Nonmalignant obstruction is a common problem with metal stents in the treatment of esophageal cancer

Morello, William; Fleischer, David E.; Salcedo, Julio; Roy, Praveen K.; Al‐Kawas, Firas H.; Benjamin, Stanley B.

doi:10.1016/s0016-5107(00)70289-6

Cited by 120 publications

(68 citation statements)

References 21 publications

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“…Tissue overgrowth is caused by tumor tissue from progressive tumor growth or by nonmalignant hyperplastic tissue growth at the end of the stent. Mayoral et al [21] reported that recurrent dysphagia was caused by nonmalignant obstructive tissue such as granulation tissue, reactive hyperplasia, and fibrosis at the proximal or distal end of the stent in 32% of patients after a mean interval of 22 weeks.…”

Section: Discussionmentioning

confidence: 99%

Malignant esophageal dysphagia palliation using insertion of a covered Ultraflex stent without fluoroscopy: a prospective observational study

et al. 2010

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Section: Discussionmentioning

confidence: 99%

Malignant esophageal dysphagia palliation using insertion of a covered Ultraflex stent without fluoroscopy: a prospective observational study

et al. 2010

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“…This hyperplastic tissue reaction can be clinically manifest as early as 2 weeks after stent placement and also at a later stage. 28 Moreover, tissue inand ⁄ or overgrowth may complicate removal of PSEMS in patients, resulting in a second oesophageal perforation.…”

Section: (98)mentioning

confidence: 99%

Systematic review: temporary stent placement for benign rupture or anastomotic leak of the oesophagus

Boeckel¹,

Sijbring²,

Vleggaar

et al. 2011

Alimentary Pharmacology &Amp; Therapeutics

259

232

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Summary Background Placement of self‐expanding metal stents (SEMS) or plastic stents (SEPS) has emerged as a minimally invasive treatment option for benign oesophageal ruptures and leaks; however, it is not clear which stent type should be preferred. Aim To assess clinical effectiveness and safety of treating benign oesophageal ruptures and anastomotic leaks with temporary placement of a stent with special emphasis on different stent designs. Methods A pooled analysis was performed after searching PubMed and EMBASE databases for studies regarding placement of fully covered and partially covered SEMS (FSEMS and PSEMS) and SEPS for this indication. Data were pooled and evaluated for clinical outcome, complications and survival. Results Twenty‐five studies, including 267 patients with complete follow‐up on outcome, were identified. Clinical success was achieved in 85% of patients and was not different between stent types (SEPS 84%, FSEMS 85% and PSEMS 86%, P = 0.97). Time of stent placement was longest for SEPS (8 weeks) followed by FSEMS and PSEMS (both 6 weeks). In total, 65 (34%) patients had a stent‐related complication. Stent migration occurred more often with SEPS [n = 47 (31%)] and FSEMS [n = 7 (26%)] than with PSEMS [n = 2 (12%), P ≤ 0.001], whereas there was no significant difference in tissue in‐ and overgrowth between PSEMS [12% vs. 7% (FSEMS) and 3% (SEPS), P = 0.68]. Conclusions Although there is a lack of randomised controlled trials, it seems that covered stent placement for a period of 6–8 weeks is safe and effective for benign oesophageal ruptures and anastomotic leaks to heal. As efficacy between different stent types is not significantly different, stent choice should depend on expected risk of stent migration (self‐expanding plastic stents and fully covered self‐expanding metal stents) and, to a minor degree, on expected risk of tissue in‐ or overgrowth (partially covered self‐expanding metal stents).

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“…The application of DXM to coronary or peripheral arteries has been investigated to reduce neointimal hyperplasia by the following plausible mechanisms; i.e., reduction of inflammatory cells at the site of vessel wall trauma, inhibition of leukocyte adhesion to endothelial cells, decrease of plateletderived growth factor (PDGF) expression, inhibition of smooth muscle cell proliferation, and inhibition of the expression of the fibroblast-and macrophage-bound metal- loproteinase which influences the synthesis of extracellular matrix [12,16,19]. Since granulation tissue is histologically highly vascularized connective tissue composed of newly formed capillaries, numerous fibroblasts, and inflammatory cells [20,21], and vascular proliferation is usually followed by division of the endothelial cells and an increase in the number of cells as a response to chronic inflammation [20], we surmise that similar mechanisms of DXM will apply to the tissue reaction secondary to stent placement in non-vascular luminal organs such as the tracheobronchial tree, urethra or esophagus. This conjecture is also supported by previous reports that subepithelial fibrosis or smooth muscle cell proliferation is significantly suppressed by locally administered DXM in bovine and mouse airway models [22,23].…”

Section: Discussionmentioning

confidence: 99%

Influence of a dexamethasone-eluting covered stent on tissue reaction: an experimental study in a canine bronchial model

et al. 2005

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This study was designed to evaluate the feasibility and efficacy of a dexamethasone (DXM)-eluting, covered, self-expanding metallic stent to reduce tissue reaction following stent placement in a canine bronchial model. We placed a DXM-eluting, polyurethane-covered, self-expanding metallic stent (drug stent, DS) and a polyurethane-covered, self-expanding metallic stent (control stent, CS) alternately in each left main bronchus and left lower lobe bronchus in 12 dogs. The stents were 20 mm in diameter and length when fully expanded. The dose of DXM was approximately 36.7 mg in each DS, but was absent in the CS. The dogs were euthanased 1 week (n=4), 2 weeks (n=4) or 4 weeks (n=4) after stent placement. Histologic findings, such as epithelial erosion/ulcer or granulation tissue thickness, were obtained from the mid-portion of the bronchus, where the stent had been placed, and evaluated between DS and CS. There were no procedure-related complications or malpositioning of any of the bronchial stents. Stent migration was detected in one dog just before euthanasia 1 week following stent placement. Stent patency was maintained until euthanasia in all dogs. Epithelial erosion/ulcer (%) was significantly less in the DS (mean+/-standard deviation, 46.88+/-23.75) than in the CS (73.75+/-14.08) (P=0.026) for all time-points. There was a decrease in epithelial erosion/ulcer as the follow-up period increased in both DS and CS. The granulation tissue thickness (mm) was less in DS (2.63+/-2.05) than in CS (3.49+/-2.95), although the difference was not significant (P=0.751) for all time-points. There was a tendency toward an increase in granulation tissue thickness and chronic lymphocytic infiltration as the follow-up period increased in both DS and CS. In conclusion, DXM-eluting, covered, self-expanding metallic stent seems to be effective in reducing tissue reaction secondary to stent placement in a canine bronchial model.

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Nonmalignant obstruction is a common problem with metal stents in the treatment of esophageal cancer

Cited by 120 publications

References 21 publications

Malignant esophageal dysphagia palliation using insertion of a covered Ultraflex stent without fluoroscopy: a prospective observational study

Malignant esophageal dysphagia palliation using insertion of a covered Ultraflex stent without fluoroscopy: a prospective observational study

Systematic review: temporary stent placement for benign rupture or anastomotic leak of the oesophagus

Influence of a dexamethasone-eluting covered stent on tissue reaction: an experimental study in a canine bronchial model

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