IJGII Inernational Journal of Gastrointestinal Intervention

pISSN 2636-0004 eISSN 2636-0012
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< PreviousNext >Gastrointestinal Intervention 2015; 4(2): 69~129
  • Review Article 2015-12-24

    Stent placement in benign esophageal strictures

    Wei-Zhong Zhou, Ho-Young Song, Jung-Hoon Park, Ji Hoon Shin, and Jin Hyoung Kim

    Abstract : For benign esophageal strictures, the primary treatment is balloon dilation. However, approximately 10% of the strictures are not improved after balloon dilation and are defined as refractory benign esophageal strictures. The main causes of refractory benign esophageal strictures are esophageal surgery, caustic injury, and radiotherapy. Self-expandable stents, used primarily for the palliation of malignant esophageal strictures, are now used for refractory benign strictures due to the evolution of stent materials and designs. Fully covered, self-expandable metallic stents are the most commonly used. However, major complications such as tissue overgrowth and stent migration make the long-term results unfavorable. Recent studies of biodegradable stents and drug-eluting stents have shown encouraging results which may help to reduce the major complications.

    Cited By: 1

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  • Review Article 2015-12-24

    Esophageal stents: Beyond the simple stricture

    Derek William Edwards, and Hans-Ulrich Laasch

    Abstract : Advances in chemo-radiotherapy and cancer surgery are changing the landscape of esophageal stent insertion. Where previously patients received stents for end-stage esophageal carcinoma with a poor prognosis, long-term survival is beginning to become the norm. In addition more patients are undergoing radical surgery and consequently more patients are presenting with disease relapse in altered anatomy. Furthermore, patients with extra-esophageal cancer can require stent insertion, but their underlying disease may run a different course from esophageal cancer. We illustrate the challenges for stent performance, material longevity and forward thinking of the operator presented by the change in disease spectrum and behavior.

    Cited By: 2

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  • Review Article 2015-12-24

    Recent trend in applications of polymer materials to stents

    Ratchapol Jenjob, Phruedsaporn Taranamai, Kun Na, and Su-Geun Yang

    Abstract : Stent-based polymeric material is a remarkable tool to deal with any obstructions represented in gastrointestinal (GI) tract or to be used to avoid ongoing dilation or surgery in patients with benign stenosis. The extended study of the efficacy and the safety of the stent for human body should be studied. In near future, it would be possible to use bioresorbable polymeric stent in hospital instead of using metallic stents. In this review, the advantages of bioresorbable polymeric stent over metallic stent, the stenting of polymeric stent at GI tract as well as the drug release mechanism of stent-based polymer are presented. The mechanism of drug release and many parameters affecting drug releasing process are listed. In vitro and in vivo studies of drug-eluting stent are also reported.

    Cited By: 4

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  • Review Article 2015-12-24

    Management of gastroduodenal stent-related complications

    Stephen Y. Oh, and Richard A. Kozarek

    Abstract : Endoscopic placement of a gastroduodenal self-expandable metallic stent (SEMS) is a safe and minimally invasive intervention for patients with malignant gastric outlet obstruction (GOO). One major shortcoming of SEMS, however, is a frequent need for re-interventions due to stent-related complications, such as occlusion and migration. With continuing advances in oncologic therapy and improved survival in patients with malignancy, these complications may be encountered more frequently. Mild complications include abdominal discomfort, low grade fever, and occasional vomiting without obstruction. Major complications occurring within the first week include bleeding, perforation, stent migration, severe pain, fever, and jaundice. Significant late complications include fistula formation, stent obstruction, late perforation or bleeding, biliary obstruction, and stent migration. Correctly identifying and managing SEMS-related complications in a timely manner is essential in maintaining effective palliation in patients with malignant GOO. In this review article, we discuss the management of complications arising from the placement of gastroduodenal SEMS in patients with malignant GOO.

    Cited By: 7

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  • Review Article 2015-12-24

    Photodynamic therapy in esophageal cancer

    Richard A. Kozarek

    Abstract : Historically, photodynamic therapy was an additional mechanism, along with external beam irradiation or brachytherapy, Nd:YAG laser tumor ablation or esophageal stent placement and to a lesser extent, chemotherapy, used to reestablish esophageal continuity in patients with esophageal malignancy who could not undergo resective surgery by virtue of infirmity or tumor stage. However, it has been virtually abandoned for this indication by most practitioners for over a decade. More recently, it has been used in the West to eradicate high-grade dysplasia and superficial malignancies arising in Barrett’s esophagus, although its expense, limited availability, and side effect profile make widespread use unlikely, particularly given the widespread availability of other effective techniques. The latter include endoscopic submucosal resection, endoscopic submucosal dissection, radio-frequency ablation, and cryotherapy. This review highlights the historical use of photodynamic therapy in the treatment of esophageal malignancy and potential roles for its application in the future.

    Cited By: 1

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  • Review Article 2015-12-24

    Multimodality treatment for locally advanced esophageal cancers

    Yuri Jeong, and Jong Hoon Kim

    Abstract : For several decades, there have been many efforts to improve poor outcomes of locally advanced esophageal cancer. Multimodality treatment with neoadjuvant chemoradiotherapy (CRT) followed by surgery has been accepted as a standard treatment in the locally advanced, potentially resectable esophageal cancers in many institutions based on several recent randomized trials and meta-analysis. In addition, there has been a controversy about a role of the additional surgery in patients who responded well to the CRT. In this article, we reviewed results of classic treatments, past and current multimodality treatments, and issues related to good responders after CRT.

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  • Original Article 2015-12-24

    Fluoroscopically-guided palliative stenting for the management of malignant oesophageal obstruction: A five year experience

    Kulbir Mann, Ajay P. Belgaumkar, Andrew Hatrick, and Sukhpal Singh

    Abstract : BackgroundDysphagia is often a sign of advanced malignant oesophageal disease with 90% of these patients requiring palliative intervention. This study aims to evaluate the outcomes of patients treated for malignant obstruction with self-expanding metal stents (SEMS) over a five-year period.MethodsData was collected retrospectively from patients undergoing SEMS from January 2006 to December 2010. Primary outcomes were operative details, complications, re-interventions, and mortality rates.ResultsOne hundred twenty procedures were performed on 109 patients without any immediate complications. Thirty-two patients developed early complications and 20 patients died within thirty days. Twelve patients had stent-related difficulties and 10 patients were re-stented for recurrent dysphagia. Median survival from SEMS procedure was 2.7 months with an actuarial survival of 21% at 6 months and 7% at 1 year.ConclusionSEMS is an effective and safe method of palliation for patients with non-operable oesophageal cancer. Post procedural survival is short and palliative support should be initiated as soon as diagnosis is made.

    Cited By: 2

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  • Original Article 2015-12-24

    Percutaneous transhepatic balloon dilatation of benign bilioenteric strictures: Analysis of technique and long-term outcome

    Chinmay Bhimaji Kulkarni, Sreekumar Karumathil Pullara, Srikanth Moorthy, Nirmal Kumar Prabhu, Puthukudiyil Kader Nazar, and Ramiah Rajesh Kannan

    Abstract : BackgroundTo retrospectively analyze the technique and outcome of percutaneous transhepatic biliary balloon dilatation (PBBD) used to treat benign bilioenteric strictures in a series of patients who had undergone surgery for various pathologies.MethodsWe retrieved the hospital records of 90 patients with benign biliary strictures and identified 38 patients (male:female = 21:17; mean age, 50.7 ± 16.3 years [range, 13?77 years]) with benign bilioenteric strictures, treated by PBBD between 2000 and 2014. The technique, primary patency, secondary patency, clinical success and complications of PBBD were analyzed.ResultsThe bilioenteric anastomoses were performed for postcholecystectomy bile duct injury (n = 15, 39.5%), recurrent pyogenic cholangitis (n = 9, 23.7%), patients operated for malignancies (n = 8, 21.1%), choledochal cyst excision (n = 5, 13.2%) and chronic pancreatitis (n = 1, 2.6%). All patients presented with clinical features of cholangitis. The average duration of treatment of PBBD was 3.0 ± 1.1 months (range, 1?24 months). Technical success for balloon dilatation was achieved in 33/38 (86.8%). The primary patency period and secondary patency periods were 32.5 ± 7.8 months and 22.5 ± 6.4 months, respectively. Clinical success was achieved in all patients who underwent complete balloon dilatation treatment. The post treatment mean time of follow-up was 31.4 ± 20.1 months (range, 1?140 months; median, 24 months) and was available in all patients who successfully underwent balloon dilatation treatment. Recurrence was observed in 8.1% of patients. The mean symptom-free survival time was 123.4 months (95% confidence interval, 105.8?141.1 months). One year and 2 year clinical success rate was 92.1% and 83.0%, respectively.ConclusionIrrespective of the underlying pathology balloon dilatation provides excellent long term relief from symptoms in patients with benign bilioentric stricture and should be offered as the first line of management in these patients.

    Cited By: 0

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  • Case Report 2015-12-24

    Management of jejunal bleeding by jejunal variceal embolization and portal venous recanalization after pylorus-preserving pancreaticoduodenectomy

    Dong Jae Shim, and Ji Hoon Shin

    Abstract : Gastrointestinal (GI) bleeding is a life-threatening condition that typically presents with hematemesis, melena, or hematochezia and can have various causes. Treatment strategies differ in accordance with the focus of the bleeding. Imaging modalities can reveal the bleeding focus but often cannot discriminate arterial from portal venous bleeding. The management of bleeding from ectopic varices is especially challenging because access to the bleeding point is difficult. Esophagogastric varices are usually caused by portal venous hypertension, but postoperative complications can also cause ectopic GI bleeding. Bleeding caused by portal venous obstruction can be managed with portal vein (PV) stenting, a portosystemic shunt, and adjunctive embolization of varices. We report a case of active jejunal bleeding from a portal venous obstruction after pylorus-preserving pancreaticoduodenectomy managed by PV stenting and selective jejunal variceal embolization.

    Cited By: 1

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  • Case Report 2015-12-24

    Chemoembolization for hepatocellular carcinoma supplied by the right gastric artery

    Jung Hwan Park, Ung Bae Jeon, Tae Un Kim, Jun Woo Lee, Ki Seok Choo, Ki Tae Yoon, and Mong Cho

    Abstract : There are various types of extrahepatic collateral vessels, but a right gastric artery that supplies hepatocellular carcinoma (HCC) is rare. Knowledge of this rare parasitic vessel will enhance the therapeutic efficacy of transcatheter arterial chemoembolization (TACE) for HCC. We present a case of TACE to treat a HCC that was fed by the right gastric artery. A 60-year-old man with reecurrent HCC underwent four repeated sessions of TACE. The HCC was successfully treated by TACE via the right gastric artery.

    Cited By: 0

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