BACKGROUND Colonic stents are increasingly used to treat acute malignant colonic obstructions.The Wall Flex and Niti-S D type stents are the commonly used self-expandable metallic stents available in Japan since 2012....BACKGROUND Colonic stents are increasingly used to treat acute malignant colonic obstructions.The Wall Flex and Niti-S D type stents are the commonly used self-expandable metallic stents available in Japan since 2012.Wall Flex stent has a risk of stentrelated perforation because of its axial force,while the Niti-S D type stent has a risk of obstructive colitis because of its weaker radial force.Niti-S MD type stents not only overcome these limitations but also permit delivery through highly flexible-tipped smaller-caliber colonoscopes.AIM To compare the efficacy and safety of the newly developed Niti-S MD type colonic stents.METHODS This single-center retrospective observational study included 110 patients with endoscopic self-expandable metallic stents placed between November 2011 and December 2018:Wall Flex(Group W,n=37),Niti-S D type(Group N,n=53),and Niti-S MD type(Group MD,n=20).The primary outcome was clinical success,defined as a resolution of obstructive colonic symptoms,confirmed by clinical and radiological assessment within 48 h.The secondary outcome was technical success,defined as accurate stent placement with adequate stricture coverage on the first attempt without complications.RESULTS The technical success rate was 100%in Groups W,N,and MD,and the overall clinical success rate was 89.2%(33/37),96.2%(51/53),and 100%(20/20)in Groups W,N,and MD,respectively.Early adverse events included pain(3/37,8.1%),poor expansion(1/37,2.7%),and fever(1/37,2.6%)in Group W and perforation due to obstructive colitis(2/53,3.8%)in Group N(likely due to poor expansion).Late adverse events(after 7 d)included stent-related perforations(4/36,11.1%)and stent occlusion(1/36,2.8%)in Group W and stent occlusion(2/51,3.9%)in Group N.The stent-related perforation rate in Group W was significantly higher than that in Group N(P<0.05).No adverse event was observed in Group MD.CONCLUSION In our early and limited experience,the newly developed Niti-S MD type colonic stent was effective and safe for treating acute malignant colonic obstruction.展开更多
Background： Currently, drug-eluting balloon （DEB） appears to be an attractive alternative option for the treatment of in-stent restenosis （ISR）. Nevertheless, the clinical outcomes of DEB have seldom been compare...Background： Currently, drug-eluting balloon （DEB） appears to be an attractive alternative option for the treatment of in-stent restenosis （ISR）. Nevertheless, the clinical outcomes of DEB have seldom been compared to those of new-generation drug-eluting stent （DES）. Thus, this meta-analysis aimed to evaluate the safety and efficacy of DEB compared to those of new-generation DES in the treatment of ISR. Methods： A comprehensive search of electronic databases including PubMed, EMBASE, and Cochrane Library up to November 2, 2017 was performed to identify pertinent articles comparing DEB to new-generation DES for the treatment of ISR. In addition, conference proceedings for the scientific sessions of the American College of Cardiology, American Heart Association, European Society of Cardiology, Transcatheter Cardiovascular Therapeutics, and EuroPCR were also searched. The primary endpoint was target lesion revascularization （TLR） at the longest follow-up. Dichotomous variables were presented as risk ratios （RRs） with 95% confidence intervals （C/s）, while the overall RRs were estimated using the Mantel-Haenszel random-effects model. Results： Five randomized controlled trials （RCTs） and eight observational studies involving 2743 patients were included in the present meta-analysis. Overall, DEB was comparable to new-generation DES in terms ofTLR （RR = 1.24, 95% CI： 0.89-1.72, P = 0.21 ）, cardiac death （RR = 1.55, 95% CI： 0.89-2.71, P= 0.12）, major adverse cardiovascular event （RR = 1.21,95% CI： 0.98-1.48, P = 0.07）, myocardial infarction （RR = 1.12, 95% CI： 0.72-1.76, P = 0.62）, and stent thrombosis （RR = 0.95, 95% CI： 0.38-2.42, P associated with higher risk of all-cause mortality than new-generation DES （RR = 1.65, 95% CI： 1.09-2.50, P = true in the real-world observational studies （RR = 1.79, 95% CI： 1.12-2.88, P = 0.02）. In RCTs, however, no found between the two treatment strategies in the risk of all-cause mortality. 0.92）. However, DEB was 0.02）. This was especially significant difference was Conclusions： The current meta-analysis showed that DEB and new-generation DES had comparable safety and efficacy for the treatment of ISR in RCTs. However, treatment with DEB was associated with higher risk of all-cause mortality in the real-world nonrandomized studies.展开更多
文摘BACKGROUND Colonic stents are increasingly used to treat acute malignant colonic obstructions.The Wall Flex and Niti-S D type stents are the commonly used self-expandable metallic stents available in Japan since 2012.Wall Flex stent has a risk of stentrelated perforation because of its axial force,while the Niti-S D type stent has a risk of obstructive colitis because of its weaker radial force.Niti-S MD type stents not only overcome these limitations but also permit delivery through highly flexible-tipped smaller-caliber colonoscopes.AIM To compare the efficacy and safety of the newly developed Niti-S MD type colonic stents.METHODS This single-center retrospective observational study included 110 patients with endoscopic self-expandable metallic stents placed between November 2011 and December 2018:Wall Flex(Group W,n=37),Niti-S D type(Group N,n=53),and Niti-S MD type(Group MD,n=20).The primary outcome was clinical success,defined as a resolution of obstructive colonic symptoms,confirmed by clinical and radiological assessment within 48 h.The secondary outcome was technical success,defined as accurate stent placement with adequate stricture coverage on the first attempt without complications.RESULTS The technical success rate was 100%in Groups W,N,and MD,and the overall clinical success rate was 89.2%(33/37),96.2%(51/53),and 100%(20/20)in Groups W,N,and MD,respectively.Early adverse events included pain(3/37,8.1%),poor expansion(1/37,2.7%),and fever(1/37,2.6%)in Group W and perforation due to obstructive colitis(2/53,3.8%)in Group N(likely due to poor expansion).Late adverse events(after 7 d)included stent-related perforations(4/36,11.1%)and stent occlusion(1/36,2.8%)in Group W and stent occlusion(2/51,3.9%)in Group N.The stent-related perforation rate in Group W was significantly higher than that in Group N(P<0.05).No adverse event was observed in Group MD.CONCLUSION In our early and limited experience,the newly developed Niti-S MD type colonic stent was effective and safe for treating acute malignant colonic obstruction.
文摘Background： Currently, drug-eluting balloon （DEB） appears to be an attractive alternative option for the treatment of in-stent restenosis （ISR）. Nevertheless, the clinical outcomes of DEB have seldom been compared to those of new-generation drug-eluting stent （DES）. Thus, this meta-analysis aimed to evaluate the safety and efficacy of DEB compared to those of new-generation DES in the treatment of ISR. Methods： A comprehensive search of electronic databases including PubMed, EMBASE, and Cochrane Library up to November 2, 2017 was performed to identify pertinent articles comparing DEB to new-generation DES for the treatment of ISR. In addition, conference proceedings for the scientific sessions of the American College of Cardiology, American Heart Association, European Society of Cardiology, Transcatheter Cardiovascular Therapeutics, and EuroPCR were also searched. The primary endpoint was target lesion revascularization （TLR） at the longest follow-up. Dichotomous variables were presented as risk ratios （RRs） with 95% confidence intervals （C/s）, while the overall RRs were estimated using the Mantel-Haenszel random-effects model. Results： Five randomized controlled trials （RCTs） and eight observational studies involving 2743 patients were included in the present meta-analysis. Overall, DEB was comparable to new-generation DES in terms ofTLR （RR = 1.24, 95% CI： 0.89-1.72, P = 0.21 ）, cardiac death （RR = 1.55, 95% CI： 0.89-2.71, P= 0.12）, major adverse cardiovascular event （RR = 1.21,95% CI： 0.98-1.48, P = 0.07）, myocardial infarction （RR = 1.12, 95% CI： 0.72-1.76, P = 0.62）, and stent thrombosis （RR = 0.95, 95% CI： 0.38-2.42, P associated with higher risk of all-cause mortality than new-generation DES （RR = 1.65, 95% CI： 1.09-2.50, P = true in the real-world observational studies （RR = 1.79, 95% CI： 1.12-2.88, P = 0.02）. In RCTs, however, no found between the two treatment strategies in the risk of all-cause mortality. 0.92）. However, DEB was 0.02）. This was especially significant difference was Conclusions： The current meta-analysis showed that DEB and new-generation DES had comparable safety and efficacy for the treatment of ISR in RCTs. However, treatment with DEB was associated with higher risk of all-cause mortality in the real-world nonrandomized studies.
