Стенты «Ella-cs» Уважаемые коллеги! Высылаем очередной выпуск «Issue of ELLA Abstracts»

Transcription

1 Уважаемые коллеги! Высылаем очередной выпуск «Issue of ELLA Abstracts» A. Esophageal Stenting and related topics 1 AMJG 2009; 104: Letters to Editor Early Tracheal Stenosis Post Esophageal Stent Insertion in a Patient With Lung Cancer 2 Endoscopy 2009; 41: Effect of drug-eluting metal stents in benign esophageal stricture: an in vivo animal study Background and study aims: The aim of this study in canines was to investigate the effectiveness and safety of self-expandable metal stents, which were coated with paclitaxel to minimize the tissue response. Materials and methods: 14 dogs (5-10 kg) were randomly allocated to two groups. Drug-eluting stents (DES, n = 7) or nondrug-eluting stents (non-des, n = 7) were endoscopically inserted and fixed in the esophagus of healthy dogs. Every 2 weeks, for a maximum period of 8 weeks, an endoscopic examination was performed to evaluate the status of stent insertion, the grade of tissue hyperplasia, and mucosal change at both ends of the stent. : One case of stent migration was observed after 4 weeks in the non-des group. In this group, tissue reaction and hyperplasia remained for more than 4 weeks after stent insertion. By contrast, an endoscopic examination of the surrounding esophageal mucosa in the DES group showed very little tissue reaction, and the stent was easily separated from the esophageal tissue. Conclusion: Although further studies are required to confirm our results, we suggest that these newly designed DES may provide an alternative tool to manage refractory benign esophageal stricture. 3 Dig Surg 2009; 26: Diagnostic Strategies for Pre-Treatment Staging of Patients with Oesophageal Cancer Background/Aims: Current guidelines for staging oesophageal cancer recommend a series of preoperative investigations. There is no consensus on the recommended order for these investigations or whether all investigations are necessary in all patients. Our aim was to determine an efficient strategy for pre-treatment staging of patients with oesophageal cancer. Methods: We retrospectively compared 15 staging strategies, based on all possible orders of all possible subsets of three staging modalities (computed tomography, endoscopic ultrasonography and external ultrasonography of the neck). We assumed that if distant metastases or local irresectability were found and confirmed, no further investigations would be

2 performed. Main outcome was the minimal number of investigations needed to detect all patients with incurable disease. : Using all three investigations in all 412 patients would lead to performance of 1,236 investigations. Both strategies starting with computed tomography or endoscopic ultrasonography and ending with external ultrasonography were most efficient, using a total of 1,112 investigations. Conclusion: The use of a conditional staging strategy with a specific order of imaging can reduce the number of tests necessary to identify incurable patients with oesophageal cancer by 10%. In our opinion, this is not enough to recommend implementation of a logistically more complex diagnostic system. B. Gastric outlet (GO) and duodenal stenting and related topics 4 GIE 2009; 69, 6: Efficacy and safety of the new WallFlex enteral stent in palliative treatment of malignant gastric outlet obstruction (DUOFLEX study): a prospective multicenter study Background Gastric outlet obstruction (GOO) is most commonly a complication of advanced distal gastric, periampullary, or duodenal malignancy. Palliation of obstruction is the primary aim of treatment in most of these patients. Self-expandable metal stents have emerged as an effective treatment option. Our purpose was to investigate the efficacy and safety of a newly developed enteral metal stent (WallFlex). Design Prospective multicenter cohort study. Setting Three tertiary referral centers (2 academic). Patients Fifty-one consecutive patients with symptomatic malignant GOO from January 2005 to February Intervention Placement of a self-expandable metallic stent (WallFlex). The primary end point was defined as improvement of the GOO scoring system for the remainder of the patients' lives. Secondary end points focused on efficacy and safety and global quality of life. The Gastric Outlet Obstruction Scoring System score improved (P <.001), the body mass index decreased (P <.001), and the World Health Organization performance score improved (P =.002) when the score before stenting was compared with the mean score until death. Global quality of life did not improve. Technical and clinical success was achieved in 98% and 84% of the patients. Median survival was 62 days (75% alive at 35 days, 25% alive at 156 days). Median stent patency was 307 days (75% functional at 135 days, 25% functional at 470 days). Stent dysfunction was proved in 7 patients (14%), migration in 1 (2%), and tumor overgrowth or ingrowth in 6 (12%). Limitations Lack of a control group. Conclusion

3 Placement of a WallFlex enteral stent in patients with nonresectable malignant GOO is safe and provides a statistically significant and clinically relevant relief of obstructive symptoms with a low need for reintervention. C. Biliary and pancreatic stenting, and related topics 5 GIE 2009; 69, 6: Intraluminal implantation of radioactive stents for treatment of primary carcinomas of the peripancreatic-head region: a pilot study Background Patients diagnosed with bile-duct, pancreatic-head, and ampullary carcinomas have a poor prognosis. This study evaluated the potential curative efficacy and safety of intraluminal brachytherapy by using radioactive stents for palliative treatment of these patients. Design and Setting Patients with inoperable extrahepatic bile-duct (n = 2), pancreatic-head (n = 6), or ampullary (n = 3) carcinomas were treated by intraluminal implantation of radioactive stents designed according to a computerized treatment-planning system. Interventions Both radioactive stents and commonly used self-expanding metallic or plastic stents were placed in the common bile duct (CBD) of the patients. For pancreatic carcinoma, the combination of radioactive CBD and pancreatic duct (PD) stents or only a radioactive PD stent was chosen according to the tumor position. Survival, tumor status, and complications were assessed during the follow-up period. A total of 16 radioactive stents were successively placed in all 11 patients. There were no life-threatening complications. The median survival was 150 days. After 2 months of the placement of radioactive stents, 8 patients (72.7%) had stable disease, whereas 3 patients (27.3%) showed progressive disease. The combination of radioactive stents and metallic and/or plastic stents was technically feasible and tolerable in patients with advanced tumors around the pancreatic-head area. 6 GIE 2009; 69, 6: Histologic influence of paclitaxel-eluting covered metallic stents in a canine biliary model Metallic stents for malignant biliary obstruction are susceptible to occlusion by tumor ingrowth or overgrowth. Paclitaxeleluting metallic stents (PEMSs), however, may prevent occlusion from tumor ingrowth. We evaluated the safety of PEMSs in a canine biliary model by analyzing tissue reactions by histologic examination. Design

4 Animal study. Setting and Interventions Six PEMSs and 5 control stents (CSs) were endoscopically placed in the bile ducts of 11 mongrel dogs and followed up for 6 weeks. The animals were euthanized at 6 weeks, and gross and microhistologic examinations were done. A comparison was made between dogs with PEMSs and dogs with CSs. All 11 stents were successfully placed in the bile ducts, although the distal ends of 2 PEMSs were partially exposed to the duodenal lumen. All 11 dogs survived until death without evidence of jaundice. Gross histologic examination showed mucosal hyperplasia in 3 of 6 dogs in the PEMS group, but there was no evidence of mucosal hyperplasia in the CS group. Microscopically, the epithelial layers at the middle and distal ends of the stented segments were significantly thicker in the PEMS dogs than in the CS group. Placement of PEMSs in normal canine bile ducts was without significant technical complications; however, local drug delivery from the PEMS resulted in significant histologic changes. Therefore, it is important to choose a drug in adequate concentrations to exert an antitumor effect without damaging the adjacent normal bilary mucosa. 7 GIE 2009; 69, 6: High-grade common bile duct stricture caused by diffuse adenomyomatosis 8 GIE 2009; 69, 6: Novel management of complex hilar biliary strictures with the Spyglass Direct Visualization System 9 JVIR 2009; 20, 5: Magnetic Compression Biliary enteric Anastomosis for Palliation of Obstructive Jaundice: Initial Clinical Purpose To report initial clinical experience with a nonsurgical method for sutureless biliary enteric anastomosis with use of two magnetic elements that potentially overcomes the disadvantages of other palliative methods. Materials and Methods The technique involves percutaneous transhepatic insertion of one magnet into the bile duct under fluoroscopic guidance and insertion of a second magnet endoscopically into the duodenum. The adherence of the two magnets creates ischemic necrosis of bile duct and duodenal walls. When these tissues slough, the resulting hole allows enteric passage of the magnets and creates a biliary enteric fistula for decompression of an obstructed biliary system. A magnetic compression biliary enteric

5 anastomosis (MCBEA) was created in 34 patients (nine men; mean age, 64 years; age range, y) with malignant obstructive jaundice at the level of the middle or distal common bile duct. There was no recurrent jaundice during the initial 30 postprocedural days. Total bilirubin levels decreased significantly in all patients 1 week after MCBEA formation (P <.0001), with normalization of bilirubin levels in eight of 34 patients. There was temporary occlusion caused by partial clogging of the bypass with coarse food in two cases, which was successfully revised endoscopically. Three patients required surgical revision as a result of tumor ingrowth. Median survival time was 10 months. The cause of death in all patients was progression of underlying malignancy. Creation of a biliary enteric anastomosis with magnetic compression is a feasible alternative for palliative treatment of obstructive jaundice with satisfactory results. 10 JVIR 2009; 20, 5: Colonic Perforation by a Percutaneously Displaced Biliary Stent: Report of a Case and a Review of Current Practice Percutaneous biliary interventions are often performed for biliary obstruction when endoscopic stent placement is not feasible or has failed to provide relief. These secondary percutaneous interventions may be complicated by the presence of a previously placed occluded biliary stent requiring displacement and removal. The authors report a case of colonic perforation by a plastic biliary stent that was purposely displaced into the small bowel for passage at the time of percutaneous intervention and review the current practices concerning biliary stent removal in interventional radiology and gastrointestinal endoscopy.