Double layered self-expanding metal stents for malignant esophageal obstruction, especially across the gastroesophageal junction

AIM: To evaluate the clinical outcomes of double-layered self-expanding metal stents (SEMS) for treatment of malignant esophageal obstruction according to whether SEMS crosses the gastroesophageal junction (GEJ). METHODS: Forty eight patients who underwent the SEMS insertion for malignant esophageal obstruction were enrolled. Patients were classified as GEJ group (SEMS across GEJ, 18 patients) and non-GEJ group (SEMS above GEJ, 30 patients) according to SEMS position. Double layered (outer uncovered and inner covered stent) esophageal stents were placed. RESULTS: The SEMS insertion and the clinical improvement were achieved in all patients in both groups. Stent malfunction occurred in seven patients in the GEJ group and nine patients in the non-GEJ group. Tumor overgrowth occurred in five and eight patients, respectively, food impaction occurred in one patient in each group, and stent migration occurred in one and no patient, respectively. There were no significant differences between the two groups. Reflux esophagitis occurred more frequently in the GEJ group (eight vs five patients, P = 0.036) and was controlled by proton pump inhibitor. Aspiration pneumonia occurred in zero and five patients, respectively, and tracheoesophageal fistula occurred in zero and two patients, respectively. CONCLUSION: Double-layered SEMS are a feasible and effective treatment when placed across the GEJ for malignant esophageal obstruction. Double-layered SEMS provide acceptable complications, especially migration, although reflux esophagitis is more common in the GEJ group.

Acute esophageal obstruction caused by reverse migration of gastric bezoars: A case report

BACKGROUND Bezoars can be found anywhere in the gastrointestinal tract.Esophageal bezoars are rare.Esophageal bezoars are classified as either primary or secondary.It is rarely reported that secondary esophageal bezoars caused by reverse migration from the stomach lead to acute esophageal obstruction.Guidelines recommend urgent upper endoscopy(within 24 h)for these impactions without complete esophageal obstruction and emergency endoscopy(within 6 h)for those with complete esophageal obstruction.Gastroscopy is regarded as the mainstay for the diagnosis and treatment of esophageal bezoars.CASE SUMMARY A 59-year-old man was hospitalized due to nausea,vomiting and diarrhea for 2 d and sudden retrosternal pain and dysphagia for 10 h.He had a history of type 2 diabetes mellitus for 9 years.Computed tomography revealed dilated lower esophagus,thickening of the esophageal wall,a mass-like lesion with a flocculent high-density shadow and gas bubbles in the esophageal lumen.On gastroscopy,immovable brown bezoars were found in the lower esophagus,which led to esophageal obstruction.Endoscopic fragmentation was successful,and there were no complications.The symptoms of retrosternal pain and dysphagia disappeared after treatment.Mucosal superficial ulcers were observed in the lower esophagus.Multiple biopsy specimens from the lower esophagus revealed nonspecific findings.The patient remained asymptomatic,and follow-up gastroscopy 1 wk after endoscopic fragmentation showed no evidence of bezoars in the esophagus or the stomach.CONCLUSION Acute esophageal obstruction caused by bezoars reversed migration from the stomach is rare.Endoscopic fragmentation is safe,effective and minimally invasive and should be considered as the first-line therapeutic modality.

Clinical application of metallic stents in treatment of esophageal carcinoma

AIM: To evaluate the effects of self-expanding metal stents (SEMS) in patients with malignant esophageal obstruction and to analyze their prognosis and complications. METHODS: Seventy-four metallic stents were placed under fluoroscopic guidance in 66 patients with esophageal obstruction secondary to carcinoma, of whom, 6 cases were complicated by fistula. RESULTS: After seventy-two stents were successfully used in 66 cases without any severe complications (technical successful rate was 97%), the dysphagia score improved from 3.3±0.6 to 0.8±0.5 (P<0.01), and life quality improved significantly in all these patients. All fistulae were sealed immediately after coated stents were inserted in the six patients. New stents were placed in two patients: the stent migrated more than 2 cm, in one patients and the stent slipped into stomach in the other. Minor bleeding was found only in 28 patients during the operation. Reobstruction was found in 12 patients, but was successfully cured under endoscopy. The survival rate was 78%, 57% and 11% for 6 mo, 1 year and 2 years respectively. CONCLUSION: Placement of SEMS is a simple, safe, quick and efficient surgical method for treating esophageal carcinoma obstruction. It may be used mainly as a palliative treatment of esophageal obstruction secondary to carcinoma.

Comparison of clinical features and high-resolution esophageal motility characteristics between esophagogastric junction outflow obstruction and type Ⅱ achalasia patients

Objective To compare the clinical features and high-resolution esophageal motility-impedance characteristics among esophagogastric junction outflow obstruction(Eoo)patients,typeⅡachalasia(Ach)patients and healthy controls(Con),in order to explore the values of esophageal high-resolution manometry(HRM)in diagnosis and treatment of Eoo patients.Methods Patients