Interventional Protocol for Treatment of Complications after Esophagojejunostomy for Esophagogastric Carcinoma

Bi, Yonghua; Li, Jindong; Yi, Mengfei; Yu, Zepeng; Han, Xinwei; Ren, Jianzhuang

doi:10.1155/2019/1465301

Cited by 7 publications

(12 citation statements)

References 23 publications

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“…The insertion of SEMSs is usually used in the palliative treatment of malignant esophageal stricture in patients with recurrent or advanced esophageal cancer (8)(9)(10). Fully covered SEMSs have been used as a means of alternative management for esophageal perforation and fistula (19)(20)(21), as well as a salvage therapy for patients with esophageal variceal bleeding caused by cirrhosis (11,12,22,23).…”

Section: Discussionmentioning

confidence: 99%

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Compression hemostasis using fully covered self-expandable metallic stents for refractory hemorrhages caused by esophageal cancer: A pilot study

Ren²,

Han³

2023

Front. Gastroenterol.

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ObjectiveFully covered self-expandable metallic stents (SEMSs) have been widely used as a salvage therapy for patients with esophageal variceal bleeding. However, the role of fully covered SEMSs in the management of hemorrhage caused by esophageal cancer has not yet been established. We aimed to investigate the safety and efficacy of fully covered SEMSs as a salvage therapy for esophageal cancer-related hemorrhage.MethodsFrom September 2019 to March 2022, 17 patients, who underwent the insertion of fully covered SEMS for malignant esophageal hemorrhages, were retrospectively analyzed. Chest computed tomography (CT) scans and esophagographies were performed routinely to determine the location and length of the tumor. A fully covered SEMS was implanted under fluoroscopy. Baseline demographics were retrospectively collected, that is those for sex, age, previous treatment, comorbidities, lesion type, and stent size.ResultsA total of 20 metal stents were placed in 17 patients, with a technical success rate of 100% and a hemostasis success rate of 88.2%. Stent removal was performed in three patients because of complications. No perioperative deaths were related to stent placement or removal. Five main complications (29.4%) were found after stent insertion. Stent migration and restenosis were observed in two patients (11.8%). Except for two perioperative deaths and one patient lost to follow-up, all remaining 14 patients were successfully followed up. At the end of follow-up, two patients had survived without obvious symptoms, and a total of 12 patients were dead owing to tumor progression (n = 10), severe infection (n = 1), and cerebrovascular accident (n = 1). The median overall survival was 13.8 months.ConclusionInsertion of a fully covered SEMS may be a safe and effective means of the salvage management of refractory esophageal cancer-related hemorrhage, and its use in this context may lead to the development of innovative methods for compression hemostasis. However, further study with a larger sample size and comparison with other forms of salvage therapy.

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Section: Discussionmentioning

confidence: 99%

“…Self-expandable metallic stent (SEMS) placement has been served as palliative treatment for advanced esophageal patients with esophageal fistula or stricture (8)(9)(10). Fully covered SEMSs have been widely used as a salvage therapy for patients with esophageal variceal bleeding (11,12).…”

Section: Introductionmentioning

confidence: 99%

Compression hemostasis using fully covered self-expandable metallic stents for refractory hemorrhages caused by esophageal cancer: A pilot study

Ren²,

Han³

2023

Front. Gastroenterol.

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“…All non-invasive procedures were performed under uoroscopic guidance similar to previous reports (2,4,8,9). The lidocaine gel was orally taken to anesthetize the esophagus.…”

Section: Three-tube Methodsmentioning

confidence: 99%

“…Patients with narrowing stomach tube received covered stent placement at the level of the anastomosis. Retrievable esophageal covered stents (Nanjing Micro-Tech Medical Company, Nanjing, China) were used in 11 patients (3,8,9). The median diameter of the stents was 20 mm, ranging from 18 to 22 mm.…”

Section: Esophageal Covered Stent Placementmentioning

confidence: 99%

A non-invasive protocol for the treatment of gastro-mediastinal or gastro-pleural fistula after esophagogastrectomy

Wang

Ren

et al. 2023

Preprint

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Background: We aimed to study the safety and efficacy of three tubes with or without covered esophageal stent placement for the management of gastro-mediastinal or gastro-pleural fistula. Methods: We retrospectively assessed the clinical data of 31 consecutive patients with gastro-mediastinal or gastro-pleural fistula treated by using a non-invasive protocol. Patients received three tubes (jejunal feeding tube, gastrointestinal drainage tube and abscess drainage tube) with or without esophageal covered stent placement. All patients received continue abscess drainage and nutritional support after procedure. The tubes and/or esophageal covered stents were removed after fistula healing. Results: All patients received three tubes placement and 11 patients with lumenal narrowing received esophageal covered stent placement. Technically success was found in all patients, with no perioperative death, esophageal rupture or massive hemorrhage. Abscess cavity disappeared in 22 patients, with a clinical success rate of 71.0%. All patients received esophageal stent placement were cured and stents were removed, for the median duration of 1.6 months (IQR 1.4, 3.7). Three patients showed clinical improved, with markedly decreased abscess cavity and markedly shrunk fistula. The median survival was 30.8 months. The 1-, 3-, 5-year survival rates were 71.1%, 46.1% and 39.5%, respectively. Conclusions: A non-invasive protocol of three tubes with or without covered esophageal stent placement is safe and effective for gastro-mediastinal or gastro-pleural fistula after esophagogastrectomy.

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“…In addition to its role as a diagnostic and primary endoscopic therapeutic measure, endoscopy plays also a relevant role in the treatment of postoperative complications after EC resection [ 10 ]. Postoperative complications that may require endoscopic therapy are as follows: anastomotic hemorrhage, anastomotic insufficiency, delayed gastric emptying, and anastomotic stenosis.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Management for Post-Surgical Complications after Resection of Esophageal Cancer

Wichmann¹,

Fusco²,

Werner³

et al. 2022

Cancers

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Background: Esophageal cancer (EC) is the sixth-leading cause of cancer-related deaths in the world. Esophagectomy is the most effective treatment for patients without invasion of adjacent organs or distant metastasis. Complications and relevant problems may occur in the early post-operative course or in a delayed fashion. Here, innovative endoscopic techniques for the treatment of postsurgical problems were developed during the past 20 years. Methods: Endoscopic treatment strategies for the following postoperative complications are presented: anastomotic bleeding, anastomotic insufficiency, delayed gastric passage and anastomotic stenosis. Based on a literature review covering the last two decades, therapeutic procedures are presented and analyzed. Results: Addressing the four complications mentioned, clipping, stenting, injection therapy, dilatation, and negative pressure therapy are successfully utilized as endoscopic treatment techniques today. Conclusion: Endoscopic treatment plays a major role in both early-postoperative and long-term aftercare. During the past 20 years, essential therapeutic measures have been established. A continuous development of these techniques in the field of endoscopy can be expected.

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Interventional Protocol for Treatment of Complications after Esophagojejunostomy for Esophagogastric Carcinoma

Cited by 7 publications

References 23 publications

Compression hemostasis using fully covered self-expandable metallic stents for refractory hemorrhages caused by esophageal cancer: A pilot study

Compression hemostasis using fully covered self-expandable metallic stents for refractory hemorrhages caused by esophageal cancer: A pilot study

A non-invasive protocol for the treatment of gastro-mediastinal or gastro-pleural fistula after esophagogastrectomy

Endoscopic Management for Post-Surgical Complications after Resection of Esophageal Cancer

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