Temporary placement of an expandable polyester silicone-covered stent for treatment of refractory benign esophageal strictures

BACKGROUND: Benign, refractory esophageal strictures are an important therapeutic challenge. Metal stents occasionally have been used, but results have been disappointing. The present study assessed the safety and the efficacy of temporary placement of the new expandable polyester silicone-covered stent for management of problematic esophageal strictures. METHODS: Fifteen patients with benign esophageal strictures were treated by temporary (6 weeks) placement of an expandable polyester silicone-covered stent. All patients had previously been treated, unsuccessfully, by repetitive endoscopic dilation. RESULTS: Stent placement was successful in all patients. There was no procedure-related complication. Dilation with over-the-guidewire polyvinyl dilators was required before stent placement. With the stent in situ, dysphagia completely resolved in all patients. Six weeks after placement, one stent was found to have migrated into the stomach. In the remaining patients, the stent was easily removed with a foreign body forceps. The pretreatment dysphagia score was 3 (range 2-4); the post-treatment score was 1 (range 0-1) (p < 0.0005). Long-term resolution (mean follow-up 22.7 [2.6] months) of the stricture was achieved in 12 patients (80%). The treatment failed in 3 patients, all of whom continue to require periodic dilation. CONCLUSIONS: In patients with benign esophageal strictures refractory to conventional dilation, temporary placement of a removable expandable polyester silicone-covered stent may lead to long-term relief of dysphagia with minimal morbidity.     

Successful sealing of benign esophageal leaks after temporary placement of a self-expanding plastic stent without fluoroscopic guidance

INTRODUCTION: We report on our experience with the temporary use of a self-expanding plastic stent (SEPS) in the treatment of non-malignant esophageal leaks. MATERIAL AND METHODS: Between November 2001 and May 2005 ten patients with iatrogenic esophageal perforations (n = 4), post-surgical leaks (n = 5) and esophago-mediastinal fistulas after caustic injury (n = 1) were treated by temporary SEPS placement. In eight out of ten patients SEPS placement was done without fluoroscopy due to the emergency setting. Stent removal was performed with a rat-toothed forceps. RESULTS: Leaks were located in the proximal (n = 1), middle (n = 6) and distal (n = 3) parts of the esophagus. The mean leakage size was 2 cm. Stent placement without fluoroscopy was always successful. The median duration of stent therapy was 55.5 days (range 15,438). In 7/10 cases the SEPS was readily removed, showing complete healing of the former leak. Four patients died during the follow-up. However, their deaths were not related to the stent therapy. DISCUSSION: The temporary use of the SEPS represents a safe method for sealing benign esophageal leaks. In the emergency-setting SEPS placement without fluoroscopy is feasible and the stent can be easily removed. In contained perforations without severe mediastinitis of the mid esophagus the SEPS should be discussed as a gentle first-line therapy.     

Successful closure of a coronary vessel rupture with a vein graft stent: Case report

We report a successful percutaneous closure of a brisk coronary artery rupture with a custom-made “vein graft stent,” a Palmaz-Schatz stent covered with a vein graft. This method is an elegant and effective alternative to the traditional surgical approach and should be considered whenever technically and clinically feasible. © 1996 Wiley-Liss, Inc.     

Successful endoscopic closure of a benign gastrocolonic fistula using human fibrin sealant through gastroscopic approach: a case report and review of the literature

Gastrocolonic fistula is a well-recognized but rare complication of a variety of diseases, and surgical or endoscopic procedures. If not promptly treated it might result in death due to severe nutritional debility, fluid and electrolyte imbalances. The rarity of the condition leaves clinicians without a proven management option. Traditionally, operative treatment has been advocated. Spontaneous closure of a gastrocolonic fistula, with conservative management only, is infrequent. In the era of minimally invasive surgery the management approach warrants a review. We report a case where non-surgical treatment with local instillation of human fibrin glue was successfully undertaken, as demonstrated by contrast studies, to treat a benign gastrocolonic fistula, and might be a valid alternative to both surgical and medical treatment, although the patient's return to high risk behaviour resulted in a recurrence. Furthermore, in high operative risk patients or those with poor prognosis, this approach might prevent major morbidity, mortality or prolonged hospital stay.     

Successful management of a blunt pancreatic trauma by endoscopic stent placement

The present study reports a case involving a 17-year-old man who was brought to the emergency department of our hospital with severe upper abdominal pain following a blow received in a rugby game. Emergency computed tomography (CT) revealed severe pancreatic neck injury, and the patient was subsequently given conservative treatment in the High Care Unit. Forty-eight hours later, follow-up enhanced CT revealed that the pancreas was clearly lacerated and the amount of peripancreatic fluid was increasing; furthermore, serum amylase and elastase levels were elevated. Endoscopic retrograde pancreatography revealed that contrast medium in the main pancreatic duct (MPD) had leaked to the parenchyma, indicating an MPD injury. To prevent traumatic pancreatitis from worsening, a stent was inserted endoscopically to a site distal to the injured portion of the MPD. Thereafter, the patient’s condition dramatically improved, and his serum amylase levels returned to normal. CT revealed that the apparent pancreatic edema and peripheral fluid were also decreased. During a short-term follow-up period of 6 months, removal of the stent was uneventfully carried out and the patient did not develop any exocrine or endocrine insufficiency. We suggest that, in some cases, endoscopic management of traumatic pancreatic duct disruption is feasible and effective.     

Malignant colojejunal fistula: Case report and review of malignant coloenteric fistula

A patient with a malignant colojejunal fistula with associated severe weight loss and diarrhea is described. To the authors' knowledge, this paper represents the second reported case of this type of malignant fistula. A discussion of the pathogenesis and treatment of this rather unique fistula and a review of malignant coloenteric fistulas in general are presented.     

Spontaneous appendicocutaneous fistula: Case report and liteature review

A report is presented describing an exceptional case of spontaneous appendicocutaneous fistula (only six cases in the literature). Chronic appendiceal fistulas—that is primary communications between the appendix and an adjacent hollow viscus or the skin—occur rarely. Various types of appendicular fistula are considered and the literature is reviewed. Symptoms depend on location of the fistula and organ involved. The pathogenesis of such an unusual lesion is discussed. Appendectomy and excision or closure of the fistula is the radical therapy when the diagnosis is made.     

Successful placement and re-expansion of a new balloon expandable stent to maintain patency of the ductus arteriosus in a newborn animal model

Objective: We performed this study in order to evaluate the usefulness of a new balloon expandable stent for maintaining ductal patency in a neonatal piglet model and to evaluate the ability to re-expand the stent weeks following initial implantation. Background: Maintaining patency of the ductus arteriosus without administration of Prostaglandin E has been reported previously using balloon dilation and stent implantation techniques. However, the experience is limited and the currently available stents are not modified for neonates. Methods: 14 newborn piglets all at age 12 days and median weight 3.6 Kg (range 2.7-4.3 Kg), underwent initial balloon dilation of the ductus arteriosus. Angiography after dilation demonstrated no significant left to right shunt. All piglets underwent successful stent (3.5 mm x 17 mm) placement in the ductus arteriosus. Results: Percutaneous ductal stent implantation via the arterial route was successful in all piglets with angiographic demonstration of a significant left to right shunt. Follow-up studies at weekly intervals with color flow Doppler were used to confirm patency of the stents. In 3 piglets the stent was not patent at initial follow-up and autopsy revealed sub-optimal stent placement. In two animals the stent was later re-expanded to 4 mm at 22 days, in one to 4 mm at 30 days and in one to 6 mm at 15 days, maintaining flow for an additional period of 15 to 34 days.(ABSTRACT TRUNCATED AT 250 WORDS)     

Inferior mesenteric arteriovenous fistula: Case report and world-literature review

Arteriovenous fistulas between the inferior mesenteric artery and vein are rare, with only 26 primary and secondary cases described in the literature. Secondary fistulas occur following operations of the left hemicolon and manifest as abdominal pain, abdominal mass, gastrointestinal bleeding, colonic ischemia and portal hypertension. Symptom intensities are flow-dependent, and can range from minimal symptoms to severe heart failure due to left to right shunt. Diagnosis is usually established by radiological or intraoperative examination. Treatment options include embolization and/or surgical resection. Therapeutic decisions should be adapted to the unique characteristics of the fistula on an individual basis. A new case of a primary arteriovenous fistula is described and discussed along with a complete review of the literature. The patient in this report presented with signs and symptoms of colonic ischemia without portal hypertension. The optimal treatment for this patient required a combination of embolization and surgical operation. The characteristics of these rare inferior mesenteric arteriovenous fistulas are examined and some considerations concerning diagnostic and therapeutic strategies that should be followed are presented.     

球囊扩张与临时性金属支架置入治疗良性气道狭窄的疗效分析

目的观察和分析经支气管镜球囊扩张与临时性金属支架置入治疗良性气道狭窄的疗效。方法将30例良性气道狭窄的患者随机分为两组,球囊扩张组(A组,n=15例)和临时性金属支架置入组(B组,n=15例),疗程均为2个月,随访共6个月,观察两组治疗前后气促评分、狭窄段管腔直径等指标的变化。结果观察6个月末时,两组患者的狭窄段管腔直径均较治疗前增加,差异有统计学意义,气促指数均较治疗前降低,差异有统计学意义;临时性金属支架置入组与球囊扩张组相比,气促评分显著降低,狭窄段管腔直径显著升高,差异均有统计学意义,同时临时性金属支架置入组再狭窄发生率低于球囊扩张组。结论临时性金属支架置入治疗良性气道狭窄疗效优于球囊扩张,且术后再狭窄率较低。     

Successful treatment of a benign solitary rectal ulcer by temporary diverting sigmoidostomy: Report of a case

Summary A rare case of a solitary benign rectal ulcer in which conservative medical therapy was unsuccessful is described. Diversion of the fecal stream by temporary sigmoidostomy resulted in rapid healing of the ulcer. This entity presents diagnostic and therapeutic problems, which are discussed. The use of temporary sigmoidostomy in such cases is recommended. Department of Surgery Department of Gastroenterology     

Successful concomitant treatment of a coronary-to-pulmonary artery fistula and a left anterior descending artery stenosis using a single covered stent graft: a case report and literature review

This report describes a case of a 47-year-old man who presented with early post-Q wave myocardial infarction angina and an atherosclerotic left anterior descending stenosis associated to a coronary-to-pulmonary artery fistula. Both coronary stenosis and fistula were successfully treated with a single polytetrafluoroethylene-covered stent graft implantation by intravascular ultrasound-guided procedure.     

Use of a self-expandable covered stent for closure of a fistula at a cervical anastomosis after pharyngo-laryngo-esophagectomy: a case report

We report a case of a fistula caused by cervical anastomotic leakage after pharyngo-laryngo-esophagectomy that was successfully and safely treated with a self-expandable covered stent. A patient with esophageal carcinoma and inferior pharyngeal carcinoma underwent pharyngo-laryngo-esophagectomy. Postoperatively, a major anastomotic insufficiency formed with constant outflow of salivary juice. The fistula did not show a tendency to close, and therefore we decided to cover the primary orifice of the fistula from the inner side by placing a stent over the orifice. Stent placement was performed endoscopically on the 35th postoperative day. Fifteen days later, a gastrografin study showed closure of the fistula, and 21 days after placement the stent was removed successfully. In this case the patient had a permanent tracheostoma, and therefore the airway and digestive tract were separated. This condition may have contributed to the successful stent therapy that was performed without harmful effects on the airway.