Results of a new method to stop acute bleeding from esophageal varices: implantation of a self-expanding stent

Zehetner, Jörg; Shamiyeh, Andreas; Wayand, W.; Hubmann, Rainer

doi:10.1007/s00464-008-0009-7

Cited by 90 publications

(90 citation statements)

References 21 publications

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“…De esta forma, se desarrolló un stent metálico autoexpandible completamente recubierto como alternativa a la terapia de taponamiento con balón en el sangrado variceal refractario agudo. Hasta el momento, este dispositivo cuenta con cuatro estudios realizados, el mayor de ellos con 34 pacientes y que ha demostrado resultados favorables en términos de control inmediato de la hemorragia, con un 77% a 100% de éxito y baja proporción de complicaciones, como técnica de salvación (9,10). En el caso especial de las várices gás-tricas, el balón de Linton-Nachlass todavía desempeña un papel importante (11).…”

Section: Discussionunclassified

Manejo de un sangrado por úlcera posligadura de várices esofágicas mediante prótesis metálica autoexpandible: reporte de un caso y revisión de la literatura

Rey

Solano

Sierra

et al. 2015

Rev. Colomb. Gastroenterol.

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ResumenLos inicios del manejo del sangrado variceal con compresión directa datan de 1930 por Westphal y colaboradores. Después, en 1950, se desarrolló el balón de Sengstaken-Blakemore, defi nido por Panes y colaboradores como la primera línea de terapia; en 1980, a nivel de várices esofágicas y en várices gástricas, se empleaba el balón de Linton-Nachlass (1, 2). Se presenta el caso clínico de un paciente con cirrosis hepática por hepatitis C, Child B, con várices esofágicas, a las cuales se les realizó ligadura en dos ocasiones por sangrado y en la segunda ocasión por inminencia de ruptura, esta última llevada a cabo dos semanas antes del evento. El paciente muestra un cuadro clínico compatible con hemorragia de vías digestivas altas masiva, con evidencia endoscópica de úlcera esofágica sangrante que no mejora con terlipresina, ni escleroterapia con adrenalina, ni compresión local con balón de acalasia. En consecuencia, como terapia de rescate se decide colocar un stent esofágico metálico autoexpandible parcialmente recubierto (por no contar con totalmente recubierto en el momento), con control parcial del sangrado. Es recomendable el uso del stent como terapia de rescate para el sangrado por várices esofágicas refractarias. Debe emplearse el diseñado especialmente para esta indicación (SX-Ella Danis), como un puente para poder estabilizar al paciente y realizar una terapia defi nitiva como la TIPS, tal cual como se procedió en un nuestro paciente. Palabras claveStent esofágico, hemorragia variceal refractaria, úlcera esofágica. AbstractEarly treatment of bleeding varices with direct compression dates from the work by Westphal et al. in 1930. Later in 1950, Sengstaken-Blakemore developed their balloon which Panes and collaborators defi ned as the fi rst line of therapy for esophageal varices in 1980 while they used the Linton-Nachlass balloon for gastric varices (1, 2).This study presents the clinical case of a patient with liver cirrhosis due to hepatitis C, (Child B) with esophageal varices which were ligated on two different occasions because of bleeding. On the second occasion a rupture was imminent and ligation occurred two weeks prior to the event. The patient presented a clinical picture compatible with massive upper gastrointestinal bleeding with endoscopic evidence of a bleeding esophageal ulcer that did not improve with terlipressin, sclerotherapy with adrenaline, or balloon dilatation. Consequently, it was to use a partially covered self-expanding metal esophageal stent for salvage therapy since a completely covered stent was not available at that time. Stenting achieved partial control of bleeding. We recommend the use of stenting with a stent specifi cally designed for this indication (SX-Ella Danis) as salvage therapy for refractory bleeding from esophageal varices. The stent can be used as a bridge to stabilize the patient in order to perform TIPS as the defi nitive treatment, as in the case of our patient.

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Section: Discussionunclassified

Manejo de un sangrado por úlcera posligadura de várices esofágicas mediante prótesis metálica autoexpandible: reporte de un caso y revisión de la literatura

Rey

Solano

Sierra

et al. 2015

Rev. Colomb. Gastroenterol.

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“…Кровотечение было оста-новлено, а стент после стабилизации клиничес-кой ситуации был удалён из пищевода через несколько дней [28,29]. Это послужило началом использования саморасширяющихся металли-ческих стентов, ранее применявшихся при ле-чении злокачественных пищеводных стенозов, перфораций пищевода и трахеопищеводных свищей, для остановки кровотечения из ВРВ пи-щевода у больных ПГ [8, 23,41,43].…”

Section: казанский медицинский журнал 2016 г том 97 №6unclassified

“…эти же авторы опубликова-ли свои результаты лечения в общей сложности 34 больных с острыми пищеводными кровоте-чениями установкой в пищевод саморасширя-ющихся металлических стентов [29,43]. У всех пациентов причиной ПГ был ЦП, в том числе у 13 -субкомпенсированный (класс В по ChildPugh), у 21 -декомпенсированный (класс С по Child-Pugh).…”

Section: противопоказания к применению стентаunclassified

“…Во всех случаях причиной смерти была полиорганная и печёночная недостаточность при стабильном гемостазе [29,43]. У всех больных с помощью установки стен-тов в пищевод был получен стабильный гемо-стаз.…”

Section: противопоказания к применению стентаunclassified

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Pros and cons of Danis stent application in esophageal bleeding

Anisimov

Юрьевич²,

Loginov³

et al. 2016

Kazan Med J

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Aim. A critical analysis of world clinical experience of endoscopic hemostasis with self-expanding nitinol Danis stents application in acute bleeding from esophageal varices.Methods. Literature data of last 10 years about self-expanding nitinol Danis stents application at the peak of esophageal bleeding or in high risk of its recurrence were analyzed.Results. The advantages of Danis stent include minimal injury, good tolerance by the patient, providing physiological drainage of saliva and the possibility of fluid and food intake through the mouth, possibility of a repeated endoscopic inspection of the esophagus and stomach after the application of the stent, reducing the risk of aspiration pneumonia, the impossibility of removal or displacement by the patient in agitation. According to most authors, Danis stent allows saving time to get ready for safe transjugular intrahepatic portocaval shunt (TIPS), surgical intervention or liver transplantation. This time should be used for performing all procedures necessary to stabilize the patient’s condition and clarify the nature of the existing pathology. Disadvantages include high risk of migration from the esophagus into the stomach with loss of its plugging function, limitation for treatment of only esophageal varices, development of small erosions or ulcers on the mucous membrane of the esophagus after removal of the stent. When Danis stent was used as a final method of treatment in patients who do not fit for TIPS or liver transplant, the mortality rate reached 50%.Conclusion. To date, it is not yet clarified whether endoscopic hemostasis with self-expanding nitinol Danis stents should be firmly used in the treatment algorithm of patients with variceal bleeding; confirmation of initial clinical results in further comparative randomized controlled trials is necessary.

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“…In the largest series, all 34 patients whose "bleeding could not be stopped using standard therapy" had successful placement with no rebleeding and one minor complication (an esophageal ulcer). (9) Stent migration requiring endoscopic repositioning occurred in seven patients. Because observational studies are well known to overestimate the efficacy of interventions, a randomized trial is extremely important to define the utility of this device.…”

Section: Self-expanding Metal Stentsmentioning

confidence: 99%

Deflating balloon tamponade: Should we expand the use of stents for severe refractory esophageal variceal bleeding?

Laine

2016

Hepatology

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A cute esophageal variceal bleeding (EVB) remains among the most serious emergencies managed by gastroenterologists and hepatologists. Most patients do well during the acute episode with current endoscopic and pharmacologic therapy. In this issue of HEPATOLOGY, Escorsell and colleagues report a randomized trial comparing a very old and a very new intervention for the challenging minority of patients with refractory acute EVB.(1) Acute EVBCurrent guidelines recommend endoscopic ligation and vasoactive medication for treatment of acute EVB, with consideration of transjugular intrahepatic portosystemic shunt in high-risk patients.(2) Randomized trials indicate that 2%-13% of patients with acute EVB treated as recommended have persistent or recurrent bleeding over 5 days or during hospitalization. (3,4) Consensus guidelines recommend transjugular intrahepatic portosystemic shunt for patients who have persistent bleeding despite initial endoscopic and medical therapy, while a second endoscopic treatment may be tried if bleeding recurs after initial hemostasis. (2) Balloon tamponade is currently recommended only for refractory EVB as a temporary bridge to definitive therapy.(2) However, randomized trials have not focused solely on patients with persistent active bleeding despite endoscopic and medical intervention, the high-risk group in whom balloon tamponade may be considered. Balloon TamponadeBalloon tamponade is among the oldest therapies used for variceal bleeding. Case series suggest initial bleeding control in 90% of patients.(5) Major complications, including esophageal rupture, airway obstruction, and aspiration pneumonia, occur in 12% of patients and may be lethal.(5) Deaths attributed to use of balloon tamponade occurred in 6% of patients in these series. (5) Randomized trials comparing tamponade to medical therapy with vasopressin, somatostatin, or terlipressin reveal no significant difference in initial control of bleeding or mortality. Randomized trials comparing tamponade to sclerotherapy for EVB show trends or significant benefit for sclerotherapy in initial hemostasis, and all indicate better sustained or definitive hemostasis with sclerotherapy. (6)(7)(8) Thus, tamponade for acute EVB is not better than medical therapy, is less effective than endoscopic therapy, and not uncommonly causes serious and sometimes fatal complications. My view has been that the use of tamponade should be exceedingly rare: e.g., patients with persistent massive known EVB awaiting endoscopy or awaiting transjugular intrahepatic portosystemic shunt after unsuccessful endoscopic intervention. Self-Expanding Metal StentsThe removable covered self-expanding metal stent used by Escorsell et al. was designed specifically to treat EVB Abbreviation: EVB, esophageal variceal bleeding.

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Results of a new method to stop acute bleeding from esophageal varices: implantation of a self-expanding stent

Abstract: The use of a self-expanding stent to stop acute bleeding from esophageal varices is a new therapeutic method. The authors' initial experience, which involved no method-related mortality or complications, is encouraging. More data are necessary to confirm their results.

Cited by 90 publications

References 21 publications

Manejo de un sangrado por úlcera posligadura de várices esofágicas mediante prótesis metálica autoexpandible: reporte de un caso y revisión de la literatura

Manejo de un sangrado por úlcera posligadura de várices esofágicas mediante prótesis metálica autoexpandible: reporte de un caso y revisión de la literatura

Pros and cons of Danis stent application in esophageal bleeding

Deflating balloon tamponade: Should we expand the use of stents for severe refractory esophageal variceal bleeding?

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