AIM:To compare diverse endoscopic interventions in the management of occluded uncovered self-expanding metal stents(SEMSs) that had been placed for palliative treatment of unresectable malignant biliary obstruction.ME...AIM:To compare diverse endoscopic interventions in the management of occluded uncovered self-expanding metal stents(SEMSs) that had been placed for palliative treatment of unresectable malignant biliary obstruction.METHODS:A retrospective review was undertaken in 4 tertiary endoscopic centers to determine optimal management of different types of occluded SEMSs.The technical success of performed treatment in occluded SEMSs,the patency of the stent,the need for re-intervention and the financial costs of each treatment were analyzed.RESULTS:Fifty four patients were included in the analysis;21 received Hanaro,19 Wallstent and 14 Flexus.For the relief of obstruction,a plastic stent was inserted in 24 patients,a second SEMS in 25 and mechanical cleaning was performed in 5 patients.The overall median second patency rates between second SEMSs and plastic stents did not differ(133 d for SEMSs vs 106 d for plastic stents;P = 0.856).Similarly,no difference was found between the overall survival of SEMS and plastic stent groups,and no procedure-related complications occurred.Incremental cost analysis showed that successive plastic stenting was a cost-saving strategy at least in Greece.CONCLUSION:Insertion of uncovered SEMSs or plastic stents is a safe and effective treatment for occluded uncovered SEMSs;insertion of plastic stents appears to be the most cost-effective strategy.展开更多
AIM:To describe a modified technique for placement of a tracheobronchial self-expanding plastic stent(SEPS) in patients with benign refractory hypopharyngeal strictures in order to improve dysphagia and allow strictur...AIM:To describe a modified technique for placement of a tracheobronchial self-expanding plastic stent(SEPS) in patients with benign refractory hypopharyngeal strictures in order to improve dysphagia and allow stricture remodeling.METHODS:A case series of four consecutive patients with complex hypopharyngeal strictures after combinedtherapy for laryngeal cancer,previously submitted to multiple sessions of dilation without lasting improvement,is presented.All patients underwent placement of a small diameter and unflared tracheobronchial SEPS.Main outcome measurements were improvement of dysphagia and avoiding of repeated dilation.RESULTS:The modified introducer system allowed an easy and technically successful deployment of the tracheobronchial Polyflex stent through the stricture.All four patients developed complications related to stent placement.Two patients had stent migration(one proximal and one distal),two patients developed phanryngocutaneous fistulas and all patients with stents in situ for more than 8 wk had hyperplastic tissue growth at the upper end of the stent.Stricture recurrence was observed at 4 wk follow-up after stent removal in all patients CONCLUSION:Although technically feasible,placement of a tracheobronchial SEPS is associated with a high risk of complications.Small diameter stents must be kept in place for longer than 3 mo to allow adequate time for stricture remodeling.展开更多
文摘AIM:To compare diverse endoscopic interventions in the management of occluded uncovered self-expanding metal stents(SEMSs) that had been placed for palliative treatment of unresectable malignant biliary obstruction.METHODS:A retrospective review was undertaken in 4 tertiary endoscopic centers to determine optimal management of different types of occluded SEMSs.The technical success of performed treatment in occluded SEMSs,the patency of the stent,the need for re-intervention and the financial costs of each treatment were analyzed.RESULTS:Fifty four patients were included in the analysis;21 received Hanaro,19 Wallstent and 14 Flexus.For the relief of obstruction,a plastic stent was inserted in 24 patients,a second SEMS in 25 and mechanical cleaning was performed in 5 patients.The overall median second patency rates between second SEMSs and plastic stents did not differ(133 d for SEMSs vs 106 d for plastic stents;P = 0.856).Similarly,no difference was found between the overall survival of SEMS and plastic stent groups,and no procedure-related complications occurred.Incremental cost analysis showed that successive plastic stenting was a cost-saving strategy at least in Greece.CONCLUSION:Insertion of uncovered SEMSs or plastic stents is a safe and effective treatment for occluded uncovered SEMSs;insertion of plastic stents appears to be the most cost-effective strategy.
文摘AIM:To describe a modified technique for placement of a tracheobronchial self-expanding plastic stent(SEPS) in patients with benign refractory hypopharyngeal strictures in order to improve dysphagia and allow stricture remodeling.METHODS:A case series of four consecutive patients with complex hypopharyngeal strictures after combinedtherapy for laryngeal cancer,previously submitted to multiple sessions of dilation without lasting improvement,is presented.All patients underwent placement of a small diameter and unflared tracheobronchial SEPS.Main outcome measurements were improvement of dysphagia and avoiding of repeated dilation.RESULTS:The modified introducer system allowed an easy and technically successful deployment of the tracheobronchial Polyflex stent through the stricture.All four patients developed complications related to stent placement.Two patients had stent migration(one proximal and one distal),two patients developed phanryngocutaneous fistulas and all patients with stents in situ for more than 8 wk had hyperplastic tissue growth at the upper end of the stent.Stricture recurrence was observed at 4 wk follow-up after stent removal in all patients CONCLUSION:Although technically feasible,placement of a tracheobronchial SEPS is associated with a high risk of complications.Small diameter stents must be kept in place for longer than 3 mo to allow adequate time for stricture remodeling.
