of the ba lloon catheter dilation of lower gastrointestinal stenoses. METHODS: First a gui de-wire was introduced into the stenosis followed under x-ray control by a dou ble-lumen balloon catheter, or directly through the endoscope a balloon cathete r, with progressive dilation under pressures of 1.5 to 3 atm. The result was ass essed via the decreased indentation of the balloon and the increased diameter of the stenosis. RESULTS:Between January 1985 and November 2002, 133 dilations wer e performed on 57 patients. The cause of the stenosis was postoperative stenosis in 44 patients, Crohn’s disease in 6, ulcerative colitis in 2, postirradiative stenosis in 1, ischemic stenosis in 1, and scarring of the anus in 3 patients. Four of the st enoses were localized to the anus, 45 to the rectum, 7 to the colon, and 1 to th e terminal ileum. The average diameter of the stenosis was increased from 7.2 (r ange, 1-14) mm to 19.7 (range, 14-25) mm. Colostomies were closed in 11 of 17 cases. In five patients, the ileus state ceased, and the three colocutaneous fis tulas healed rapidly. In 17 of 57 patients, reoperation was proposed. In one pat ient, fever as a complication was treated with antibiotics. CONCLUSIONS: The dil ation of benign stenoses of the lower gastrointestinal tract with a balloon cath eter is an effective and safe method, which in most cases (70 percent) results i n long-term elimination of the obstructive symptoms, so that surgery can be avo ided.
