Background: Self- expandable metal stents (SEMS) are being increasingly used to palliate malignant stenoses of the gastric outlet and proximal small bowel. Accordingly, we reviewed our experience in this setting. Meth...Background: Self- expandable metal stents (SEMS) are being increasingly used to palliate malignant stenoses of the gastric outlet and proximal small bowel. Accordingly, we reviewed our experience in this setting. Methods: Patients with gastric outlet or proximal small bowel stents were identified by reviewing hospi tal charts. Outcome criteria included survival data, need for reintervention, an d clinical improvement. Results: A total of 52 SEMS were placed in 36 patients w ith nonesophageal upper GI stenosis. Initial stent placement was successful in 9 2% and clinical improvement documented in 75% . Mean survival of patients who eventually died was 3.5 months. Seven patients are alive (mean follow- up, 5.0 months). Stent dysfunction occurred in 36% and required subsequent interventi ons. Biliary obstruction was documented in 50% of patients, 12 of whom had pre viously undergone biliary stenting and 5 who needed subsequent biliary decompres sion. Conclusions: Enteral stent placement has been reported to be an effective alternative for palliation of high- risk surgical patients with malignant gastr ic outlet and small bowel obstruction. Considering the short life expectancy of these patients and significant complications including stent mi gration, perforation, biliary obstruction, and need for subsequent endoscopic , radiologic and surgical interventions, the authors suggest that this procedure be performed in experienced centers on selected patients only and that biliary decompression be ensured early.展开更多
Self expandable metal stents deployed across the gastroesophageal junction predispose to gastroesophageal reflux. The efficacy of a stent with an antireflux mechanism in preventing gastroesophageal reflux was assessed...Self expandable metal stents deployed across the gastroesophageal junction predispose to gastroesophageal reflux. The efficacy of a stent with an antireflux mechanism in preventing gastroesophageal reflux was assessed. Thirty patients with carcinoma of the distal esophagus or of the gastric cardia were randomized to receive either a stent with a windsock-type antireflux valve (FerX-Ella) (n = 15) or a standard open stent (n = 15) of the same design minus the valve. Gastr oesophageal reflux was assessed by using standardized questionnaires and by 24- hour pH monitoring 14 days after treatment. Technical problems occurred during stent placement in 3 patients: migration (n = 2) and a problem with the introduci ng system (n = 1). Dysphagia improved from a median score of 3 (liquids only) to 1 (eat some solid food) in the antireflux group and from 3 to 0 (solid foods) i n the open stent group (p >0.20). Reflux symptoms were reported by 3/12 patients (25%) with an antireflux stent and by 2/14 (14%) with an open stent. In 11 patients, 24-hour pH monitoring was obtained, and increased esophageal acid expos ure (normal: < 4%) was present with both types of stent: median 24-hour reflux time (9 patients) with the antireflux stent was 23% vs. 10% in (2 patients) with the open stent (p = NS). Major complications occurred in 3 patients (20%) in each group and included bleeding (n = 3), severe pain (n = 2), and aspiration pn eumonia (n = 1). The main cause of recurrent dysphagia was stent migration, which occurred in 7 of the 30 patients (23%). The FerX-Ella antireflux stent provi ded relief of dysphagia caused by malignancy of the distal esophagus and gastric cardia. However, the antireflux valve failed to prevent gastroesophageal reflux .展开更多
AIM: To ascertain clinical outcome and complications of self-expandable metal stents for endoscopic palliation of patients with malignant obstruction of the gastrointestinal (GI) tract. METHODS: A retrospective review...AIM: To ascertain clinical outcome and complications of self-expandable metal stents for endoscopic palliation of patients with malignant obstruction of the gastrointestinal (GI) tract. METHODS: A retrospective review was performed throughout August 2000 to June 2005 of 53 patients with gastric outlet obstruction caused by stomach cancer. All patients had symptomatic obstruction including nausea, vomiting, and decreased oral intake. All received self-expandable metallic stents. RESULTS: Stent implantation was successful in all 53 (100%) patients. Relief of obstructive symptoms was achieved in 43 (81.1%) patients. No immediate stent-related complications were noted. Seventeen patients had recurrent obstruction (tumor ingrowth in 14 patients, tumor overgrowth in 1 patient, and partial distal stent migration in 2 patients). The mean survival was 145 d. Median stent patency time was 187 d. CONCLUSION: Endoscopic placement of self-expandable metallic stents is a safe and effective treatment for the palliation of patients with inoperable malignant gastric outlet obstruction caused by stomach cancer.展开更多
文摘Background: Self- expandable metal stents (SEMS) are being increasingly used to palliate malignant stenoses of the gastric outlet and proximal small bowel. Accordingly, we reviewed our experience in this setting. Methods: Patients with gastric outlet or proximal small bowel stents were identified by reviewing hospi tal charts. Outcome criteria included survival data, need for reintervention, an d clinical improvement. Results: A total of 52 SEMS were placed in 36 patients w ith nonesophageal upper GI stenosis. Initial stent placement was successful in 9 2% and clinical improvement documented in 75% . Mean survival of patients who eventually died was 3.5 months. Seven patients are alive (mean follow- up, 5.0 months). Stent dysfunction occurred in 36% and required subsequent interventi ons. Biliary obstruction was documented in 50% of patients, 12 of whom had pre viously undergone biliary stenting and 5 who needed subsequent biliary decompres sion. Conclusions: Enteral stent placement has been reported to be an effective alternative for palliation of high- risk surgical patients with malignant gastr ic outlet and small bowel obstruction. Considering the short life expectancy of these patients and significant complications including stent mi gration, perforation, biliary obstruction, and need for subsequent endoscopic , radiologic and surgical interventions, the authors suggest that this procedure be performed in experienced centers on selected patients only and that biliary decompression be ensured early.
文摘Self expandable metal stents deployed across the gastroesophageal junction predispose to gastroesophageal reflux. The efficacy of a stent with an antireflux mechanism in preventing gastroesophageal reflux was assessed. Thirty patients with carcinoma of the distal esophagus or of the gastric cardia were randomized to receive either a stent with a windsock-type antireflux valve (FerX-Ella) (n = 15) or a standard open stent (n = 15) of the same design minus the valve. Gastr oesophageal reflux was assessed by using standardized questionnaires and by 24- hour pH monitoring 14 days after treatment. Technical problems occurred during stent placement in 3 patients: migration (n = 2) and a problem with the introduci ng system (n = 1). Dysphagia improved from a median score of 3 (liquids only) to 1 (eat some solid food) in the antireflux group and from 3 to 0 (solid foods) i n the open stent group (p >0.20). Reflux symptoms were reported by 3/12 patients (25%) with an antireflux stent and by 2/14 (14%) with an open stent. In 11 patients, 24-hour pH monitoring was obtained, and increased esophageal acid expos ure (normal: < 4%) was present with both types of stent: median 24-hour reflux time (9 patients) with the antireflux stent was 23% vs. 10% in (2 patients) with the open stent (p = NS). Major complications occurred in 3 patients (20%) in each group and included bleeding (n = 3), severe pain (n = 2), and aspiration pn eumonia (n = 1). The main cause of recurrent dysphagia was stent migration, which occurred in 7 of the 30 patients (23%). The FerX-Ella antireflux stent provi ded relief of dysphagia caused by malignancy of the distal esophagus and gastric cardia. However, the antireflux valve failed to prevent gastroesophageal reflux .
文摘AIM: To ascertain clinical outcome and complications of self-expandable metal stents for endoscopic palliation of patients with malignant obstruction of the gastrointestinal (GI) tract. METHODS: A retrospective review was performed throughout August 2000 to June 2005 of 53 patients with gastric outlet obstruction caused by stomach cancer. All patients had symptomatic obstruction including nausea, vomiting, and decreased oral intake. All received self-expandable metallic stents. RESULTS: Stent implantation was successful in all 53 (100%) patients. Relief of obstructive symptoms was achieved in 43 (81.1%) patients. No immediate stent-related complications were noted. Seventeen patients had recurrent obstruction (tumor ingrowth in 14 patients, tumor overgrowth in 1 patient, and partial distal stent migration in 2 patients). The mean survival was 145 d. Median stent patency time was 187 d. CONCLUSION: Endoscopic placement of self-expandable metallic stents is a safe and effective treatment for the palliation of patients with inoperable malignant gastric outlet obstruction caused by stomach cancer.
