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 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
Objective.It was suggested that coronary stent design and coating may affect stent performance and hence induce varying degrees of thrombogenesis and neointimal hyperplasia.T he purpose of this study is to compare th...Objective.It was suggested that coronary stent design and coating may affect stent performance and hence induce varying degrees of thrombogenesis and neointimal hyperplasia.T he purpose of this study is to compare the6-month follow-up results between o ld and new Multilink stents with the method of intravascular ultrasound(IVUS)imaging.Methods.We have performed old(n =40)and new(n =35)Multilink stent implantations on 75patients with coronary artery disease.Coron ary angiography was performed before,immediately after,and 6months after the in-stent procedure respectively.Six-month follow-up IVUS imaging was performed and analyzed off-line.Results.Minimal lumen cross sectional area(CSA)of new Multilink stents was signific antly larger than that of old Multilink stents(P=0.0053).Mean stent lumen area of new Multili nk stents was significantly larger than that of old Multilink stents(P=0.040).Similarly,minimal lumen diameter(MLD)of new Multilink stents was larger than that of old Mul tilink stents(P=0.011).Old Multilink stents had a higher percentage of plaque area than new Multilink stent s.Conclusion.The new Multilink stent is obviously superior to old Multilink stents,in particular,in the stent MLD and lumen CSA---major determinants of the restenosis.展开更多
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 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Objective.It was suggested that coronary stent design and coating may affect stent performance and hence induce varying degrees of thrombogenesis and neointimal hyperplasia.T he purpose of this study is to compare the6-month follow-up results between o ld and new Multilink stents with the method of intravascular ultrasound(IVUS)imaging.Methods.We have performed old(n =40)and new(n =35)Multilink stent implantations on 75patients with coronary artery disease.Coron ary angiography was performed before,immediately after,and 6months after the in-stent procedure respectively.Six-month follow-up IVUS imaging was performed and analyzed off-line.Results.Minimal lumen cross sectional area(CSA)of new Multilink stents was signific antly larger than that of old Multilink stents(P=0.0053).Mean stent lumen area of new Multili nk stents was significantly larger than that of old Multilink stents(P=0.040).Similarly,minimal lumen diameter(MLD)of new Multilink stents was larger than that of old Mul tilink stents(P=0.011).Old Multilink stents had a higher percentage of plaque area than new Multilink stent s.Conclusion.The new Multilink stent is obviously superior to old Multilink stents,in particular,in the stent MLD and lumen CSA---major determinants of the restenosis.
