A simplified technique of esophageal self-expandable metallic stent placement without fluoroscopic and endoscopic guidance for treating esophageal carcinoma

Kini, Ratnakar; Ramanathan, Sabarinathan; Thangavel, Pugazhendhi; Karunakaran, Premkumar; Mohamed, Kani Shaik; Ananthavadivelu, Murali

doi:10.5152/tjg.2018.17112

Cited by 3 publications

(4 citation statements)

References 20 publications

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“…Both patients survived for more than 30 days following the procedure [39]. In another study by Kini et al, one patient each in two study groups, "with fluoroscopic guidance" and "without fluoroscopic guidance", respectively, had intra-procedural perforation [51]. Garcio-Cano reported mediastinitis in 1 patient due to a perforation during stent insertion which was closed with two other stents [25].…”

Section: Discussionmentioning

confidence: 97%

“…In 14 of the included studies [24,25,[38][39][40][41][42][43][44][45][46][47][48][49], the esophageal stent was deployed under direct endoscopic view where as a through-thescope (TTS) technique was used in only one study [9]. In two studies [50,51], the esophageal stent was placed over a guidewire and confirmation of accurate positioning was done by post deployment endoscopy.…”

Section: Discussionmentioning

confidence: 99%

“…The authors concluded that both endoscopic and fluoroscopic techniques exhibited a comparable statistically significant improvement in dysphagia and that both techniques were equally safe. And while the conventional approach reduced procedure time and patient discomfort, the stents in the simplified technique were all fully covered and so a head-to-head comparison of techniques and outcomes could not be made with surety [51]. Ferriera et al concluded that both approaches are equally safe in terms of early and late complications [41].…”

Section: Discussionmentioning

confidence: 99%

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Clinical efficacy and safety of palliative esophageal stenting without fluoroscopy: a systematic review and meta-analysis

et al. 2020

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Background and study aims Despite advances in curative treatments for esophageal cancer, many patients often present with advanced disease. Dysphagia resulting in significant weight loss and malnutrition leads to poor quality of life. Palliative esophageal stenting with self-expanding metal stents (SEMS) helps alleviate symptoms and prolongs survival. However, access to fluoroscopy may be limited at certain centers causing delay in patient care. Methods We searched multiple databases from inception to November 2019 to identify studies evaluating the efficacy and safety of endoscopic palliative esophageal stenting and selected only those studies where fluoroscopic guidance was not used. Our primary aim was to calculate the overall technical as well as clinical success. Using meta-regression analysis, we also evaluated the effect of tumor location and obstruction length on overall technical and clinical success. Results A total of 1778 patients from 17 studies were analyzed. A total of 2036 stents were placed without the aid of fluoroscopy. The pooled rate of technical success was 94.7 % (CI 89.9–97.3, PI 55–99; I2 = 85) and clinical success was 82.1 % (CI 67.1–91.2, PI 24–99; I2 = 87). Based on meta-regression analysis both the length of obstruction and tumor location did not have any statistically significant effect on technical and clinical success. The pooled rate of adverse events was 4.1 % (CI 2.4–7.2; I2 = 72) for stent migration, 8.1 % (CI 4.1–15.4; I2 = 89) for tumor overgrowth and 1.2 % (CI 0.7–2; I2 = 0) for perforation. The most frequent clinical adverse event was retro-sternal chest pain. Conclusion Palliative esophageal stenting without fluoroscopy using SEMS is both safe and effective in patients with advanced esophageal cancer.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Clinical efficacy and safety of palliative esophageal stenting without fluoroscopy: a systematic review and meta-analysis

et al. 2020

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“…SEMS deployment requires advanced endoscopy skills for complex procedures and knowledge to manage potential adverse events. 18 - 20 Thus, we sought to develop standardized training processes to achieve proficiency in SEMS deployment for participating endoscopists. A curriculum to train endoscopists and ancillary support teams, including anesthetists and nurses, was developed in collaboration with BSC and the American Society for Gastrointestinal Endoscopy (ASGE).…”

Section: Methodsmentioning

confidence: 99%

Improving Access to Self-Expanding Metal Stents for Patients With Esophageal Cancer in Eastern Africa: A Stepwise Implementation Strategy

Mushi

Mwachiro

Buckle

et al. 2021

JCO Global Oncology

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PURPOSE The eastern corridor of Africa is affected by a high burden of esophageal cancer (EC), with > 90% of patients presenting with advanced disease. Self-expanding metal stents (SEMS) have been previously reported as safe and effective for palliation of malignant dysphagia in resource-limited settings; however, access is limited throughout Eastern Africa. METHODS In response to demand for palliative interventions for patients with dysphagia because of EC, the African Esophageal Cancer Consortium (AfrECC) partnered with the Clinton Health Access Initiative to improve access to SEMS in Eastern Africa. We undertook a stepwise implementation approach to (1) identify barriers to SEMS access, (2) conduct a market analysis, (3) select an industry partner, (4) establish regulatory and procurement processes, (5) develop endoscopic training resources, (6) create a medical device registry, and (7) establish principles of accountability. RESULTS Following an evaluation of market demand and potential SEMS manufacturers, Boston Scientific Corporation announced its commitment to launch an access program to provide esophageal SEMS to patients in Tanzania, Kenya, Malawi, and Zambia at a subsidized price. Parallel regulatory and procurement processes were established in each participating country. Endoscopy training courses were designed and conducted, using the Training-of-Trainers model. A device registry was created to centralize data for quality control and to monitor channels of SEMS distribution. Principles of accountability were developed to guide the sustainability of this endeavor. CONCLUSION The AfrECC Stent Access Initiative is an example of a multisector partnership formed to provide an innovative solution to align regional needs with a supply chain for a high-priority medical device.

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Safe oesophageal stent deployment using a checklist system instead of fluoroscopy

et al. 2022

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A simplified technique of esophageal self-expandable metallic stent placement without fluoroscopic and endoscopic guidance for treating esophageal carcinoma

Abstract: ABSTRACT

Cited by 3 publications

References 20 publications

Clinical efficacy and safety of palliative esophageal stenting without fluoroscopy: a systematic review and meta-analysis

Clinical efficacy and safety of palliative esophageal stenting without fluoroscopy: a systematic review and meta-analysis

Improving Access to Self-Expanding Metal Stents for Patients With Esophageal Cancer in Eastern Africa: A Stepwise Implementation Strategy

Safe oesophageal stent deployment using a checklist system instead of fluoroscopy

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