Tumor bleeding is the most common cause of UGIB in cancer patients. UGIB in cancer patients correlates with a high mortality rate regardless of the bleeding source. Current endoscopic treatments may not be effective in preventing rebleeding or improving survival.

ESD and TEM are both safe and effective for the treatment of early rectal cancer.

The use of self-expandable metallic stents has increased recently to palliate inoperable esophageal neoplasia and also in the management of benign strictures. Migration is one of the most common complications after stent placement and the endoscopist should be able to recognize and manage this situation. Several techniques for managing migrated stents have been described, as well as new techniques for preventing stent migration. Most stents have a "lasso" at the upper flange which facilitates stent repositioning or removal. An overtube, endoloop and large polypectomy snare may be useful for the retrieval of stents migrated into the stomach. External fixation of the stent with Shim's technique is efficient in preventing stent migration. Suturing the stent to the esophageal wall, new stent designs with larger flanges and double-layered stents are promising techniques to prevent stent migration but they warrant validation in a larger cohort of patients.© 2014 Baishideng Publishing Group Co., Limited. All rights reserved.Key words: Endoscopy; Stents; Esophageal cancer; Benign strictures; Complications Core tip: Migration of self-expandable esophageal stents occurs in up to 36% of cases. The lasso system available in most stents provides a safe way to remove or reposition the stent while it is still in the esophagus. However, when the stent migrates into the stomach, other techniques are needed to guarantee a safer retrieval. The use of clipping, suturing or external fixation should be considered for stents at high risk for migration.Martins BC, Retes FA, Medrado BF, Lima MS, Pennacchi CMPS, Kawaguti FS, Safatle-Ribeiro AV, Uemura RS, MalufFilho F. Endoscopic management and prevention of migrated esophageal stents. World J Gastrointest Endosc 2014; 6(2): 49-54 Available from:

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The device modification for PEG using the introducer technique is feasible, safe, and efficient in outpatients with obstructive head and neck cancer. In this series, it allowed the use of a larger-caliber tube with low complication rates and no procedure-related mortality.

The push and introducer PEG techniques seem to be both safe and effective but present different complication profiles. The choice of PEG technique in patients with HNC should be made individually.

A 79-year-old man with metastatic adenocarcinoma of the cardia was submitted to palliative chemotherapy and esophageal stenting for relief of dysphagia. After the fourth cycle of chemotherapy he was admitted to the emergency department complaining of dysphagia. At endoscopy a significant regression of the lesion size and migration of the stent into the stomach were noticed. The standard gastroscope (9.8 mm) was easily inserted into the gastric chamber. In order to facilitate the use of the proximal lasso system to close the proximal end of the stent, the standard gastroscope was switched to the therapeutical scope, and a 10-Fr biliary stent pusher was inserted into the largest operational channel followed by a grasp forceps (• " Fig. 1). The lasso was grasped and pulled back into the pusher while the endoscopist's assistant advanced it against the stent. This maneuver allowed the constraining of the proximal end of the stent, facilitating its removal (• " Fig. 2 and• " Video 1). The occurrence of esophageal stent migration after chemoradiation therapy can be as high as 40 % [1]. Esophageal stent migration is not an emergency. Indeed, some authors advocate a "wait and see" approach [2]. On the other hand there are some reports of distal migration with intestinal obstruction and impaction requiring surgery [2 -4]. In our view, endoscopic removal of a distally migrated esophageal stent is desirable whenever possible. However, the withdrawal may be a challenging procedure [5]. Many different approaches for safe endoscopic removal of a migrated stent have been described, such as the use of an overtube, a snare combined with a rat-toothed forceps, and an endoloop device [6].We believe that the "grasper and pusher" method is an elegant and safe technique to deal with a migrated esophageal stent, especially when a significant reduction in tumor size has occurred allowing the passage of a therapeutic endoscope. Endoscopy_UCTN_Code_TTT_1AO_2AZCompeting interests: None Video 1Endoscopic removal of the migrated esophageal stent using the "grasper and pusher" method. UCTN -Unusual cases and technical notes E10Martins B et al. Endoscopic removal of migrated esophageal stent -the "grasper and pusher" method … Endoscopy 2012; 44: E10 This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.

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