Esophageal stent placement without optical or fluoroscopic visualization.
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ABSTRACT:
SUBMITTER: Mwachiro MM
PROVIDER: S-EPMC6031224 | biostudies-literature | 2017 Nov
REPOSITORIES: biostudies-literature
Publications
Esophageal stent placement without optical or fluoroscopic visualization.
Mwachiro Michael M MM Parker Robert K RK Chepkwony Robert R Burgert Stephen L SL White Russell E RE
VideoGIE : an official video journal of the American Society for Gastrointestinal Endoscopy 20171012 11
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Project description:BackgroundCentral airway obstruction and fistula are treated with a tracheobronchial Y stent. In the currently used self-expandable metal Y stents, the delivery system is 8 mm in diameter and requires either a 9 mm tracheal tube or rigid bronchoscope to enable airway control during insertion. In this study we present a novel technique of laryngeal mask airway (LMA) assisted Y stent insertion, enabling airway control during deployment of the Y stent.MethodsAll procedures using LMA in assisting Y stent insertions between 2014-2020 were reviewed. Data collected included demographics, clinical diagnosis and disease characteristics, indication, procedural success rates, clinical outcome and survival.ResultsA total of 10 patients with a median age of 61.5 years (range 37-73) underwent LMA assisted Y stent insertion. Indications for stent insertion were malignant disease with central airway obstruction or fistula. In all cases airway patency was achieved leading to improvement of symptoms and performance status. No procedural complications were reported. The median survival was 4.5 weeks (range: 2-26).ConclusionsLMA assisted Y stent insertion enables airway control during the procedure. In comparison to silicone Y stent insertion, the procedure is less cumbersome, shorter in duration and does not require the use of general anesthesia or rigid bronchoscopy.Key pointsSIGNIFICANT FINDINGS OF THE STUDY: LMA assisted Y stent insertion enables airway control during the implantation of metallic self-expanding Y stent. The procedure does not require the use of general anesthesia or rigid bronchoscopy.What this study addsIn this study we present the technique and outcomes of LMA assisted Y stent insertion. This method of Y stent insertion provides an additional treatment option for patients with central airway obstruction and fistula.
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Project description:This is a retrospective study to evaluate the prevention of complications of metallic stent placement in patients with unresectable advanced esophageal cancer. A total of 87 patients were treated with 4 types of metal stents in the esophagus over a period of 18 years. Stent placement was technically successful. The most common prior treatment was chemoradiotherapy. There were no significant differences in the rate of patients with no complications among the prior treatments. Approximately, 30% of patients had the most common chest pain in complications. Stent placement within one month after the completion of chemoradiotherapy should be avoided for the prevention of the chest pain. There was no significant difference in the rate of patients with no complications by lesion location. The rate of no complications was higher for the Niti-S stent than the Gianturco Z-stent or Ultraflex stent. Of note, no complications were noted for the Niti-S ultrathin stent at all. Among cases of stent-related death, the most common type of complication was respiratory disorder caused by the stent that seems to be thick and hard. Therefore, the stent with thin and flexible characteristics like the Niti-S ultrathin stent will solve the various problems of esophageal stent placement.
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Project description:BackgroundPalliative treatments and stents are necessary for relieving dysphagia in patients with esophageal cancer. The aim of this study was to simultaneously compare available treatments in terms of complications.MethodsWeb of Science, Medline, Scopus, Cochrane Library and Embase were searched. Statistical heterogeneity was assessed using the Chi2 test and was quantified by I2. The results of this study were summarized in terms of Risk Ratio (RR). The random effects model was used to report the results. The rank probability for each treatment was calculated using the p-score.ResultsOut of 17855 references, 24 RCTs reported complications including treatment related death (TRD), bleeding, stent migration, aspiration, severe pain and fistula formation. In the ranking of treatments, thermal ablative therapy (p-score = 0.82), covered Evolution® stent (p-score = 0.70), brachytherapy (p-score = 0.72) and antireflux stent (p-score = 0.74) were better treatments in the network of TRD. Thermal ablative therapy (p-score = 0.86), the conventional stent (p-score = 0.62), covered Evolution® stent (p-score = 0.96) and brachytherapy (p-score = 0.82) were better treatments in the network of bleeding complications. Covered Evolution® (p-score = 0.78), uncovered (p-score = 0.88) and irradiation stents (p-score = 0.65) were better treatments in network of stent migration complications. In the network of severe pain, Conventional self-expandable nitinol alloy covered stent (p-score = 0.73), polyflex (p-score = 0.79), latex prosthesis (p-score = 0.96) and brachytherapy (p-score = 0.65) were better treatments.ConclusionAccording to our results, thermal ablative therapy, covered Evolution® stents, brachytherapy, and antireflux stents are associated with a lower risk of TRD. Moreover, thermal ablative therapy, conventional, covered Evolution® and brachytherapy had lower risks of bleeding. Overall, fewer complications were associated with covered Evolution® stent and brachytherapy.
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Project description:ObjectivesColonic manometry catheter placement can be performed by colonoscopy or fluoroscopy. Our objective was to compare outcomes of colonoscopic to fluoroscopic catheter placement in children based on the extent of colon study and the likelihood of catheter displacement.MethodsColonic manometry studies performed between May 2015 and May 2022 were reviewed. All studies with catheter placement per rectum were included. Data on patient demographics, medical and surgical history, and information on catheter placement (type of catheter, placement technique, position, and displacement) were recorded.ResultsWe reviewed 555 studies and included 482 studies performed on 453 children (51% female, median age 10 years, interquartile range: 7-14 years). The catheter was placed during colonoscopy in 274 studies and using fluoroscopy in 208 studies. Children with colonoscopic placement were significantly older (median age 11 vs. 8 years, p < 0.001), more commonly male (55% vs. 41%, p = 0.003), and more commonly had functional constipation (85% vs. 69%, p < 0.001). Children with fluoroscopic placement more often had pediatric intestinal pseudo-obstruction (10% vs. 1%, p < 0.001), a diverting ostomy (21% vs. 7%, p < 0.001), and a cecostomy (10% vs. 4%, p = 0.023). A successful catheter placement (reaching ascending colon) was significantly more common using colonoscopy (49% vs. 23%, p < 0.001). There were no differences in frequency or extent of catheter displacement between colonoscopic and fluoroscopic placement.ConclusionsColonoscopic placement was superior to fluoroscopic placement in terms of the extent of the colon studied with no differences in frequency of catheter displacement. Colonoscopic placement should be the preferred method in most children with refractory constipation.
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Project description:Symptoms including pain and discomfort commonly present during ureteral stenting is not well understood. We investigated global changes in ureters at the transcriptional, translational, and functional levels while stents are indwelling and following removal and recovery using a porcine model. Polaris stents (6Fr, Boston Scientific, Natick, MA) were cystoscopically inserted with placement confirmed using fluoroscopy. For proteomics samples, ureters were stented for 14 days and recovered for 7 days and each pig was stented unilaterally so that the contralateral unstented kidney and ureter served as an internal control.
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