Endoscopic placement of self-expandable metallic stents for palliation of patients with malignant gastric outlet obstruction is safe and feasible. Patients with malignant gastric outlet obstruction undergoing enteral ...Endoscopic placement of self-expandable metallic stents for palliation of patients with malignant gastric outlet obstruction is safe and feasible. Patients with malignant gastric outlet obstruction undergoing enteral stent insertion were identified from endoscopy databases. Duration of oral intake after stent insertion was calculated by using the log-rank test. Factors associated with duration of oral intake were assessed by using Cox multivariable regression analysis. A total of 176 patients (mean age 65 [14] years) treated at 4 centers from 1996 to 2003 were identified. Obstruction was caused by cancer of the pancreas in 84, the stomach in 20, the bile duct in 15, the major duodenal papilla in 8, another primary site in 16, and metastases in 33. The site of obstruction was the duodenum in 125, the distal stomach in 17, the stomach and the duodenum in 18, and surgical anastomosis in 16 patients. Stent deployment was technically successful in 173. Complications occurred in 14 patients. Seventeen patients were lost to follow-up. Of the remaining 159 patients, 133 resumed oral intake for a median time of 146 days: 95%CI [65, 202]. On regression analysis, chemotherapy after stent placement was associated with prolonged duration of oral intake (hazard ratio 0.41: 95%CI [0.23, 0.72]). After enteral stent insertion for malignant gastric outlet obstruction, 84%of patients resumed oral intake for a median time of 146 days. Chemotherapy after enteral stent insertion was independently associated with prolongation of oral intake.展开更多
19世纪的牙医Charles Stent怎会想到他因为发明了用于制造牙膜的热弹性材料而引发了支架的最初设想,使其名字在100年后的消化领域被如此频繁的提及.消化系疾病的支架治疗是继血管介入术后另一个发展异常迅速的领域.20世纪80年代,人们已...19世纪的牙医Charles Stent怎会想到他因为发明了用于制造牙膜的热弹性材料而引发了支架的最初设想,使其名字在100年后的消化领域被如此频繁的提及.消化系疾病的支架治疗是继血管介入术后另一个发展异常迅速的领域.20世纪80年代,人们已开始用塑料支架治疗各种恶性食管狭窄,但因操作过程复杂、并发症发生率高、疗效差等原因使其应用范围大受限制.1990年德国学者Domschke et al[1]最先报道使用Wallstent金属支架治疗恶性食管狭窄以来,整个支架治疗的概念、方法进入了新的阶段.近10年来,随着各种不同材质、构造、形状的金属支架及推送器的问世和技术改进,支架治疗的整体效果、各种并发症的发生率及处理手段均有了相应的变化.回顾金属支架的演进、改良和发展历史,全面了解各类支架的物理性能、特点和临床应用情况,对实际操作工作中支架的选择、支架效能的发挥和降低并发症率都是大有裨益的.展开更多
We report a case of a pseudoaneurysm of the right hepatic artery observed 9 mo after the endoscopic placement of a Wallstent,for bile duct stenosis,which was treated with transcatheter arterial embolization.The patien...We report a case of a pseudoaneurysm of the right hepatic artery observed 9 mo after the endoscopic placement of a Wallstent,for bile duct stenosis,which was treated with transcatheter arterial embolization.The patient presented with obstructive jaundice and was diagnosed with inoperable common bile duct cancer.A plastic stent was inserted endoscopically to drain the bile,and chemotherapy was initiated.Abdominal pain and jaundice appeared approximately 6 mo after the beginning of chemotherapy.A diagnosis of stent occlusion and cholangitis was made,and the plastic stent was removed and substituted with a self-expandable metallic stent(SEMS) endoscopically.Nine months after SEMS insertion,contrast-enhanced computed tomography showed a pseudoaneurysm of the right hepatic artery protruding into the common bile duct lumen and in contact with the SEMS.The shape and size of the pseudoaneurysm and diameter of its neck was determined by contrast-enhanced ultrasonography using Sonazoid.A micro-catheter was led into the pseudoaneurysm in the right hepatic artery,GDC Detachable Coils were placed,and IDC Detachable Coils were then placed in the right hepatic artery on the distal and proximal sides of the pseudoaneurysm using the isolation method.There have been a few reports on pseudoaneurysm associated with stent placement in the biliary tract employing percutaneous transhepatic procedures,however,reports of pseudoaneurysms associated with endoscopic SEMS placement are very rare.展开更多
文摘Endoscopic placement of self-expandable metallic stents for palliation of patients with malignant gastric outlet obstruction is safe and feasible. Patients with malignant gastric outlet obstruction undergoing enteral stent insertion were identified from endoscopy databases. Duration of oral intake after stent insertion was calculated by using the log-rank test. Factors associated with duration of oral intake were assessed by using Cox multivariable regression analysis. A total of 176 patients (mean age 65 [14] years) treated at 4 centers from 1996 to 2003 were identified. Obstruction was caused by cancer of the pancreas in 84, the stomach in 20, the bile duct in 15, the major duodenal papilla in 8, another primary site in 16, and metastases in 33. The site of obstruction was the duodenum in 125, the distal stomach in 17, the stomach and the duodenum in 18, and surgical anastomosis in 16 patients. Stent deployment was technically successful in 173. Complications occurred in 14 patients. Seventeen patients were lost to follow-up. Of the remaining 159 patients, 133 resumed oral intake for a median time of 146 days: 95%CI [65, 202]. On regression analysis, chemotherapy after stent placement was associated with prolonged duration of oral intake (hazard ratio 0.41: 95%CI [0.23, 0.72]). After enteral stent insertion for malignant gastric outlet obstruction, 84%of patients resumed oral intake for a median time of 146 days. Chemotherapy after enteral stent insertion was independently associated with prolongation of oral intake.
文摘19世纪的牙医Charles Stent怎会想到他因为发明了用于制造牙膜的热弹性材料而引发了支架的最初设想,使其名字在100年后的消化领域被如此频繁的提及.消化系疾病的支架治疗是继血管介入术后另一个发展异常迅速的领域.20世纪80年代,人们已开始用塑料支架治疗各种恶性食管狭窄,但因操作过程复杂、并发症发生率高、疗效差等原因使其应用范围大受限制.1990年德国学者Domschke et al[1]最先报道使用Wallstent金属支架治疗恶性食管狭窄以来,整个支架治疗的概念、方法进入了新的阶段.近10年来,随着各种不同材质、构造、形状的金属支架及推送器的问世和技术改进,支架治疗的整体效果、各种并发症的发生率及处理手段均有了相应的变化.回顾金属支架的演进、改良和发展历史,全面了解各类支架的物理性能、特点和临床应用情况,对实际操作工作中支架的选择、支架效能的发挥和降低并发症率都是大有裨益的.
文摘We report a case of a pseudoaneurysm of the right hepatic artery observed 9 mo after the endoscopic placement of a Wallstent,for bile duct stenosis,which was treated with transcatheter arterial embolization.The patient presented with obstructive jaundice and was diagnosed with inoperable common bile duct cancer.A plastic stent was inserted endoscopically to drain the bile,and chemotherapy was initiated.Abdominal pain and jaundice appeared approximately 6 mo after the beginning of chemotherapy.A diagnosis of stent occlusion and cholangitis was made,and the plastic stent was removed and substituted with a self-expandable metallic stent(SEMS) endoscopically.Nine months after SEMS insertion,contrast-enhanced computed tomography showed a pseudoaneurysm of the right hepatic artery protruding into the common bile duct lumen and in contact with the SEMS.The shape and size of the pseudoaneurysm and diameter of its neck was determined by contrast-enhanced ultrasonography using Sonazoid.A micro-catheter was led into the pseudoaneurysm in the right hepatic artery,GDC Detachable Coils were placed,and IDC Detachable Coils were then placed in the right hepatic artery on the distal and proximal sides of the pseudoaneurysm using the isolation method.There have been a few reports on pseudoaneurysm associated with stent placement in the biliary tract employing percutaneous transhepatic procedures,however,reports of pseudoaneurysms associated with endoscopic SEMS placement are very rare.
