Salvage therapy of bleeding esophageal tumor by fully covered self-expandable metallic stent: A case report

Abstract

The role of self-expandable metallic stents is gradually evolving for a diverse group of benign and malignant gastrointestinal tract problems, with luminal obstruction being by far the most common. Although its role in refractory variceal bleeding is well established, it has rarely been tried for tumor-related bleeding, with only a few case reports in this regard. We share our experience of successfully controlling esophageal tumor–related bleeding with the use of a fully covered self-expandable metallic stent. A 58-year-old woman with irresectable distal esophageal cancer, presented with hematemesis. Esophago-gastro-duodenoscopy revealed an obstructing esophageal tumor with diffuse oozing of blood. This was unamenable to local injection of adrenaline and hemospray; therefore, a temporary self-expandable metallic stent was parked to create a tamponade effect. This successfully stopped bleeding and the patient remained asymptomatic till discharge. However, she was lost to follow-up, and therefore, the stent was removed after a period of 5 months instead of 2 weeks.

Compression hemostasis using fully covered self-expandable metallic stents for refractory hemorrhages caused by esophageal cancer: A pilot study

“…Thus, esophageal hemorrhage is most likely to be fatal. Endoscopic treatment modalities are first-line treatments of tumor hemostasis (6). However, rebreeding occurs frequently despite the variety of endoscopic interventions (7).…”

“…Relatedly, D'Souza et al ( 24) successfully induced hemostasis with the insertion of fully covered SEMS in a patient with uncontrollable duodenal hemorrhage caused by invasion of local recurrent hepatocellular carcinoma. Currently, only a few case reports or a small number of case series report the use of fully covered SEMSs for esophageal cancer to achieve hemostasis after the failure of endoscopic interventions to do so (6,12,15). Zhou et al described a successful hemostasis with the placement of a fully covered SEMS in four patients with malignant esophageal hemorrhage (12).…”

“…Zhou et al described a successful hemostasis with the placement of a fully covered SEMS in four patients with malignant esophageal hemorrhage (12). Bilal et al (6) inserted a fully covered SEMS in a patient with a diffusely bleeding esophageal tumor with a severe luminal obstruction, which resulted in complete hemostasis and the resolution of symptoms. Isono et al ( 15) also successfully induced hemostasis in a patient with a hemorrhage caused by esophageal tumor after esophageal stent placement.…”

“…Esophageal hemorrhage occurs in approximately 1%-5% of patients with advanced esophageal cancer, which is a big challenge (5). As a first-line treatment of tumor hemostasis, many kinds of endoscopic treatment modalities have been used, including the application of heater probes, local injections of adrenaline, argon plasma coagulation, and cryotherapy, and radiofrequency ablation (6). However, rebreeding occurs frequently despite the variety of endoscopic interventions (7).…”

“…Fully covered SEMSs have been widely used as a salvage therapy for patients with esophageal variceal bleeding (11,12). However, only a few case reports and case series, such as those on duodenal tumors (13,14) and esophageal cancer (6,12,15), report the use of fully covered SEMSs for malignant tumors in the upper gastrointestinal track to achieve hemostasis after the failure of conventional endoscopic interventions.…”