SX-Ella Danis stent in massive upper gastrointestinal bleeding in cirrhosis – a case series

Jain, Mayank; Balkrishanan, Mahadevan; Snk, Chenduran; Cgs, Sridhar; Ramakrishnan, Ravi; Venkataraman, Jayanthi

doi:10.5114/ceh.2018.75959

Cited by 6 publications

(3 citation statements)

References 8 publications

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“…Importantly, this data set includes a substantial number of cases early in the experience of many users as data was collected from the point of introduction of this new device at each center. This is in keeping with the extremely high technical success rates (90 %-100 %) described in the limited existing literature 16 17 18 20 21 24 25 26 . Interestingly, only eight of 32 SEMS (25 %) were placed by interventional endoscopists, suggesting that training in advanced endoscopic techniques is not necessarily required for successful deployment of the SEMS.…”

Section: Discussionsupporting

confidence: 82%

The role of a novel self-expanding metal stent in variceal bleeding: a multicenter Australian and New Zealand experience

et al. 2022

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Background and study aims Refractory variceal bleeding is associated with high mortality in patients with chronic liver disease. A fully-covered self-expanding metal stent (SEMS) has been reported to have excellent rates of technical success and initial bleeding control; however, studies to date are small and limited to Europe and Asia. Our aim was to evaluate the efficacy and safety of this SEMS for control of refractory variceal bleeding (VB). Patients and methods A retrospective analysis was undertaken of all patients who received the SX-ELLA Danis SEMS for management of VB at 9 tertiary centers across Australia and New Zealand. A total of 32 SEMS had been deployed in 30 patients (median age 53.3). Results Technical success of SEMS placement was achieved in 100 % of cases, resulting in immediate control of bleeding across 31 of 32 cases (96.9 %). Re-bleeding with SEMS in situ occurred in three of 32 cases (9.4 %). Mean SEMS in-dwelling time was 6.4 days. Delayed SEMS migration occurred in 6.3 % of cases. Interventional radiological therapy for management of varices within 6 weeks was performed in 12 of 30 patients (40 %). Death with SEMS in situ occurred in seven of 30 patients (23.3 %). Seven-day bleeding-related mortality was 16.7 %, 14-day mortality 23.3 %, and 6-week mortality 33.3 %. Three of 30 patients (10 %) received orthotopic liver transplantation following SEMS insertion, including two patients within 6 weeks. Conclusions SX-Danis Ella SEMS is highly effective for immediate control of refractory VB and bridging to definitive therapy because it has excellent technical success rates, appears to be relatively easy to use, and has low rates of serious adverse events.

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Section: Discussionsupporting

confidence: 82%

The role of a novel self-expanding metal stent in variceal bleeding: a multicenter Australian and New Zealand experience

et al. 2022

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“…Self-expanding covered stents work in a similar fashion as balloon tamponade by applying pressure to the mucosa and compressing vessels. Jain et al reported that esophageal stents may also be used to control bleeding secondary to post-banding esophageal ulcers [18]. However, safe placement of a stent requires additional training and experienced staff that may not be available in emergencies, especially if fluoroscopy is necessary when through-the-scope stents are not offered.…”

Section: Discussionmentioning

confidence: 99%

430 Balloon Tamponade Utilization for Severe Esophagitis Causing Hemorrhagic Shock

Thaker¹,

Pajot²,

Mikolajczyk³

et al. 2020

Diseases of the Esophagus

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Esophagitis as a cause of upper gastrointestinal bleeding (UGIB) is a difficult entity to treat and is associated with significant morbidity. Epidemiologic studies note a 7-18% incidence of significant hemorrhage due to esophagitis. Current existing treatment options for UGIB complicated by hemorrhagic shock secondary to severe esophagitis are limited when there is a lack of response to proton pump inhibitor (PPI) medical therapy. Methods We present a case series of two patients who developed hemorrhagic shock from esophagitis, underwent endoscopic evaluation revealing limited treatment options, and ultimately required balloon tamponade resulting in successful resolution of bleeding and improvement in hemodynamics. A 55-year-old male with history of alcoholism complicated chronic pancreatitis and esophagitis presented with seizures. On admission he experienced hemorrhagic nasogastric tube output, anemia unresponsive to transfusions and hemodynamic instability. A 44-year-old patient with decompensated alcoholic cirrhosis was initially admitted for renal failure, and during the hospitalization developed melena and hemorrhagic shock requiring transfusions and vasopressors. The patients were promptly started on PPI infusion. Results Both patients underwent esophagogastroduodenoscopy revealing severe bleeding esophagitis extending from the gastroesophageal junction to the proximal esophagus and no varices. Active bleeding was not amenable to endoscopic therapy and both patients underwent balloon tamponade placement. The first patient required inflation of both the esophageal and gastric balloons for control of hemorrhage for 6 hours whereas the second patient required just gastric balloon inflation for 12 hours. Bleeding, transfusion requirement, and hemodynamics improved in both patients. Second look endoscopy demonstrated resolution of bleeding and hemostatic spray was applied to the esophagus prophylactically. Neither patient had recurrence of bleeding during the hospitalization. Conclusion UGIB secondary to esophagitis is difficult to control due to the highly vascularized nature of the esophagus. Endoscopic therapies are limited in extensive mucosal injury and risks of complications such as perforation are high. Other therapeutic options such as angiography are restricted due to vascular collateralization and surgical interventions have high morbidity and mortality. Balloon tamponade provides a viable treatment option for severe UGIB secondary to esophagitis that is not responsive to medical therapy.

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“…Fully covered SEMS (Ella Danis) is increasingly being used with the same indication. 56 Hemostatic powders have been used for post-EVL ulcers, and currently are used as a bridging therapy until definitive endoscopy is possible. 57 The only validated option when hemospray is not available, is injection of cyanoacrylate beneath the ulcer base in conjunction with pharmacotherapy.…”

Section: Variceal Bleed Esophageal Variceal Bleedmentioning

confidence: 99%

Gastrointestinal Emergencies and the Role of Endoscopy

Dixit

Sahu

Venkatesh

et al. 2022

Journal of Digestive Endoscopy

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Many gastrointestinal (GI) disorders present to the emergency room with acute clinical presentations, some even life threatening. Common emergencies encountered that require urgent endoscopic interventions include GI hemorrhage (variceal and nonvariceal), foreign body ingestion, obstructive jaundice, postprocedure-related complications such as postpolypectomy bleed or perforation, etc. A major advantage of emergency endoscopy is that it is cost effective and, on many occasions, can be life-saving. The present review will highlight a practical approach on various endoscopic modalities and their use in the GI emergencies.

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SX-Ella Danis stent in massive upper gastrointestinal bleeding in cirrhosis – a case series

Abstract: We report our experience of three cases of decompensated cirrhosis with massive upper gastrointestinal bleeding, which required insertion of an SX-Ella Danis stent for hemostasis. The procedure is safe and effective.

Cited by 6 publications

References 8 publications

The role of a novel self-expanding metal stent in variceal bleeding: a multicenter Australian and New Zealand experience

The role of a novel self-expanding metal stent in variceal bleeding: a multicenter Australian and New Zealand experience

430 Balloon Tamponade Utilization for Severe Esophagitis Causing Hemorrhagic Shock

Gastrointestinal Emergencies and the Role of Endoscopy

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