Esophageal stent migration: Testing few hypothesis with a simplified mathematical model

Garbey, Marc; Salmon, R; Fikfak, Vid; Clerc, Claude

doi:10.1016/j.compbiomed.2016.10.024

Cited by 18 publications

(15 citation statements)

References 42 publications

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“…10,12 While a feasible and effective treatment for those patients, stent migration can occur in up to 21-30% of patients, 14,15 as was the case in our patient, and has been shown to be associated with strong esophageal peristalsis, stent design, and the interaction of the stent with the esophageal wall. 15 Lastly, the third and most invasive approach is a pure surgical one. Miller and Sukov reported a PEF patient whose pericardial and esophageal defects were repaired primarily using a myocutaneous flap.…”

Section: Discussionsupporting

confidence: 51%

“…Bunch et al and Quénéhervé et al reported cases of esophageal perforation after AF ablations managed by endoscopic placement of an esophageal stent with serial esophagrams to verify that there was no further leakage into the pericardium 10,12 . While a feasible and effective treatment for those patients, stent migration can occur in up to 21‐30% of patients, 14,15 as was the case in our patient, and has been shown to be associated with strong esophageal peristalsis, stent design, and the interaction of the stent with the esophageal wall 15 …”

Section: Discussionmentioning

confidence: 58%

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Surgical and endoscopic management of a pericardioesophageal fistula after radiofrequency pulmonary vein isolation

Siroky

Niazi

Ghaly

et al. 2020

Pacing Clinical Electrophis

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Introduction: The most feared complication of pulmonary vein isolation (PVI) is an atrioesophageal fistula (AEF). While rare (0.1-0.25%), primary surgical closure (as opposed to esophageal stenting) is associated with lower mortality. Pericardioesophageal fistula (PEF) may present prior to fistulization into the atrium. Unfortunately, data on the optimal management of PEFs are lacking. Case report: Seventy-one-year-old male with AF presented with chest pain 3 weeks after radiofrequency PVI. Computed tomography angiography (CTA) chest and echocardiogram showed pneumopericardium. Barium esophagram showed extravasation from esophagus into the pericardium without connection to the left atrium. Sternotomy with mediastinal exploration exposed the pericardial defect, over which a CorMatrix patch was placed. The fistula was then stented endoscopically with endosuture fixation. Poststent esophagram did not show barium leak, and the patient was discharged home. One week later, the patient returned with enterococcal and candida bacteremia and an acute right parietal/occipital lobe infarct. Barium esophagram showed contrast extravasation into the pericardium. The patient rapidly succumbed to his illness and died. Autopsy revealed pericardial abscess posterior to the LA in communication with the esophagus. Extension to the LA was not seen. Conclusion: While the surgical treatment of AEF is relatively well established, there is no consensus in the management of PEF. While prior small series have suggested PEF may be managed with esophageal stenting, our case illustrates the limitations of this approach.

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Section: Discussionsupporting

confidence: 51%

Section: Discussionmentioning

confidence: 58%

Surgical and endoscopic management of a pericardioesophageal fistula after radiofrequency pulmonary vein isolation

Siroky

Niazi

Ghaly

et al. 2020

Pacing Clinical Electrophis

View full text Add to dashboard Cite

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“…Migration behaviors observed in clinical practices [22,23] were not considered in this work. It has been shown that a larger radial/bending strength, correlated with higher contact force between stent and the lesion, could mitigate the migration of a straight stent [24].…”

Section: Discussionmentioning

confidence: 99%

Experimental evaluation of self-expandable metallic tracheobronchial stents

Wang

Dong

et al. 2019

Nanotechnology Reviews

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The self-expandable metallic stents have been widely used in tracheobronchial obstruction or fistulation, including the J-shaped and Y-shaped stents, named after the shape of the branch-stem junction of the stent. However, there is scarce data on the mechanical performance of these tracheobronchial stents, which is essential for optimal stent implantation. In this work, eight self-expandable metallic tracheobronchial stents in three types (i.e., straight, J-shaped, and Y-shaped), with or without cover, were characterized. The compression resistance of the stems was investigated through both compression and indentation tests. The bending resistance of the branches in the J-shaped and Y-shaped stents was assessed through the bending test. Our results demonstrated that the covered stents exhibited a significantly higher compression resistance and bending resistance than the uncovered ones. The branches had a minimal impact on the compression resistance of the stem. The branch of the J-shaped stent showed a significantly lower bending resistance than the Y shaped one. This work provides a testing framework for the J-shaped and Y-shaped stents,which could shed some light on the optimal design of stent with branches.

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“…For stent placement, RM fluoroscopy allows exact measurement of the length of the stenosis and the size of the adjacent tubular esophagus, facilitating choice of the most appropriate stent for the individual. Correct sizing of the placed stent is important to minimize risk of migration of fully covered stents 9 . In addition, marking the stenosis with external markers or injection with lipiodol appears to be less precise and might no longer be necessary.…”

Section: Discussionmentioning

confidence: 99%

Road Map fluoroscopy successfully guides endoscopic interventions in the esophagus

et al. 2017

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Background and study aims Road Map (RM) fluoroscopy is a radiological technique that enables visualization of anatomic structures using image subtraction at peak opacification. RM fluoroscopy has never previously been evaluated for use in endoscopy. The aim of this study was to evaluate the usefulness of RM in guiding endoscopic intervention in the esophagus. Patients and methods This was a monocentric observational trial of consecutive patients with esophageal strictures in a university hospital. Twenty-seven investigations using RM were performed in 24 patients undergoing esophageal endoscopy. Indications for the procedure were balloon dilatation (n = 7 including 2 pneumatic balloon dilatations for treatment of achalasia), bougie dilatation (n = 7) and diagnostic endoscopy (n = 1). In addition, 12 stents, 7 partially covered and 5 fully covered, were placed using RM as a guide for determination of stent length and diameter. Stents were deployed under RM guidance. Results In all procedures, RM successfully guided the intervention. Endoscopic control endoscopy confirmed adequate stent placement in all cases. Conclusion RM allows permanent and accurate radiographic imaging of stenoses and esophageal anatomic changes. It is an easy and safe method of guiding endoscopic interventions that require radiological imaging.

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Esophageal stent migration: Testing few hypothesis with a simplified mathematical model

Cited by 18 publications

References 42 publications

Surgical and endoscopic management of a pericardioesophageal fistula after radiofrequency pulmonary vein isolation

Surgical and endoscopic management of a pericardioesophageal fistula after radiofrequency pulmonary vein isolation

Experimental evaluation of self-expandable metallic tracheobronchial stents

Road Map fluoroscopy successfully guides endoscopic interventions in the esophagus

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