Effectiveness of Open versus Antireflux Stents for Palliation of Distal Esophageal Carcinoma and Prevention of Symptomatic Gastroesophageal Reflux

Laasch, Hans-Ulrich; Marriott, A.; Wilbraham, L.; Tunnah, Sharon; England, Ruth; Martin, D. F.

doi:10.1148/radiol.2252011763

Cited by 117 publications

(81 citation statements)

References 36 publications

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“…Stricture at the gastroesophageal junction is amenable to stent insertion with a high rate of technical and clinical success. But severe reflux and aspiration might happen, and a one-way flap valve on the gastric side of the stent could prevent those complications [6][7][8] . Insertion of a metallic stent in the proximal esophageal lesion is technically difficult.…”

Section: Discussionmentioning

confidence: 99%

“…A coated stent placement may prevent tumor ingrowth, but cannot prevent overgrowth of tumors and benign hyperplasic tissues at the edge of stents, but a secondary stent insertion may solve this problem. With stents confined, the risk of perforation and bleeding was low, and ELT or electrocautery might be another good choice [7] . Placement of esophageal metallic stent could lead to many complications.…”

Section: Discussionmentioning

confidence: 99%

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Clinical application of metallic stents in treatment of esophageal carcinoma

Yang¹

2004

WJG

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AIM:To evaluate the effects of self-expanding metal stents (SEMS) in patients with malignant esophageal obstruction and to analyze their prognosis and complications. METHODS:Seventy-four metallic stents were placed under fluoroscopic guidance in 66 patients with esophageal obstruction secondary to carcinoma, of whom, 6 cases were complicated by fistula. RESULTS:After seventy-two stents were successfully used in 66 cases without any severe complications (technical successful rate was 97%), the dysphagia score improved from 3.3±0.6 to 0.8±0.5 (P<0.01), and life quality improved significantly in all these patients. All fistulae were sealed immediately after coated stents were inserted in the six patients. New stents were placed in two patients: the stent migrated more than 2 cm, in one patient and the stent slipped into stomach in the other. Minor bleeding was found only in 28 patients during the operation. Reobstruction was found in 12 patients, but was successfully cured under endoscopy. The survival rate was 78%, 57% and 11% for 6 mo, 1 year and 2 years respectively. CONCLUSION:Placement of SEMS is a simple, safe, quick and efficient surgical method for treating esophageal carcinoma obstruction. It may be used mainly as a palliative treatment of esophageal obstruction secondary to carcinoma.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical application of metallic stents in treatment of esophageal carcinoma

Yang¹

2004

WJG

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“…The authors concluded that the anti-reflux stent was effective in preventing gastro-esophageal reflux [35]. A randomized study comparing this type of anti-reflux stent (25 patients) with a standard open Flamingo Wallstent (25 patients) showed that 3/25 (12%) versus 24/25 (96%) patients, respectively, reported symptoms of gastro-esophageal reflux (P < 0.001), whereas no differences in dysphagia improvement, complications, or reintervention rate were found [34]. Do and colleagues designed a different type of anti-reflux stent with a reflux valve consisting of three leaflets, like a tricuspid valve of the heart instead of the ''windsock-type'' valve.…”

Section: Consmentioning

confidence: 96%

Palliative therapy

Homs

Kuipers

Siersema

2005

Journal of Surgical Oncology

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There are a wide variety of palliative treatments for esophageal cancer. The aim of most treatments is to maintain oral food intake, which should stabilize or even improve quality of life. Stent placement is currently the most widely used treatment modality for palliation of dysphagia from esophageal cancer. Stent placement offers a rapid relief of dysphagia, however, the rate of complications (late hemorrhage) and recurrent dysphagia (stent migration, tumor overgrowth) is relatively high. The scientific evidence to advocate the use of anti-reflux stents for the prevention of gastro-esophageal reflux is currently too low. Photodynamic therapy is mostly used in North America; however, due to the high costs of the treatment, the long-lasting side effects and the necessity of repeated treatments, it is not an ideal treatment for palliation of malignant dysphagia. Nd:YAG laser is a relatively effective and safe treatment modality, although laser treatment is also expensive, technically difficult and requiring repeated treatment sessions at 4-6 weeks intervals. Single dose brachytherapy compares favorably to stent placement in long-term effectiveness and safety. Effective treatment strategies are probably 12 Gy given in one fraction or 16 Gy given in two fractions. Palliative chemotherapy offers response rates in recent trials (including partial and complete responses) ranging from 35% to 50%. Whether palliative chemotherapy also results in a survival benefit is not established yet. For clinical trials on palliation of esophageal cancer, the measurement of quality of life is an important outcome measure. The cancer-specific EORTC QLQ-C30 and the esophageal cancer-specific EORTC-OES-18 are validated measures for establishing quality of life status. For the future, a multimodality approach with stent placement or brachytherapy in combination with chemotherapy may be indicated.

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“…Эти результаты были подтвержде-ны в исследовании H-U Laasch и соавт. [12], в кото-ром у 3 (12%) пациентов из 25 с установленным в зону кардии антирефлюксным Z-стентом был выра-женный рефлюкс по сравнению с 24 (96%) пациен-Рис. 3.…”

Section: рис 2 выполнение эндоскопического стентирования пищеводаunclassified

The peculiarities of stenting in the patients with cardioesophageal cancer

Costamagna¹,

Gusev²,

Burdyukov³

et al. 2015

Dok. gastroenterol.

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Заболеваемость злокачественными новообразо-ваниями пищеводно-желудочного перехода в запад-ных странах резко увеличилась за последние 30 лет. Пятилетняя выживаемость пациентов с опухолью именно пищеводно-желудочного перехода состав-ляет менее 20% [1,2]. Тяжелым и нередко фаталь-ным осложнением этого заболевания является дис-фагия. Поэтому больные, страдающие выраженной степенью дисфагии, должны в неотложном порядке быть подвергнуты паллиативному лечению. Для проведения симптоматической терапии неопера-бельным пациентам при опухолевых стенозах пище-вода и зоны кардии выполняется установка само-раскрывающихся металлических стентов.По сравнению со стандартным методом стенти-рования опухолевого стеноза проксимального отде-ла пищевода, установка стента в зону пищеводно-желудочного перехода имеет некоторые дополни-тельные особенности и, следовательно, несет в себе более высокий риск развития осложнений [3].В этой статье представлен клинический случай стентирования зоны пищеводно-желудочного пе-рехода во время эндоскопического курса, прове-денного в рамках 15-й Международной конферен-

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Effectiveness of Open versus Antireflux Stents for Palliation of Distal Esophageal Carcinoma and Prevention of Symptomatic Gastroesophageal Reflux

Abstract: This antireflux stent is as safe and effective as the standard open stent in relieving malignant dysphagia and was successful in reducing symptomatic gastroesophageal reflux.

Cited by 117 publications

References 36 publications

Clinical application of metallic stents in treatment of esophageal carcinoma

Clinical application of metallic stents in treatment of esophageal carcinoma

Palliative therapy

The peculiarities of stenting in the patients with cardioesophageal cancer

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