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
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
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
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
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
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.
Cited By: 0
Cited By: 2
Cited By: 0
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
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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