Through-the-scope placement of a fully covered metal stent for palliation of malignant dysphagia: a prospective cohort study (with video)

Vermeulen, Bram D.; Reijm, Agnes N.; Bogt, Ruben D. van der; Hooft, Jeanin E. van; Spaander, Manon C.W.; Siersema, Peter D.

doi:10.1016/j.gie.2019.06.030

Cited by 9 publications

(6 citation statements)

References 22 publications

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“…Different to our data, they reported two patients with upper GI hemorrhage and one with an esophageal perforation, despite no patient dying from stent‐related causes. Different to our larger series, they didn’t use X‐ray control or guidewire in about one third of the patients 15 . In terms of two manufacturers, the two stents are different.…”

Section: Discussionmentioning

confidence: 69%

Through‐the‐scope esophageal stent for the relief of malignant dysphagia: Results of a multicentric study (with video)

Mangiavillano

Auriemma

Bianchetti

et al. 2020

Digestive Endoscopy

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Background and aim: In presence of malignant dysphagia, in patients unfit for surgery, the placement of a self-expandable metal stent (SEMS) represents a safe and effective palliative treatment. Esophageal stents (ES) present an over-the-wire mechanism where the stent is deployed under X-ray control. Recently a through-the-scope (TTS) ES was launched. The aim of our retrospective study is to assess the technical and clinical success of the new TTS-ES. Materials and methods: Patients with malignant dysphagia caused by esophageal cancer or ab-extrinsic compression, who underwent TTS esophageal stent in six Italian endoscopic referral centers, were retrospectively reviewed. Results: A total of 40 patients were enrolled. TTS stent placement was successful in 39/40 patients (97.5%). 31 patients had an Ogilvie score of 4, nine an Ogilvie 3. After 2 weeks from stent placement 29 reported Ogilvie score of 0, eight a score of 1. None of the patients developed retrosternal pain requiring drugs. No patient experienced perforation, bleeding or migration. A total of seven patients (18%) developed dysphagia as late adverse event (AE). Conclusion: Through-the-scope ES presented less AEs, in terms of bleeding and perforation, if compared to the previous published data. An anti-migration system could be helpful, especially when the stent is placed for "ab-extrinseco" malignant dysphagia.

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Section: Discussionmentioning

confidence: 69%

Through‐the‐scope esophageal stent for the relief of malignant dysphagia: Results of a multicentric study (with video)

Mangiavillano

Auriemma

Bianchetti

et al. 2020

Digestive Endoscopy

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“…Meta-regression analysis, however, is a weak statistic in terms of assessing the predictive effects of a variable to the reported outcome. In 14 of the included studies [24,25,[38][39][40][41][42][43][44][45][46][47][48][49], the esophageal stent was deployed under direct endoscopic view where as a through-thescope (TTS) technique was used in only one study [9]. In two studies [50,51], the esophageal stent was placed over a guidewire and confirmation of accurate positioning was done by post deployment endoscopy.…”

Section: Discussionmentioning

confidence: 99%

“…Access to fluoroscopic services may also not be readily available in certain medical centers. Traditionally, SEMS have been placed under direct endoscopic visualization, however, more recently, a through-the-scope technique has also been described [9]. The aim of our study was to evaluate the overall clinical efficacy and safety of esophageal SEMS placement without the aid of fluoroscopy.…”

Section: Introductionmentioning

confidence: 99%

Clinical efficacy and safety of palliative esophageal stenting without fluoroscopy: a systematic review and meta-analysis

et al. 2020

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Background and study aims Despite advances in curative treatments for esophageal cancer, many patients often present with advanced disease. Dysphagia resulting in significant weight loss and malnutrition leads to poor quality of life. Palliative esophageal stenting with self-expanding metal stents (SEMS) helps alleviate symptoms and prolongs survival. However, access to fluoroscopy may be limited at certain centers causing delay in patient care. Methods We searched multiple databases from inception to November 2019 to identify studies evaluating the efficacy and safety of endoscopic palliative esophageal stenting and selected only those studies where fluoroscopic guidance was not used. Our primary aim was to calculate the overall technical as well as clinical success. Using meta-regression analysis, we also evaluated the effect of tumor location and obstruction length on overall technical and clinical success. Results A total of 1778 patients from 17 studies were analyzed. A total of 2036 stents were placed without the aid of fluoroscopy. The pooled rate of technical success was 94.7 % (CI 89.9–97.3, PI 55–99; I2 = 85) and clinical success was 82.1 % (CI 67.1–91.2, PI 24–99; I2 = 87). Based on meta-regression analysis both the length of obstruction and tumor location did not have any statistically significant effect on technical and clinical success. The pooled rate of adverse events was 4.1 % (CI 2.4–7.2; I2 = 72) for stent migration, 8.1 % (CI 4.1–15.4; I2 = 89) for tumor overgrowth and 1.2 % (CI 0.7–2; I2 = 0) for perforation. The most frequent clinical adverse event was retro-sternal chest pain. Conclusion Palliative esophageal stenting without fluoroscopy using SEMS is both safe and effective in patients with advanced esophageal cancer.

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“…With respect to oesophageal self-expanding metal stents (SEMS), eight recent studies of demonstrated a risk of 0% significant haemorrhage within 7 days of insertion. [150][151][152][153][154][155][156][157] However, studies including delayed haemorrhage showed a risk of 9% in an RCT comparing small-diameter stents with large-diameter stents and an 8% risk in a large retrospective series of 997 patients. 158 159 Causes of haemorrhage included aorta-oesophageal fistula formation, and continued oozing from tumours.…”

Section: Endoscopic Stentingmentioning

confidence: 99%

Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update

Veitch

Radaelli

Alikhan

et al. 2021

Gut

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This is a collaboration between the British Society of Gastroenterology (BSG) and the European Society of Gastrointestinal Endoscopy (ESGE), and is a scheduled update of their 2016 guideline on endoscopy in patients on antiplatelet or anticoagulant therapy. The guideline development committee included representatives from the British Society of Haematology, the British Cardiovascular Intervention Society, and two patient representatives from the charities Anticoagulation UK and Thrombosis UK, as well as gastroenterologists. The process conformed to AGREE II principles and the quality of evidence and strength of recommendations were derived using GRADE methodology. Prior to submission for publication, consultation was made with all member societies of ESGE, including BSG. Evidence-based revisions have been made to the risk categories for endoscopic procedures, and to the categories for risks of thrombosis. In particular a more detailed risk analysis for atrial fibrillation has been employed, and the recommendations for direct oral anticoagulants have been strengthened in light of trial data published since the previous version. A section has been added on the management of patients presenting with acute GI haemorrhage. Important patient considerations are highlighted. Recommendations are based on the risk balance between thrombosis and haemorrhage in given situations.

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Through-the-scope placement of a fully covered metal stent for palliation of malignant dysphagia: a prospective cohort study (with video)

Cited by 9 publications

References 22 publications

Through‐the‐scope esophageal stent for the relief of malignant dysphagia: Results of a multicentric study (with video)

Through‐the‐scope esophageal stent for the relief of malignant dysphagia: Results of a multicentric study (with video)

Clinical efficacy and safety of palliative esophageal stenting without fluoroscopy: a systematic review and meta-analysis

Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update

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