Endoscopic palliative treatment for esophageal and gastric cancer: techniques, complications, and survival in a population-based cohort of 948 patients

Thompson, Alistair; Rapson, T.; Gilbert, Fiona J.; Park, K. G.

doi:10.1007/s00464-003-9256-9

Cited by 39 publications

(19 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…With this strategy, our migration rate decreased to 27% (overlapping covered nitinol stents) and we were able to approach the migration rate for esophageal stents (24%), possibly due to greater mucosal surface area in contact with the stents [3,[11][12][13]. Previous studies have shown that the main morbidity of covered stents was migration while that for uncovered stents was tissue ingrowth and difficult extraction [5,6,9]. Deployment of an uncovered stent within a covered stent has been shown to reduce the migration rate while avoiding tissue ingrowth [4].…”

Section: Discussionmentioning

confidence: 47%

“…Chronic fistulas are initially treated conservatively but often need high-risk revisional surgery. Recently, endoscopic covered stents have been used successfully for treatment of anastomotic complications after esophageal resection [3][4][5]. Case series evaluating stents to treat anastomotic leaks after Roux-en-Y gastric bypass have shown success [6][7][8][9].…”

mentioning

confidence: 98%

See 1 more Smart Citation

Long-term outcome after endoscopic stent therapy for complications after bariatric surgery

et al. 2010

View full text Add to dashboard Cite

Although bariatric surgery effectively reduces the mortality risk from obesity-related comorbidities [1,2], it is associated with a 1-5% risk of anastomotic complications. Anastomotic leaks have traditionally been treated with a combination of drainage with long-term parenteral nutrition or postanastomotic enteral nutrition, allowing the leak to heal. Strictures at the gastrojejunostomy are initially treated with repeated endoscopic dilation, but revisional bariatric surgery is needed for refractory strictures with its associated high complication rate. Chronic fistulas are initially treated conservatively but often need high-risk revisional surgery. Recently, endoscopic covered stents have been used successfully for treatment of anastomotic complications after esophageal resection [3][4][5]. Case series evaluating stents to treat anastomotic leaks after Roux-en-Y gastric bypass have shown success [6][7][8][9]. However, the numbers of patients enrolled in these studies are small, and only short-term outcomes are reported.The primary aim of this study is to present long-term healing rates after endoscopically placed covered stents in the treatment of various anastomotic complications after bariatric surgery. The secondary aim is to analyze symptom improvement scores, complications, and factors affecting stent migration. Materials and methodsWe performed a retrospective analysis of all patients treated with endoscopic stents for staple-line complications after bariatric surgery from The study was approved by the University of Missouri Institutional Review Board.Inclusion criteria were patients who underwent either Roux-en-Y gastric bypass or sleeve gastrectomy with subsequent anastomotic complications defined as acute staple-line leaks, chronic anastomotic fistulas or refractory anastomotic strictures. Acute leaks were defined as those occurring within 1 month postoperatively. Refractory anastomotic strictures were defined as persistent clinically significant strictures that were endoscopically dilated more than twice without resolution. Chronic fistulas were defined as enterocutaneous or gastrogastric fistulas for longer than 1 month.The stents were placed using both endoscopic and fluoroscopic guidance with endoscopy being used to delineate the area of leak, stricture or fistula. This pathology was then marked with either a radiopaque marker on the skin surface or by injecting water-soluble contrast in the mucosa adjacent to the pathology to use as an internal marker. Strictures were identified and dilated for at least

show abstract

Section: Discussionmentioning

confidence: 47%

mentioning

confidence: 98%

Long-term outcome after endoscopic stent therapy for complications after bariatric surgery

et al. 2010

View full text Add to dashboard Cite

show abstract

“…Placement of a self-expanding metal stent is the most frequently used method for palliation of malignant dysphagia [13][14][15][16][17][18]. The first generation metal stents were uncovered, with the disadvantage of tumor ingrowth.…”

Section: Consmentioning

confidence: 99%

Palliative therapy

Homs

Kuipers

Siersema

2005

Journal of Surgical Oncology

View full text Add to dashboard Cite

There are a wide variety of palliative treatments for esophageal cancer. The aim of most treatments is to maintain oral food intake, which should stabilize or even improve quality of life. Stent placement is currently the most widely used treatment modality for palliation of dysphagia from esophageal cancer. Stent placement offers a rapid relief of dysphagia, however, the rate of complications (late hemorrhage) and recurrent dysphagia (stent migration, tumor overgrowth) is relatively high. The scientific evidence to advocate the use of anti-reflux stents for the prevention of gastro-esophageal reflux is currently too low. Photodynamic therapy is mostly used in North America; however, due to the high costs of the treatment, the long-lasting side effects and the necessity of repeated treatments, it is not an ideal treatment for palliation of malignant dysphagia. Nd:YAG laser is a relatively effective and safe treatment modality, although laser treatment is also expensive, technically difficult and requiring repeated treatment sessions at 4-6 weeks intervals. Single dose brachytherapy compares favorably to stent placement in long-term effectiveness and safety. Effective treatment strategies are probably 12 Gy given in one fraction or 16 Gy given in two fractions. Palliative chemotherapy offers response rates in recent trials (including partial and complete responses) ranging from 35% to 50%. Whether palliative chemotherapy also results in a survival benefit is not established yet. For clinical trials on palliation of esophageal cancer, the measurement of quality of life is an important outcome measure. The cancer-specific EORTC QLQ-C30 and the esophageal cancer-specific EORTC-OES-18 are validated measures for establishing quality of life status. For the future, a multimodality approach with stent placement or brachytherapy in combination with chemotherapy may be indicated.

show abstract

“…All of these techniques have significant limitations related to delay in therapy, morbidity, lack of tolerance, and ineffective nutritional supplementation. Preoperative esophageal stenting is a concept that is beginning to be evaluated as a potential technique to maximize efficient dysphagia relief as well as to maximize nutritional supplementation prior to surgical resection [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

The use of self-expanding silicone stents in esophageal cancer care: optimal pre-, peri-, and postoperative care

et al. 2008

View full text Add to dashboard Cite

show abstract

Endoscopic palliative treatment for esophageal and gastric cancer: techniques, complications, and survival in a population-based cohort of 948 patients

Abstract: These data define the reality of endoscopic palliative therapy for patients with advanced esophageal or gastric cancer and provide a baseline against which future improvements in care can be measured.

Cited by 39 publications

References 24 publications

Long-term outcome after endoscopic stent therapy for complications after bariatric surgery

Long-term outcome after endoscopic stent therapy for complications after bariatric surgery

Palliative therapy

The use of self-expanding silicone stents in esophageal cancer care: optimal pre-, peri-, and postoperative care

Contact Info

Product

Resources

About