Esophageal Stents for Acute Variceal Bleeding: Expanding the Possibilities

INTRODUCTION: We aim to discuss the utility of self-expandable esophageal metal stent (SEMS) in variceal bleeding in challenging cases. METHODS: Case description, discussion on patient management and decision-making process in an uncommon situation, from a multidisciplinary point of view. RESULTS: We report a case of a cirrhotic patient with refractory variceal bleeding who underwent a SEMS placement, which remained in situ for 9 months. This decision was based on the initial poor status and short life expectancy, limiting the consideration of other options for lowering portal hypertension, along with an underlying prothrombotic predisposition. However, the patient's general and hepatic improvement and the development of dysphagia led to the SEMS removal, exposing a large esophageal–tracheal fistula. DISCUSSION: Early patient evaluation, risks of long-term SEMS, and life expectancy should be taken in consideration before SEMS placement.

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Endoscopic hemostasis with self-expanding nitinol stents (literature review)

Anisimov

Loginov

Ибрагимов

et al. 2020

Ann. hir. gepatol.

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Aim. A critical analysis of modern scientific publications on the application in complex treatment program of patients with acute bleeding from esophageal varices endoscopic hemostasis with self-expanding nitinol Danish stents.Methods. Literature data are presented on the results of treating patients at the height of esophageal bleeding or with a high risk of recurrence by installing self-expanding nitinol Danish stents.Results. The advantages of Danish stent include low trauma; good tolerance; physiological saliva drainage and the possibility of receiving fluid and food through the mouth; repeated endoscopic examination of the esophagus and stomach after the introduction of the stent; reducing the risk of aspiration pneumonia; the impossibility of removal or displacement by the patient in a state of excitement. The disadvantages of self-expanding nitinol Danish stents, in addition to the risk of migration from the esophagus to the stomach with loss of its plugging function, include the limitation of the therapeutic effect only to varicose veins of the esophagus, the development of small erosions or ulcers on the mucous membrane of the esophagus after stent removal.Conclusion. The extent to which endoscopic hemostasis with self-expanding nitinol Danish stents will take a strong place in the treatment of patients with variceal bleeding is not clear. In the recommendations of the Baveno VI Consensus the method is considered as an attractive alternative to Sengstaken–Blackmore balloon tamponade, however, the need for confirmation of the initial clinical results by further comparative randomized controlled trials is indicated.

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Esophageal Stents for Acute Variceal Bleeding: Expanding the Possibilities

Cited by 6 publications

References 15 publications

Cirrhosis and Bleeding Esophageal Varices: Historic Perspectives

Cirrhosis and Bleeding Esophageal Varices: Historic Perspectives

Long-Term Self-Expandable Metal Stent (SEMS) for Esophageal Variceal Bleeding: A Picture of the Natural History

Endoscopic hemostasis with self-expanding nitinol stents (literature review)

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