Endoscopic management of complications of self-expandable metal stents for treatment of malignant esophageal stenosis and tracheoesophageal fistulas

Renáta Bor, Anna Fábián, Anita Bálint, Klaudia Farkas, Mónika Szücs, Ágnes Milassin, L. Czakó, Mariann Rutka, T. Molnár, Zoltán Szepes

Research output: Contribution to journalArticle

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Abstract

Background: Self-expandable metal stent (SEMS) implantation may rapidly improve the symptoms of malignant esophageal stenosis and tracheoesophageal fistulas (TEF). However, dysphagia often returns subsequently and repeated endoscopic intervention may be necessary. The aims of the study were to identify the risk factors of complications, and the frequency and efficacy of repeated endoscopic interventions; and to provide technical recommendations on appropriate stent selection. Methods: We analyzed retrospectively the clinical data of 212 patients with locally advanced esophageal cancer who underwent SEMS implantation. Results: A total of 238 SEMS implantations were performed with 99.06% technical success and 1.26% procedure-related deaths in the enrolled 212 cases. Complications occurred in 84 patients (39.62%) and in 55 cases (25.94%) repeated endoscopic procedures were required. Early reintervention 24-48 h after the stent implantations was necessary due to stent migration (12 cases), arrhythmia (2 cases), intolerable retrosternal pain (1 case) and dyspnea (1 case). An average of 1.98 repeated gastroscopies (range 1-6; median 2), 13.58 weeks (range 1.5-48; median 11) after the stent implantation were performed during the follow-up period: 37 stent repositions, 23 restent implantations, 15 endoscopic esophageal dilations and 7 stent removals. In 48 cases (87.3%) oral feeding of patients was made possible by endoscopic interventions. Conclusions: In a quarter of SEMS implantations, complications occur that can be successfully managed by endoscopic interventions. Our experiences have shown that individualized stent choice may substantially reduce the complications rate and make repeated endoscopic interventions easier.

Original languageEnglish
Pages (from-to)599-607
Number of pages9
JournalTherapeutic Advances in Gastroenterology
Volume10
Issue number8
DOIs
Publication statusPublished - Aug 1 2017

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Esophageal Fistula
Tracheoesophageal Fistula
Esophageal Stenosis
Stents
Therapeutics
Gastroscopy
Esophageal Neoplasms
Deglutition Disorders
Self Expandable Metallic Stents
Dyspnea
Cardiac Arrhythmias
Dilatation
Pain

Keywords

  • esophageal cancer
  • esophageal obstruction
  • self-expandable metal stent

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Endoscopic management of complications of self-expandable metal stents for treatment of malignant esophageal stenosis and tracheoesophageal fistulas. / Bor, Renáta; Fábián, Anna; Bálint, Anita; Farkas, Klaudia; Szücs, Mónika; Milassin, Ágnes; Czakó, L.; Rutka, Mariann; Molnár, T.; Szepes, Zoltán.

In: Therapeutic Advances in Gastroenterology, Vol. 10, No. 8, 01.08.2017, p. 599-607.

Research output: Contribution to journalArticle

Bor, Renáta ; Fábián, Anna ; Bálint, Anita ; Farkas, Klaudia ; Szücs, Mónika ; Milassin, Ágnes ; Czakó, L. ; Rutka, Mariann ; Molnár, T. ; Szepes, Zoltán. / Endoscopic management of complications of self-expandable metal stents for treatment of malignant esophageal stenosis and tracheoesophageal fistulas. In: Therapeutic Advances in Gastroenterology. 2017 ; Vol. 10, No. 8. pp. 599-607.
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abstract = "Background: Self-expandable metal stent (SEMS) implantation may rapidly improve the symptoms of malignant esophageal stenosis and tracheoesophageal fistulas (TEF). However, dysphagia often returns subsequently and repeated endoscopic intervention may be necessary. The aims of the study were to identify the risk factors of complications, and the frequency and efficacy of repeated endoscopic interventions; and to provide technical recommendations on appropriate stent selection. Methods: We analyzed retrospectively the clinical data of 212 patients with locally advanced esophageal cancer who underwent SEMS implantation. Results: A total of 238 SEMS implantations were performed with 99.06{\%} technical success and 1.26{\%} procedure-related deaths in the enrolled 212 cases. Complications occurred in 84 patients (39.62{\%}) and in 55 cases (25.94{\%}) repeated endoscopic procedures were required. Early reintervention 24-48 h after the stent implantations was necessary due to stent migration (12 cases), arrhythmia (2 cases), intolerable retrosternal pain (1 case) and dyspnea (1 case). An average of 1.98 repeated gastroscopies (range 1-6; median 2), 13.58 weeks (range 1.5-48; median 11) after the stent implantation were performed during the follow-up period: 37 stent repositions, 23 restent implantations, 15 endoscopic esophageal dilations and 7 stent removals. In 48 cases (87.3{\%}) oral feeding of patients was made possible by endoscopic interventions. Conclusions: In a quarter of SEMS implantations, complications occur that can be successfully managed by endoscopic interventions. Our experiences have shown that individualized stent choice may substantially reduce the complications rate and make repeated endoscopic interventions easier.",
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AU - Bor, Renáta

AU - Fábián, Anna

AU - Bálint, Anita

AU - Farkas, Klaudia

AU - Szücs, Mónika

AU - Milassin, Ágnes

AU - Czakó, L.

AU - Rutka, Mariann

AU - Molnár, T.

AU - Szepes, Zoltán

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N2 - Background: Self-expandable metal stent (SEMS) implantation may rapidly improve the symptoms of malignant esophageal stenosis and tracheoesophageal fistulas (TEF). However, dysphagia often returns subsequently and repeated endoscopic intervention may be necessary. The aims of the study were to identify the risk factors of complications, and the frequency and efficacy of repeated endoscopic interventions; and to provide technical recommendations on appropriate stent selection. Methods: We analyzed retrospectively the clinical data of 212 patients with locally advanced esophageal cancer who underwent SEMS implantation. Results: A total of 238 SEMS implantations were performed with 99.06% technical success and 1.26% procedure-related deaths in the enrolled 212 cases. Complications occurred in 84 patients (39.62%) and in 55 cases (25.94%) repeated endoscopic procedures were required. Early reintervention 24-48 h after the stent implantations was necessary due to stent migration (12 cases), arrhythmia (2 cases), intolerable retrosternal pain (1 case) and dyspnea (1 case). An average of 1.98 repeated gastroscopies (range 1-6; median 2), 13.58 weeks (range 1.5-48; median 11) after the stent implantation were performed during the follow-up period: 37 stent repositions, 23 restent implantations, 15 endoscopic esophageal dilations and 7 stent removals. In 48 cases (87.3%) oral feeding of patients was made possible by endoscopic interventions. Conclusions: In a quarter of SEMS implantations, complications occur that can be successfully managed by endoscopic interventions. Our experiences have shown that individualized stent choice may substantially reduce the complications rate and make repeated endoscopic interventions easier.

AB - Background: Self-expandable metal stent (SEMS) implantation may rapidly improve the symptoms of malignant esophageal stenosis and tracheoesophageal fistulas (TEF). However, dysphagia often returns subsequently and repeated endoscopic intervention may be necessary. The aims of the study were to identify the risk factors of complications, and the frequency and efficacy of repeated endoscopic interventions; and to provide technical recommendations on appropriate stent selection. Methods: We analyzed retrospectively the clinical data of 212 patients with locally advanced esophageal cancer who underwent SEMS implantation. Results: A total of 238 SEMS implantations were performed with 99.06% technical success and 1.26% procedure-related deaths in the enrolled 212 cases. Complications occurred in 84 patients (39.62%) and in 55 cases (25.94%) repeated endoscopic procedures were required. Early reintervention 24-48 h after the stent implantations was necessary due to stent migration (12 cases), arrhythmia (2 cases), intolerable retrosternal pain (1 case) and dyspnea (1 case). An average of 1.98 repeated gastroscopies (range 1-6; median 2), 13.58 weeks (range 1.5-48; median 11) after the stent implantation were performed during the follow-up period: 37 stent repositions, 23 restent implantations, 15 endoscopic esophageal dilations and 7 stent removals. In 48 cases (87.3%) oral feeding of patients was made possible by endoscopic interventions. Conclusions: In a quarter of SEMS implantations, complications occur that can be successfully managed by endoscopic interventions. Our experiences have shown that individualized stent choice may substantially reduce the complications rate and make repeated endoscopic interventions easier.

KW - esophageal cancer

KW - esophageal obstruction

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