scholarly journals Self-Expanding Metal Stenting for Palliation of Patients with Malignant Colonic Obstruction: Effectiveness and Efficacy on 255 Patients with 12-Month's Follow-up

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Søren Meisner ◽  
Ferran González-Huix ◽  
Jo G. Vandervoort ◽  
Alessandro Repici ◽  
Dimitrios Xinopoulos ◽  
...  
Keyword(s):  
Stent Placement ◽  
Clinical Success ◽  
Colonic Obstruction ◽  
Metal Stents ◽  
Control Group ◽  
Metal Stent ◽  
Multicenter Studies ◽  
Malignant Colonic Obstruction ◽  
Procedural Success

Background. Self-expanding metal stents can alleviate malignant colonic obstruction in incurable patients and avoid palliative stoma surgery.Objective. Evaluate stent effectiveness and safety on palliation of patients with malignant colorectal strictures.Design. Two prospective, one Spanish and one global, multicenter studies.Settings. 39 centers (22 academic, 17 community hospitals) from 13 countries.Patients. A total of 257 patients were enrolled, and 255 patients were treated with a WallFlex uncovered enteral colonic stent. Follow-up was up to 12 months or until death or retreatment.Interventions(s). Self-expanding metal stent placement.Main Outcome Measures. Procedural success, clinical success, and safety.Results. Procedural success was 98.4% (251). Clinical success rates were 87.8% at 30 days, 89.7% at 3 months, 92.8% at 6 months, and 96% at 12 months. Overall perforation rate was 5.1%. Overall migration rate was 5.5%. Overall death rate during follow-up was 48.6% (124), with 67.7% of deaths related to the patient’s colorectal cancer, unrelated in 32.3%. Only 2 deaths were related to the stent or procedure.Limitations. No control group.Conclusions. The primary palliative option for patients with malignant colonic obstruction should be self-expanding metal stent placement due to high rates of technical success and efficacy in symptom palliation and few complications.

Abstract 1787: Vertebral Artery Stent Placement for Symptomatic Patients: One-Year Follow-up

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Samir N Patel ◽  
J. Stephen Jenkins ◽  
Christopher J White ◽  
Paul McMullan ◽  
J.P. Reilly ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Stent Placement ◽  
Clinical Success ◽  
High Morbidity ◽  
Symptom Resolution ◽  
Non Invasive ◽  
Procedural Success ◽  
Repeat Angiography ◽  
One Year

Background : Symptomatic vertebral artery stenosis (VAS) has a five-year stroke risk of 30%–35%. Mortality associated with posterior circulation (PC) strokes is high, ranging from 20%–30%. Surgical revascularization is rarely performed due to high morbidity and mortality. Endovascular revascularization with stents offers a potential treatment option for these patients. Methods : One hundred nine patients (116 arteries, 70% male) underwent stent placement for extracranial (91%) and intracranial (9%) VAS from 1995–2006. Symptoms included vertigo (63%), visual changes (31%), syncope (11%), ataxia (7%), and drop attack (5%). Four patients had asymptomatic critical stenosis. Sixty-one patients (56%) had bilateral VAS, 74 patients (69%) had concomitant carotid disease, and 43 patients (39%) had a prior stroke. Procedural success was defined as residual stenosis of ≤ 20% without peri-procedural stroke or death. Clinical success was defined as procedural success with symptom resolution. Restenosis was defined as angiographic narrowing within the stent of ≥ 70% or > 50% with recurrent symptoms, or evidence of severe stenosis on non-invasive imaging (ultrasound, CT, or MR). Results : Procedural and clinical success was achieved in 108 (99.1%) and 95 (94.3%) patients, respectively. At one year, follow-up was obtained in 91 patients (83.5%), 6 patients (5.5%) had died, 5 patients (5.3%) experienced a PC stroke, and 47 patients (43.1%) underwent repeat angiography and/or non-invasive imaging. Eighty-seven of the 91 patients were initially symptomatic, 69 (79.3%) of which were symptom-free at one year. Three of those that had recurrent symptoms never achieved clinical success, 9 had developed restenosis, and 7 underwent successful re-intervention. At median follow-up of 31 months (lower and upper quartiles of 13.0 and 51.8 months), 72.5% were alive and 71.6% remained symptom-free. Conclusion : Our data demonstrates that stenting for VAS can be successfully performed in 99% of patients without peri-procedural stroke or death and is associated with durable symptom resolution in approximately 80% of patients at one year. In these high-risk patients, endovascular therapy for symptomatic VAS appears to be safe and effective at relieving symptoms.

scholarly journals Safety and outcomes of endoscopic ultrasound-guided drainage for malignant biliary obstruction using cautery-enabled lumen-apposing metal stent

2020 ◽  
Vol 08 (11) ◽  
pp. E1633-E1638
Author(s):  
Jerry Yung-Lun Chin ◽  
Samir Seleq ◽  
Frank Weilert
Keyword(s):  
Clinical Success ◽  
Clinical Success Rate ◽  
Metal Stents ◽  
Metal Stent ◽  
Endoscopic Retrograde ◽  
Stent Patency ◽  
Stent Occlusion ◽  
Secondary Endpoints ◽  
Mean Time

Abstract Background and study aims There is increasing evidence to suggest that EUS-guided biliary drainage (EUS-BD) is a safe and effective treatment alternative for patients with malignant biliary obstructions (MBOs) after failed endoscopic retrograde cholangiopancreatography. Patients and methods We performed a retrospective analysis of data prospectively collected from patients with MBO who underwent choledochoduodenostomy (CDS) or gallbladder drainage (GBD) between August 2016 and June 2020 using the electrocautery-enabled lumen-apposing metal stents (ECE-LAMS). The primary endpoint was technical and clinical success. Secondary endpoints were adverse events (AEs) and reinterventions. Results A total of 60 patients were included in the study, with 56 CDS and 4 GBD. Median age was 76 years with 57 % male (34/60). The most common indication for EUS-BD was pancreatic cancer (78 %). Technical success was achieved in 100 % of cases, with a clinical success rate of 91.7 %. Mean total bilirubin pre-procedure was 202 umol/L (normal < 20 umol/L) and 63.8 umol/L post procedure (P < .001). Twenty-one patients had bilirubin recorded at 2 weeks post EUS-BD with 20 of 21 patients demonstrating > 50 % reduction in bilirubin (mean bilirubin reduction 75 %). AEs occurred in 12 of 60 patients (20 %), all of which were mild. The reintervention rate was 11.7 % (7/60). Stent occlusion occurred in 10 of 60 patients (16.7 %) with a mean time to stent occlusion of 46.2 days (3–133). Stent patency of 83.3 % was observed with a mean follow up of 7.9 months. Conclusion EUS-CDS and GBD using ECE-LAMS are effective EUS-based techniques for managing patients with MBO. AEs are usually mild and resolved by reintervention.

scholarly journals What is the Impact of the Proportion of Solid Necrotic Content on the Number of Necrosectomies during EUS-Guided Drainage using Lumen-Apposing Metallic Stents of Pancreatic Walled-off Necrosis ?

2020 ◽  
Vol 29 (4) ◽  
pp. 623-628
Author(s):  
Andrada Seicean ◽  
Cristina Pojoga ◽  
Ofelia Mostean ◽  
Sorana Bolboaca ◽  
Madalina Ilie ◽  
...  
Keyword(s):  
Pancreatic Necrosis ◽  
Clinical Success ◽  
Metal Stents ◽  
Metal Stent ◽  
Endoscopic Necrosectomy ◽  
Medical Centers ◽  
One Step ◽  
Walled Off Necrosis ◽  
The Impact

Background and Aims: The fully-covered, lumen apposing metal stents are designed for one step placement, facilitating the direct endoscopic necrosectomy into the walled-off pancreatic necrosis. However, the prediction of the number of necrosectomy sessions in these patients is not known. This study evaluated the association between the proportion of solid necrotic material inside walled-off necrosis, as assessed during the endosonography placement of a lumen apposing metal stent, and the number of necrosectomies subsequently required. Methods: Patients from three tertiary medical centers with symptomatic walled off pancreatic necrosis (pain, infection, gastric/biliary obstruction) at more than 4 weeks after onset of acute pancreatitis were retrospectively analysed. Proportion of solid necrotic debris was estimated during endosonography procedure of lumen apposing metal stents placement. Necrosectomy was performed when obstruction or inflammation occurred subsequently. Lumen apposing metal stents were removed after clearance of necrotic content. Results: In 46 patients with successful lumen apposing metal stents placement, necrosectomy was performed in 39 patients (72.78%). Performance of 3 or more necrosectomies was significantly associated with more than 50% pancreatic necrosis (p=0.032), but not with walled-off pancreatic necrosis size or location. Necrotic infection during lumen apposing metal stents stenting was associated with hypoalbuminemia, but not with necrosectomy requirement. Clinical success after a median follow-up of 13.37 months was 87%. Conclusions: Walled-off pancreatic necrosis with more than 50% solid necrotic content were associated with more necrosectomy procedures, requiering longer endoscopy time, intravenous sedations, and higher costs.

scholarly journals Endoskopinis ūminės storosios žarnos obstrukcijos gydymas

2003 ◽  
Vol 1 (1) ◽  
pp. 0-0
Author(s):  
Kęstutis Adamonis ◽  
Dainius Pavalkis ◽  
Žilvinas Saladžinskas ◽  
Algimantas Tamelis
Keyword(s):  
Intestinal Obstruction ◽  
Colonic Obstruction ◽  
Cost Effective ◽  
University Hospital ◽  
Metal Stents ◽  
Metal Stent ◽  
Colorectal Obstruction ◽  
Underlying Malignancy ◽  
Malignant Gastrointestinal Obstruction ◽  
Self Expandable Metal Stent

Kęstutis Adamonis, Dainius Pavalkis, Žilvinas Saladžinskas, Algimantas TamelisKMU Gastroenterologijos klinika, KMU Chirurgijos klinika Šiuolaikis virškinimo trakto piktybinės obstrukcijos gydymas vis labiau tampa minimaliai invazinis. Ligoniai, sergantys storosios žarnos vėžiu, komplikuotu obstrukcija, į gydymo įstaigas patenka skubos tvarka, neretai sunkios būklės, ir nėra idealūs kandidatai chirurginei operacijai. Šiuolaikinėje medicinos literatūroje gausėja mokslinių straipsnių apie sėkmingą ir saugų endoskopiniu būdu įkišamų savaime išsiplečiančių metalinių stentų naudojimą proktologijoje. Nors stentai ir yra brangūs, tačiau proktologinis stentavimas yra rentabili procedūra, leidžianti ligoniams, sergantiems storosios žarnos vėžiu, komplikuotu ūminė storosios žarnos obstrukcija, išvengti neatidėliotinos operacijos, o esant nerezektabiliam vėžiui, – kolostomos. Straipsnyje aprašomas KMU Chirurgijos klinikoje atliktas pirmasis Lietuvoje sėkmingas endoskopinis ūminės žarnų obstrukcijos gydymas stentuojant žarnyną. Prasminiai žodžiai: žarnyno obstrukcija, kolorektinis vėžys, endoskopija, stentavimas. Acute colonic obstruction: endoscopical management Kęstutis Adamonis, Dainius Pavalkis, Žilvinas Saladžinskas, Algimantas Tamelis Management of malignant gastrointestinal obstruction presents a significant challenge. Most patients are in a profoundly decompensated state due to underlying malignancy and are not ideal candidates for invasive surgical procedures. In recent years, self-expandable metal stents have emerged as an effective and safe, less invasive alternative for the treatment of malignant intestinal obstruction. Although stents are expensive, the procedure appears to be cost-effective, since emergency surgery can be avoided in patients with acute bowel obstruction, and in those with advanced disease no resection of the colon is necessary. Here we report a retrospective analysis of a first self-expandable metal stent placed for colorectal obstruction at Kaunas Medical University Hospital, as well as review the literature published on self-expandable metal stent placement. Our first data confirm self-expandable metal stent efficacy in palliation of malignant intestinal obstruction. Keywords: intestinal obstruction, colorectal cancer, endoscopy, endoluminal stenting.

Periprocedural and Long-Term Outcomes of Stent Implantation for De Novo Subclavian Artery Disease

2019 ◽  
Vol 53 (4) ◽  
pp. 284-291
Author(s):  
Hirokazu Onishi ◽  
Toru Naganuma ◽  
Koji Hozawa ◽  
Tomohiko Sato ◽  
Hisaaki Ishiguro ◽  
...  
Keyword(s):  
Subclavian Artery ◽  
Stent Implantation ◽  
De Novo ◽  
Clinical Success ◽  
Primary Patency ◽  
Success Rates ◽  
Long Term Outcomes ◽  
Procedural Success

Introduction: The purpose of the current study was to investigate the periprocedural and long-term outcomes of stent implantation for de novo subclavian artery (SCA) disease. Material and Methods: We retrospectively investigated consecutive patients with de novo SCA lesions undergoing elective endovascular therapy procedures at our center between April 2004 and September 2015. All patients were included in the analyses of periprocedural outcomes, including procedural and clinical success. Subsequently, patients who completed the clinical follow-up and were assessed with brachial systolic pressure differences between the diseased and the contralateral arms, or angiographic stenosis, after stent implantation with procedural success were included in the analyses of long-term outcomes, including primary patency. Results: There were 62 patients (median 71.0 years, interquartile range 65.3-76.0 years; 45 men) with 62 de novo SCA lesions included in the analyses of periprocedural outcomes. There were 46 stenoses (74.2%) and 16 occlusions (25.8%). Our results indicated high procedural success rates for overall (95.2%), stenotic (97.8%), and occlusive (87.5%) lesions. Similarly, high clinical success rates were observed for overall (91.9%), stenotic (93.5%), and occlusive (87.5%) lesions. The median follow-up time was 6.0 years (interquartile range, 2.6-8.3 years). There were 48 patients with 48 de novo SCA lesions included in the analyses of long-term outcomes. Primary patency estimates were 97.7% (1 year), 97.7% (3 years), 93.1% (5 years), and 87.6% (7 years). Also, we observed a high estimate for freedom from reintervention for the target vessel (93.8%). Conclusion: Stent implantation for de novo SCA disease can be performed successfully and safely with favorable periprocedural and long-term outcomes.

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