The use of self-expanding metal stents to treat acute esophageal variceal bleeding

Hubmann, Rainer; Bodlaj, Gerd; Czompo, M.; Benkő, László; Pichler, Peter-Paul; Al-Kathib, S.; Kiblböck, P.; Shamyieh, A.; Biesenbach, Georg

doi:10.1055/s-2006-944662

Cited by 170 publications

(129 citation statements)

References 11 publications

Supporting

Mentioning

117

Contrasting

Unclassified

Order By: Relevance

“…Recently preliminary studies have shown that the placement of self-expanding metallic stents as an alternative to balloon tamponade for the control of refractory variceal hemorrhage may be beneficial [41,42] but these findings must be confirmed in other trials before their use can be introduced in clinical practice. Emergency EGD may be at the same time diagnostic and therapeutic.…”

Section: Management Of Variceal Bleedingmentioning

confidence: 99%

Endoscopic Management of Variceal Haemorrhage

Dell’Era

Iannuzzi

Franchis

2015

Journal of Gastroenterology and Hepatology Research

View full text Add to dashboard Cite

One of the most important complications of portal hypertension, in the setting of liver cirrhosis or of non-cirrhotic portal hypertension, is upper gastrointestinal bleeding from ruptured gastroesophageal varices and portal hypertensive gastropathy. The management of the acute variceal bleeding is a multidisciplinary process that includes the initial assessment of the patient, effective resuscitation, timely diagnosis, control of bleeding and prevention of early rebleeding and complications such as infection, hepatorenal syndrome, or hepatic encephalopathy. Antibiotic prophylaxis, conservative targets for blood transfusions and combination therapy with vasoactive drugs and endoscopic treatments are the first-line measures in the management of acute variceal bleeding; transjugular intrahepatic portosystemic shunts should be proposed early to high-risk patients or as a rescue therapy for those who fail first-line treatment.

show abstract

Section: Management Of Variceal Bleedingmentioning

confidence: 99%

Endoscopic Management of Variceal Haemorrhage

Dell’Era

Iannuzzi

Franchis

2015

Journal of Gastroenterology and Hepatology Research

View full text Add to dashboard Cite

show abstract

“…The Polyflex stent is being increasingly used for benign esophageal strictures and has also been used with success in the management of post-operative esophageal leak [58] . Another novel use for temporary esophageal stent placement was in the management of acute esophageal variceal bleeding [59] . Although the findings of this small study were positive, a large comparative trial would be required before SEMS could replace the current therapy for bleeding varices.…”

Section: Resultsmentioning

confidence: 99%

Endoscopic stenting-Where are we now and where can we go?

Mcloughlin¹,

Byrne²

2008

WJG

View full text Add to dashboard Cite

Self expanding metal stents (SEMS) play an important role in the management of malignant obstructing lesions in the gastrointestinal tract. Traditionally, they have been used for palliation in malignant gastric outlet and colonic obstruction and esophageal malignancy. The development of the polyflex stent, which is a removable self expanding plastic stent, allows temporary stent insertion for benign esophageal d i s e a s e a n d p o s s i b l y fo r p a t i e n t s u n d e r g o i n g neoadjuvant chemotherapy prior to esophagectomy. Potential complications of SEMS insertion include perforation, tumour overgrowth or ingrowth, and stent migration. Newer stents are being developed with the aim of increasing technical and clinical success rates, while reducing complication rates. Other areas of development include biodegradable stents for benign disease and radioactive or drug-eluting stents for malignant disease. It is hoped that, in the future, newer stents will improve our management of these difficult conditions and, possibly, provide prognostic as well as symptomatic benefit in the setting of malignant obstruction.© 2008 The WJG Press. All rights reserved. [9] and improvements in quality of life, dysphagia, and eating scales [10] for brachytherapy. It has been suggested that, as stent re-intervention is likely to be increased for those who live longer, SEMS should be considered for those with a poorer prognosis, and chemo/radiotherapy, with temporary stent placement, for those with a longer life expectancy [2] . A Korean group inserted a removable nitinol stent in 47 patients who had concur rent radiotherapy and extracted the stent in 24 patients after 4 wk, leaving the stent in place in the remaining patients [11] . The complication and re-intervention rates were significantly lower in the group in which the stent was extracted, while the dysphagia-progression-free and overall survival rates were significantly longer. No randomized trials have yet been conducted with the Polyflex stent, which is the only removable stent licensed in the USA in this setting. Further randomized trials of SEMS in combination with other treatment modalities would help determine the optimal management strategy in terms of symptom control and overall survival. Drugeluting and radioactive stents may also have a future role in the management of esophageal malignancy; these have been tested with success in animal models [12,13] . In cases where the distal margin of the stent crosses the gastro-esophageal (GE) junction there are now SEMS available with an anti-reflux mechanism. Survival has been shown to be reduced in patients in whom the stent crossed the GE junction [14] . A study which compared an open stent with the Z-stent with Dua antireflux valve found that 96% of patients with the open stent had reflux symptoms, compared with 12% with the antireflux mechanism [15] . Several other SEMS with antireflux mechanisms have been manufactured. Further work will be required to determine the overall efficacy and complic...

show abstract

“…В ноябре 2002 г. Ян Даниш попытался остановить кровотечение из ВРВ пищевода у 27-летнего мужчины, страдавшего ПГ в исходе хроничес-кого вирусного гепатита С и ВИЧ-инфекции, перенёсшего за 3 года до этого трансплантацию печени, осложнённую тяжёлой коагулопатией, путём имплантации саморасширяющегося ме-таллического стента. 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

Pros and cons of Danis stent application in esophageal bleeding

Anisimov

Юрьевич²,

Loginov³

et al. 2016

Kazan Med J

View full text Add to dashboard Cite

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.

show abstract

The use of self-expanding metal stents to treat acute esophageal variceal bleeding

Cited by 170 publications

References 11 publications

Endoscopic Management of Variceal Haemorrhage

Endoscopic Management of Variceal Haemorrhage

Endoscopic stenting-Where are we now and where can we go?

Pros and cons of Danis stent application in esophageal bleeding

Contact Info

Product

Resources

About