Clinical Endoscopy

Impact of sarcopenia on biliary drainage during neoadjuvant therapy for pancreatic cancer: Kunio Kataoka, Eizaburo Ohno, Takuya Ishikawa, Kentaro Yamao, Yasuyuki Mizutani, Tadashi Iida, Hideki Takami, Osamu Maeda, Junpei Yamaguchi, Yukihiro Yokoyama, Tomoki Ebata, Yasuhiro Kodera, Hiroki Kawashima; Clin Endosc 2024;57(1):112-121. Published online July 18, 2023; DOI: https://doi.org/10.5946/ce.2022.278

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Background
/Aims: Since the usefulness of neoadjuvant chemo(radiation) therapy (NAT) for pancreatic cancer has been demonstrated, recurrent biliary obstruction (RBO) in patients with pancreatic cancer with a fully covered self-expandable metal stent (FCSEMS) during NAT is expected to increase. This study investigated the impact of sarcopenia on RBO in this setting.
Methods
Patients were divided into normal and low skeletal muscle index (SMI) groups and retrospectively analyzed. Patient characteristics, overall survival, time to RBO (TRBO), stent-related adverse events, and postoperative complications were compared between the two groups. A Cox proportional hazard model was used to identify the risk factors for short TRBO.
Results
A few significant differences were observed in patient characteristics, overall survival, stent-related adverse events, and postoperative complications between 38 patients in the normal SMI group and 17 in the low SMI group. The median TRBO was not reached in the normal SMI group and was 112 days in the low SMI group (p=0.004). In multivariate analysis, low SMI was the only risk factor for short TRBO, with a hazard ratio of 5.707 (95% confidence interval, 1.148–28.381; p=0.033).
Conclusions
Sarcopenia was identified as an independent risk factor for RBO in patients with pancreatic cancer with FCSEMS during NAT.

Citations

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Endeavors to prevent stent malfunction: new insights into the risk factors for recurrent biliary obstruction
Sung-Jo Bang
Clinical Endoscopy.2024; 57(1): 56. CrossRef
Skeletal muscle status and survival among patients with advanced biliary tract cancer
Shinya Takaoka, Tsuyoshi Hamada, Naminatsu Takahara, Kei Saito, Go Endo, Ryunosuke Hakuta, Kota Ishida, Kazunaga Ishigaki, Sachiko Kanai, Kohei Kurihara, Hiroki Oyama, Tomotaka Saito, Tatsuya Sato, Tatsunori Suzuki, Yukari Suzuki, Shuichi Tange, Yurie Tok
International Journal of Clinical Oncology.2024; 29(3): 297. CrossRef

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A novel fully covered metal stent for unresectable malignant distal biliary obstruction: results of a multicenter prospective study: Arata Sakai, Atsuhiro Masuda, Takaaki Eguchi, Keisuke Furumatsu, Takao Iemoto, Shiei Yoshida, Yoshihiro Okabe, Kodai Yamanaka, Ikuya Miki, Saori Kakuyama, Yosuke Yagi, Daisuke Shirasaka, Shinya Kohashi, Takashi Kobayashi, Hideyuki Shiomi, Yuzo Kodama; Clin Endosc 2024;57(3):375-383. Published online July 10, 2023; DOI: https://doi.org/10.5946/ce.2023.035

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Background
/Aims: Endoscopic self-expandable metal stent (SEMS) placement is currently the standard technique for treating unresectable malignant distal biliary obstructions (MDBO). Therefore, covered SEMS with longer stent patency and fewer migrations are required. This study aimed to assess the clinical performance of a novel, fully covered SEMS for unresectable MDBO.
Methods
This was a multicenter single-arm prospective study. The primary outcome was a non-obstruction rate at 6 months. The secondary outcomes were overall survival (OS), recurrent biliary obstruction (RBO), time to RBO (TRBO), technical and clinical success, and adverse events.
Results
A total of 73 patients were enrolled in this study. The non-obstruction rate at 6 months was 61%. The median OS and TRBO were 233 and 216 days, respectively. The technical and clinical success rates were 100% and 97%, respectively. Furthermore, the rate of occurrence of RBO and adverse events was 49% and 21%, respectively. The length of bile duct stenosis (<2.2 cm) was the only significant risk factor for stent migration.
Conclusions
The non-obstruction rate of a novel fully covered SEMS for MDBO is comparable to that reported earlier but shorter than expected. Short bile duct stenosis is a significant risk factor for stent migration.

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Endeavors to prevent stent malfunction: new insights into the risk factors for recurrent biliary obstruction
Sung-Jo Bang
Clinical Endoscopy.2024; 57(1): 56. CrossRef
Understanding mechanical properties of biliary metal stents for wise stent selection
Seok Jeong
Clinical Endoscopy.2023; 56(5): 592. CrossRef

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Refractory benign biliary stricture due to chronic pancreatitis in two patients treated using endoscopic ultrasound-guided choledochoduodenostomy fistula creation: case reports: Sho Ishikawa, Nozomi Okuno, Kazuo Hara, Nobumasa Mizuno, Shin Haba, Takamichi Kuwahara, Yasuhiro Kuraishi, Takafumi Yanaidani; Clin Endosc 2024;57(1):122-127. Published online May 16, 2023; DOI: https://doi.org/10.5946/ce.2022.149

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Benign biliary stricture (BBS) is a complication of chronic pancreatitis (CP). Despite endoscopic biliary stenting, some patients do not respond to treatment, and they experience recurrent cholangitis. We report two cases of CP with refractory BBS treated using endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) fistula creation. A 50-year-old woman and a 60-year-old man both presented with obstructive jaundice secondary to BBS due to alcoholic CP. They underwent repeated placement of a fully covered self-expandable metal stent for biliary strictures. However, the strictures persisted, causing repeated episodes of cholangitis. Therefore, an EUS-CDS was performed. The stents were eventually removed and the patients became stent-free. These fistulas have remained patent without cholangitis for more than 2.5 years. Fistula creation using EUS-CDS is an effective treatment option for BBS.

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Forward viewing liner echoendoscopy for therapeutic interventions
Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara
Clinical Endoscopy.2024; 57(2): 175. CrossRef

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Practical Experiences of Unsuccessful Hemostasis with Covered Self-Expandable Metal Stent Placement for Post-Endoscopic Sphincterotomy Bleeding: Michihiro Yoshida, Tadahisa Inoue, Itaru Naitoh, Kazuki Hayashi, Yasuki Hori, Makoto Natsume, Naoki Atsuta, Hiromi Kataoka; Clin Endosc 2022;55(1):150-155. Published online November 19, 2020; DOI: https://doi.org/10.5946/ce.2020.217

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We reviewed 7 patients with unsuccessful endoscopic hemostasis using covered self-expandable metal stent (CSEMS) placement for post-endoscopic sphincterotomy (ES) bleeding. ES with a medium incision was performed in 6 and with a large incision in 1 patient. All but 1 of them (86%) showed delayed bleeding, warranting second endoscopic therapies followed by CSEMS placement 1–5 days after the initial ES. Subsequent CSEMS placement did not achieve complete hemostasis in any of the patients. Lateral-side incision lines (3 or 9 o’clock) had more frequent bleeding points (71%) than oral-side incision lines (11–12 o’clock; 29%). Additional endoscopic hemostatic procedures with hemostatic forceps, hypertonic saline epinephrine, or hemoclip achieved excellent hemostasis, resulting in complete hemostasis in all patients. These experiences provide an alert: CSEMS placement is not an ultimate treatment for post-ES bleeding, despite its effectiveness. The lateral-side of the incision line, as well as the oral-most side, should be carefully examined for bleeding points, even after the CSEMS placement.

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Application of a New Hemostatic Clip to Prevent Delayed Bleeding After Endoscopic Sphincterotomy
Jinpei Dong, Qiushi Feng, Guigen Teng, Haixia Niu, Dapeng Bian
Journal of Clinical Gastroenterology.2024; 58(6): 614. CrossRef
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Endoscopic Self-Expandable Metal Stent Placement for Malignant Afferent Loop Obstruction After Pancreaticoduodenectomy: A Case Series and Review: Arata Sakai, Hideyuki Shiomi, Takao Iemoto, Ryota Nakano, Takuya Ikegawa, Takashi Kobayashi, Atsuhiro Masuda, Yuzo Kodama; Clin Endosc 2020;53(4):491-496. Published online March 3, 2020; DOI: https://doi.org/10.5946/ce.2019.145

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In this study, we assessed a series of our cases in which endoscopic self-expandable metal stents (SEMSs) were used to treat malignant afferent loop obstruction (ALO) that arose after pancreaticoduodenectomy (PD). We retrospectively examined the records of 7 patients who underwent endoscopic SEMS placement for malignant ALO following PD. Clinical success was achieved in all cases. The median procedure time was 30 min (range, 15–50 min). There were no cases of stent occlusion, and no procedure-related adverse events were encountered. All patients died of their primary disease, and the median overall survival period was 155 days (range, 96–374 days). A re-intervention involving endoscopic ultrasound-guided hepaticogastrostomy combined with antegrade stenting was performed for obstructive jaundice and acute cholangitis in 1 case. In conclusion, endoscopic SEMS placement may be an effective and safe treatment for malignant ALO that arises after PD.

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Efficacy of endoscopic ultrasound‐guided gastroenterostomy using self‐expandable metallic stent for afferent loop syndrome: A single‐center retrospective study
Yuya Hagiwara, Susumu Hijioka, Yoshikuni Nagashio, Yuta Maruki, Akihiro Ohba, Yuki Kawasaki, Kotaro Takeshita, Tetsuro Takasaki, Daiki Agarie, Hidenobu Hara, Shin Yagi, Soma Fukuda, Masaru Kuwada, Daiki Yamashige, Kohei Okamoto, Mark Chatto, Shunsuke Kond
Journal of Gastroenterology and Hepatology.2024;[Epub] CrossRef
Successful metal stent placement using short single-balloon endoscope for afferent loop syndrome after pancreaticoduodenectomy
Takuto Furukawa, Yuichi Takano, Jun Noda, Masataka Yamawaki, Tetsushi Azami, Fumitaka Niiya, Fumiya Nishimoto, Naotaka Maruoka, Masatsugu Nagahama
Progress of Digestive Endoscopy.2024; 104(1): 98. CrossRef
The Role of Endoscopic Management in Afferent Loop Syndrome
Clement Chun Ho Wu, Elizabeth Brindise, Rami El Abiad, Mouen A. Khashab
Gut and Liver.2023; 17(3): 351. CrossRef
Early and late effects of endoscopic interventions in patients with malignant afferent loop syndrome: A single‐center experience and literature review
Kenjiro Yamamoto, Takao Itoi, Yukitoshi Matsunami, Atsushi Sofuni, Takayoshi Tsuchiya, Shuntaro Mukai, Hiroyuki Kojima, Hirohito Minami, Ryosuke Nakatsubo, Ryosuke Tonozuka
Journal of Hepato-Biliary-Pancreatic Sciences.2023;[Epub] CrossRef
Simultaneous stent placement for biliary and afferent loop obstruction due to tumor recurrence after pancreatoduodenectomy
Tatsunori Satoh, Hirotoshi Ishiwatari, Kazuma Ishikawa, Hidenori Kimura, Hiroyuki Matsubayashi, Hiroyuki Ono
Endoscopy.2022; 54(09): E524. CrossRef
Extra-anatomic percutaneous stenting of a malignant afferent loop obstruction following pancreaticoduodenectomy
Stefan Lam, Sarah Khan, Robert Hutchins, Tim Fotheringham
International Journal of Gastrointestinal Intervention.2022; 11(2): 77. CrossRef
Endoscopic Transluminal Stent Placement for Malignant Afferent Loop Obstruction
Chinatsu Yonekura, Takashi Sasaki, Takafumi Mie, Takeshi Okamoto, Tsuyoshi Takeda, Takaaki Furukawa, Yuto Yamada, Akiyoshi Kasuga, Masato Matsuyama, Masato Ozaka, Naoki Sasahira
Journal of Clinical Medicine.2022; 11(21): 6357. CrossRef
Clinical management for malignant afferent loop obstruction
Arata Sakai, Hideyuki Shiomi, Atsuhiro Masuda, Takashi Kobayashi, Yasutaka Yamada, Yuzo Kodama
World Journal of Gastrointestinal Oncology.2021; 13(7): 684. CrossRef
Clinical management for malignant afferent loop obstruction
Arata Sakai, Hideyuki Shiomi, Atsuhiro Masuda, Takashi Kobayashi, Yasutaka Yamada, Yuzo Kodama
World Journal of Gastrointestinal Oncology.2021; 13(7): 509. CrossRef
Endoscopic Ultrasound-Guided Gastroenterostomy for Afferent Loop Syndrome
Hideyuki Shiomi, Arata Sakai, Ryota Nakano, Shogo Ota, Takashi Kobayashi, Atsuhiro Masuda, Hiroko Iijima
Clinical Endoscopy.2021; 54(6): 810. CrossRef
Percutaneous- and EUS-guided gastroenterostomy for malignant afferent limb syndrome
Dayyan Adoor, Zachary L. Smith
VideoGIE.2020; 5(11): 542. CrossRef

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Endoscopic Management of Malignant Colonic Obstruction: Seung Young Seo, Sang Wook Kim; Clin Endosc 2020;53(1):9-17. Published online January 7, 2020; DOI: https://doi.org/10.5946/ce.2019.051

Abstract PDF PubReader ePub

Advanced colorectal cancer can cause acute colonic obstruction, which is a life-threatening condition that requires emergency bowel decompression. Malignant colonic obstruction has traditionally been treated using emergency surgery, including primary resection or stoma formation. However, relatively high rates of complications, such as anastomosis site leakage, have been considered as major concerns for emergency surgery. Endoscopic management of malignant colonic obstruction using a self-expandable metal stent (SEMS) was introduced 20 years ago and it has been used as a first-line palliative treatment. However, endoscopic treatment of malignant colonic obstruction using SEMSs as a bridge to surgery remains controversial owing to short-term complications and longterm oncological outcomes. In this review, the current status of and recommendations for endoscopic management using SEMSs for malignant colonic obstruction will be discussed.

Citations

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Endoscopic Management of Colonic Obstruction
Ahmad F. Aboelezz, Mohamed O. Othman
Gastrointestinal Endoscopy Clinics of North America.2024; 34(1): 141. CrossRef
Management of obstructed colorectal carcinoma in an emergency setting: An update
Efstathios T Pavlidis, Ioannis N Galanis, Theodoros E Pavlidis
World Journal of Gastrointestinal Oncology.2024; 16(3): 598. CrossRef
Oncologic impact of colonic stents for obstructive left-sided colon cancer
Hideyuki Suzuki, Shingo Tsujinaka, Yoshihiro Sato, Tomoya Miura, Chikashi Shibata
World Journal of Clinical Oncology.2023; 14(1): 1. CrossRef
Effectiveness and early postoperative outcomes of palliative endoluminal stenting versus Hartmann’s procedure in acute malignant bowel obstruction in high-risk patients
Mohammed Fayek Mahfouz, Tamer M. Saeid Salama, Amr H. Afifi, Hany Mansour Khalil Dabous
Annals of Coloproctology.2022; 38(2): 141. CrossRef
Oncologic safety of colonic stenting as a bridge to surgery in left-sided malignant colonic obstruction: Current evidence and prospects
Sukit Pattarajierapan, Nattapanee Sukphol, Karuna Junmitsakul, Supakij Khomvilai
World Journal of Clinical Oncology.2022; 13(12): 943. CrossRef
Tendencias en el manejo quirúrgico de urgencia del cáncer de colon obstructivo. Situación departamental de Santander, Colombia, y consideraciones actuales
Silvia Inés Guerrero Macías, Ada Bustos-Guerrero, Andres Felipe Chaparro-Zaraza
Revista Colombiana de Cancerología.2022; 26(4): 362. CrossRef
Predictors of clinical outcomes of self-expandable metal stent treatment for malignant colorectal obstruction
Bora Han, Ji-Yun Hong, Eun Myung, Hyung-Hoon Oh, Hee-Chan Yang, Sang-Wook Kim, Jun Lee, Seong-Jung Kim, Yeom-Dong Han, Geom-Seok Seo, Gun-Young Hong, Ho-Dong Kim, Hyun-Soo Kim, Young-Eun Joo
Medicine.2021; 100(27): e26616. CrossRef
Obstructing Left-Sided Colonic Cancer: Is Endoscopic Stenting a Bridge to Surgery or a Bridge to Nowhere?
Augusto Lauro, Margherita Binetti, Samuele Vaccari, Maurizio Cervellera, Valeria Tonini
Digestive Diseases and Sciences.2020; 65(10): 2789. CrossRef

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Angular Positioning of Stent Increases Bowel Perforation after Self-Expandable Metal Stent Placement for Malignant Colorectal Obstruction: Jeong Guil Lee, Kwang Ho Yoo, Chang-Il Kwon, Kwang Hyun Ko, Sung Pyo Hong; Clin Endosc 2013;46(4):384-389. Published online July 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.4.384

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Background/Aims

Some factors like stent wires, balloon dilatation and use of guide wires seems to increase perforation after self-expandable metal stent (SEMS) placement, but few studies mentioned about the relationship between angulation of malignant stricture and perforation. The present study aimed to confirm that more angular positioning of stents increases perforation.

Methods

This study was conducted with retrospectively evaluation at Digestive Disease Center, CHA Bundang Medical Center, CHA University. Between January 2002 and August 2011, SEMS was inserted in 130 patients with malignant colorectal obstruction. We studied the difference in the angle of stenosis between perforation and non-perforation groups using fluorography images.

Results

SEMS insertion was performed in 130 cases of obstruction due to colon cancer. Perforation occurred in eight patients (6.2%) of them. Thirteen cases were excluded from the analysis due to poor fluoroscopic images. Among the eight patients with perforation, the mean stenosis angle was 109.9° compared to 153.1° in the nonperforation group, indicating that the angle was more acute in the perforation group (p=0.016).

Conclusions

This study shows that more angular positioning of stent increases bowel perforation after SEMS placement for malignant colorectal obstruction.

Citations

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Analysis of Reported Adverse Events With Colonic Stents: An FDA MAUDE Database Study
Chong-Chi Chiu, Kuo-Chuan Hung, Li-Ren Yeh
Journal of Clinical Gastroenterology.2023; 57(6): 640. CrossRef
Clinical outcomes of colorectal stenting
S.V. Davydova, A.G. Fedorov, O.A. Yun, A.E. Klimov
Endoskopicheskaya khirurgiya.2023; 29(6): 12. CrossRef
Colonic stenting for malignant obstructions-A review of current indications and outcomes
Amelie Lueders, Gabie Ong, Peter Davis, Jonathan Weyerbacher, Jonathan Saxe
The American Journal of Surgery.2022; 224(1): 217. CrossRef
Comparison of different types of covered self-expandable metal stents for malignant colorectal obstruction
Joon Seop Lee, Hyun Seok Lee, Eun Soo Kim, Min Kyu Jung, Jin Tae Jung, Ho Gak Kim, Dong Wook Lee, Dae Jin Kim, Yoo Jin Lee, Chang Heon Yang
Surgical Endoscopy.2021; 35(8): 4124. CrossRef
Self‐expanding metallic stent improves histopathological edema compared with transanal drainage tube for malignant colorectal obstruction
Hiroshi Takeyama, Kotaro Kitani, Tomoko Wakasa, Masanori Tsujie, Yoshinori Fujiwara, Shigeto Mizuno, Masao Yukawa, Yoshio Ohta, Masatoshi Inoue
Digestive Endoscopy.2016; 28(4): 456. CrossRef
Oncologic safety of self-expanded metal stent insertion as a bridge to elective surgery in malignant colorectal obstruction
Se Hui Oh, Nak Jun Choi, Sang Hyuk Seo, Min Sung An, Kwang Hee Kim, Ki Beom Bae, Jin Won Hwang, Sang Heon Lee, Ji Hyun Kim, Sam Ryong Jee, Mi Seon Kang, Kwan Hee Hong
Korean Journal of Clinical Oncology.2016; 12(1): 48. CrossRef
Enteral stent construction: Current principles
Hans-Ulrich Laasch, Derek W. Edwards, Ho-Young Song
International Journal of Gastrointestinal Intervention.2016; 5(2): 85. CrossRef
Comparison of through-the-scope stent insertion with standard stent insertion for the management of malignant colorectal obstruction: a prospective study
Y. Wan, Y.-Q. Zhu, N.-W. Chen, Z.-G. Wang, Y.-S. Cheng, J. Shi
Techniques in Coloproctology.2016; 20(10): 707. CrossRef
Intestinal Stricture in Crohn's Disease
Chen-Wang Chang, Jau-Min Wong, Chien-Chih Tung, I-Lun Shih, Horng-Yuan Wang, Shu-Chen Wei
Intestinal Research.2015; 13(1): 19. CrossRef
Predictive Factors for Successful Colonic Stenting in Acute Large-Bowel Obstruction
Derek J. Boyle, Christopher Thorn, Ashish Saini, Colin Elton, Gary K. Atkin, Ian C. Mitchell, Kevin Lotzof, Adrian Marcus, Pawan Mathur
Diseases of the Colon & Rectum.2015; 58(3): 358. CrossRef
Stents for colonic strictures: Materials, designs, and more
Nandakumar Srinivasan, Richard A. Kozarek
Techniques in Gastrointestinal Endoscopy.2014; 16(3): 100. CrossRef
Patients who failed endoscopic stenting for left-sided malignant colorectal obstruction suffered the worst outcomes
Tian-Zhi Lim, Dedrick Chan, Ker-Kan Tan
International Journal of Colorectal Disease.2014; 29(10): 1267. CrossRef

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Fracture of Self-Expandable Metal Stent during Endoscopic Removal in Benign Biliary Stricture: Kyu Re Joo, Chang Nyol Paik, Woo Chul Chung, Kang-Moon Lee, Jin Mo Yang; Clin Endosc 2013;46(1):95-97. Published online January 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.1.95

Abstract PDF PubReader ePub

The endoscopic insertion of the self-expandable metal stent (SEMS) in benign biliary stricture has become an alternative to surgery. Fracture or migration of SEMS can occur rarely as complications. We report a case of fracture of SEMS during endoscopic retrieval in patients with chronic pancreatitis. In this case, broken stent was successfully removed with endoscopic ballooning of bile duct and with a snare device.

Citations

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Plastic biliary stent fracture: A rare complication of percutaneous biliary drain placement
Kurren A. Mehta, Paul S. Jowell, Joshua P. Spaete
American Journal of Interventional Radiology.2022; 6: 5. CrossRef
Successful endoscopic removal of a fully covered self-expandable metallic stent that fractured above a benign distal bile duct stricture
Masatoshi Murakami, Nao Fujimori, Yuta Suehiro, Tomonobu Hioki, Kazuhide Matsumoto, Takamasa Oono, Yoshihiro Ogawa
Endoscopy.2021; 53(01): E11. CrossRef
Fracture of a Colonic Self-expandable Metallic Stent in Malignant Colonic Obstruction
Akinari Takao, Taku Tabata, Koichi Koizumi, Go Kuwata, Satomi Shibata, Makiko Mori, Kazuro Chiba, Sawako Kuruma, Tomoko Onishi, Takashi Fujiwara, Terumi Kamisawa, Junko Fujiwara, Takeo Arakawa, Kumiko Momma, Tatsu Shimoyama, Keiichi Takahashi
Internal Medicine.2018; 57(3): 329. CrossRef

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A Comparative Study on the Efficacy of Covered Metal Stent and Plastic Stent in Unresectable Malignant Biliary Obstruction: Jae Myoung Choi, Jin Hong Kim, Soon Sun Kim, Jun Hwan Yu, Jae Chul Hwang, Byung Moo Yoo, Sang Heum Park, Ho Gak Kim, Dong Ki Lee, Kang Hyun Ko, Kyo Sang Yoo, Do Hyun Park; Clin Endosc 2012;45(1):78-83. Published online March 31, 2012; DOI: https://doi.org/10.5946/ce.2012.45.1.78

Abstract PDF PubReader ePub

Background/Aims

The placement of self expandable metal stent (SEMS) is one of the palliative therapeutic options for patients with unresectable malignant biliary obstruction. The aim of this study was to compare the effectiveness of a covered SEMS versus the conventional plastic stent.

Methods

We retrospectively evaluated 44 patients with unresectable malignant biliary obstruction who were treated with a covered SEMS (21 patients) or a plastic stent (10 Fr, 23 patients). We analyzed the technical success rate, functional success rate, early complications, late complications, stent patency and survival rate.

Results

There was one case in the covered SEMS group that had failed technically, but was corrected successfully using lasso. Functional success rates were 90.5% in the covered SEMS group and 91.3% in the plastic stent group. There was no difference in early complications between the two groups. Median patency of the stent was significantly prolonged in patients who had a covered SEMS (233.6 days) compared with those who had a plastic stent (94.6 days) (p=0.006). During the follow-up period, stent occlusion occurred in 11 patients of the covered SEMS group. Mean survival showed no significant difference between the two groups (covered SEMS group, 236.9 days; plastic stent group, 222.3 days; p=0.182).

Conclusions

The patency of the covered SEMS was longer than that of the plastic stent and the lasso of the covered SEMS was available for repositioning of the stent.

Citations

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Outcomes of Self-expandable Metal Stents in Patients With Unresectable Gallbladder Cancer Undergoing Percutaneous Biliary Drainage
Pavithra Subramanian, Mukul Morya, Pankaj Gupta, Ruby Siddiqui, Anupam Singh, Vaneet Jearth, Jimil Shah, Santosh Irrinki, Jayanta Samanta, Harshal Mandavdhare, Vishal Sharma, Harjeet Singh, Saroj K. Sinha, Thakur D. Yadav, Vikas Gupta, Lileswar Kaman, Gau
Journal of Clinical and Experimental Hepatology.2024; 14(3): 101348. CrossRef
Effectiveness, safety, and factors associated with the clinical success of endoscopic biliary drainage for patients with hepatocellular carcinoma: a retrospective multicenter study
Akihiro Matsumi, Hironari Kato, Toru Ueki, Etsuji Ishida, Masahiro Takatani, Masakuni Fujii, Masaki Wato, Tatsuya Toyokawa, Ryo Harada, Hirofumi Tsugeno, Minoru Matsubara, Hiroshi Matsushita, Hiroyuki Okada
BMC Gastroenterology.2021;[Epub] CrossRef
Malignant obstructive jaundice: approaches to minimally invasive biliary decompression
B. L. Duberman, D. V. Mizgirev, A. M. Epshtein, V. N. Pozdeev, A. V. Tarabukin
Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery.2019; 24(2): 36. CrossRef
Prognostic value of inflammation-based markers in patients with recurrent malignant obstructive jaundice treated by reimplantation of biliary metal stents
Hao Jin, Qing Pang, Huichun Liu, Zongkuang Li, Yong Wang, Yimin Lu, Lei Zhou, Hongtao Pan, Wei Huang
Medicine.2017; 96(3): e5895. CrossRef
Comparison of patency and cost-effectiveness of self-expandable metal and plastic stents used for malignant biliary strictures: a Polish single-center study
Agnieszka Budzyńska, Ewa Nowakowska-Duława, Tomasz Marek, Marek Hartleb
European Journal of Gastroenterology & Hepatology.2016; 28(10): 1223. CrossRef
Endoscopic treatment options for cholangiocarcinoma
Linda Ann Hou, Jacques Van Dam
Hepatic Oncology.2014; 1(2): 229. CrossRef
Current status and issues regarding biliary stenting in unresectable biliary obstruction
Takao Itoi, Atsushi Sofuni, Fumihide Itokawa, Ryosuke Tonozuka, Kentaro Ishii
Digestive Endoscopy.2013; 25(S2): 63. CrossRef
The effects of endobiliary radiofrequency ablation in two patients with pancreatic cancer: Gross and microscopic findings
Ryan Law, Madhava Pai, Todd H. Baron, Nagy Habib
Gastrointestinal Intervention.2013; 2(2): 124. CrossRef

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A Case of Inserting Two Self-expandable Metal Stents in Dual Malignant Colonic Obstructions: Ju Wan Kim, M.D., Chang Hwan Choi, M.D., Ji Hoon Park, M.D., Bong Ki Cha, M.D., Ki-Seong Kim, M.D., Seung Mun Jung, M.D., Jae Hyuk Do, M.D. and Se Kyung Chang, M.D.; Korean J Gastrointest Endosc 2011;42(3):170-174. Published online March 28, 2011

Abstract PDF: Malignant colonic obstruction can lead an emergency operation for decompression, and this can cause post-operative complications due to poor bowel preparation. Self-expandable metal stent (SEMS) insertion is useful for avoiding an emergency operation and unnecessary complications. However, SEMS insertion for dual malignant colonic obstructions is very rare. We report here on a case of two SEMS that were inserted in dual malignant colonic obstructions caused by synchronous colon cancer. A 66-year-old man visited our hospital due to abdominal distension. Sigmoidoscopy and an abdominopelvic computerized tomographic (CT) scan revealed synchronous colon cancer at the splenic flexure and distal descending colon with dual obstruction. The initial SEMS insertion on the descending colon was not effective for decompression due to the proximal obstruction. After the second SEMS insertion on the splenic flexure through the first stent, all the signs and symptoms due to obstruction disappeared. SEMS insertion is considered to be useful for treating dual malignant colonic obstruction caused synchronous colon cancer. (Korean J Gastrointest Endosc 2011;42:170-174)

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The Efficacy and Safety of Fully Covered Self-expandable Metal Stents in Benign Extrahepatic Biliary Strictures: Byeong Uk Kim, M.D., Ja Chung Goo, M.D., Young Shim Cho, M.D., Jung Ho Han, M.D., Soon Man Yoon, M.D., Hee Bok Chae, M.D., Seon Mee Park, M.D. and Sei Jin Youn, M.D.; Korean J Gastrointest Endosc 2011;42(1):11-19. Published online January 30, 2011

Abstract PDF

Background/Aims: For the endoscopic treatment of benign biliary strictures (BBS), it has been a drawback to use plastic stents or uncovered self-expandable metal stents. We investigated the efficacy and safety of temporary placing fully covered self-expandable metal stents (FCSEMS) in BBS.

Methods: We enrolled 12 cases that followed up more than 6 months after insertion of a FCSEMS in BBS via ERCP. The cohort consisted of 9 patients with recurrent cholangitis, 2 patients with postcholecystectomy and 1 patient with chronic pancreatitis. The efficacy was assessed according to the resolution of strictures and also the restricture after stent removal, and the safety was evaluated according to the complications associated with stent placement. Finally, the removability of FCSEMSs was assessed.

Results: The median time of FCSEMS placement was 6.0 months. Resolution of the BBS was confirmed in 8 cases (67%) after a median post-removal follow-up of 8.5 months. Restricture after stent removal happened in 4 cases (33%). The complications were severe abdominal pain (n=2), pancreatic abscess (n=1) and stent migration (n=6). In 7 cases, all the FCSEMSs were successfully removed by grasping them with forceps.

Conclusions: Temporary placement of a FCSEMS in BBS showed good therapeutic effects, relative safety and easy removability. Further evaluation is needed for determining the causes of restricture and for developing a new stent with antimigration features. (Korean J Gastrointest Endosc 2011;42:11-19)

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Self-Expandable Metallic Stent Therapy for a Gastrointestinal Benign Stricture: Hae Won Han, M.D., In Seok Lee, M.D., Jae Myung Park, M.D., Jung Hwan Oh, M.D., Yu Kyung Cho, M.D., Sang Woo Kim, M.D., Myung-Gyu Choi, M.D. and In-Sik Chung, M.D.; Korean J Gastrointest Endosc 2008;37(1):1-6. Published online July 30, 2008

Abstract PDF: Background
/Aims: It is well known that self-expandable metallic stents are useful for the treatment of malignant strictures. Balloon and bougie dilation have received significant attention as a useful treatments for a gastriointestinal benign stricture, but the use of stents has some complications, including perforation and bleeding. We evaluated the clinical effectiveness and procedure- related complications of the use of self-expandable metallic stent therapy in gastrointestinal benign strictures. Methods: We inserted self-expandable metallic stents in 11 patients with benign strictures during the period from January 2003 to May 2007. Eleven patients were included in this study (six males; mean age, 50.9 years). We observed clinical improvement, as well as complications and restenosis during follow-up. We defined "recurrence" as the return of symptoms. Results: The causes of strictures were peptic ulcers (eight cases), corrosive esophagitis (two cases) and an anastomosis site stricture (one case). Three stents migrated within two weeks after placement. The mean length of time of a stent staying in a stricture was 16.1 days (3∼35 days). After stent dilation, none of the patients had dysphagia to solid food or procedure- related complications. During a mean follow-up period of 12.8 months (3∼35 months), the rate of restenosis was 36.4% (4/11 cases). All restenosis cases (two cases of peptic ulcer and two cases of corrosive esophagitis) occurred within three months after stent placement. Conclusions: We conclude that the use of self-expandable metallic stent therapy can be effective and safe for patients with gastrointestinal benign strictures. Restenosis (36.4%) occurred within three months. Future research on the management of gastrointestinal benign strictures is recommended. (Korean J Gastrointest Endosc 2008;37: 1-6)

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Uncovered Self-expandable Metal Stents (SEMS) for Gastric Outlet Obstruction Caused by Stomach Cancer: Hyoung Yoel Park, M.D., Dae Hwan Kang, M.D., Jae Sup Eum, M.D., Tae In Ha, M.D., Chan Ho Park, M.D., Kyung Yeob Kim, M.D., Cheol Woong Choi, M.D., Do Hoon Kim, M.D., Ji Young Kim, M.D., Hye Jeong Lee, M.D., Gwang Ha Kim, M.D. and Geun Am Song, M.D.; Korean J Gastrointest Endosc 2008;36(2):57-63. Published online February 27, 2008

Abstract PDF: Background
/Aims: The use of self-expandable metal stents (SEMS) is a safe and efficacious method for palliating malignant gastric outlet obstruction. However, few reports have assessed clinical outcome after the insertion of SEMS for malignant gastric outlet obstruction caused by stomach cancer. The aim of this study was to assess the usefulness of uncovered SEMS in patients with malignant gastric outlet obstruction caused by stomach cancer. Methods: We evaluated 62 patients with gastric outlet obstruction caused by stomach cancer treated by the implantation of uncovered SEMS. A total of 62 patients (43 males, 19 females) were treated between August 2000 and March 2007. A scoring system was used to grade the ability to eat. Results: Stent implantation was successful in 61 (98.4%) patients. Relief of obstructive symptoms was achieved in 49 (80.3%) patients. The mean survival duration was 143 days. The mean stent patency time was 103.5 days. An improvement in the ability to eat using the scoring system was statistically significant (p＜0.05). Conclusions: Endoscopic placement of uncovered SEMS is a safe and effective treatment for the palliation of patients with inoperable malignant gastric outlet obstruction caused by stomach cancer. (Korean J Gastrointest Endosc 2008;36:57-63)

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Effectiveness of Through-the-scope Self-expandable Metal Stent in Malignant Upper Gastrointestinal Obstruction: Eun Soon Kim, M.D.*, Jeong Seop Moon, M.D., You Sun Kim, M.D., Il Kim, M.D., Jin Kwang Lee, M.D., Seong Eun Kim, M.D., Soo Hyung Ryu, M.D. and Jung Whan Lee, M.D.; Korean J Gastrointest Endosc 2005;31(1):1-9. Published online July 30, 2005

Abstract PDF: Background
/Aims: Self-expandable metal stents (SEMS) have been used in the palliation of malignant obstruction. The purpose of this study was to evaluate the effectiveness, safety, and outcome of SEMS using through-the- scope (TTS) method in the patients with malignant upper gastrointestinal obstruction including recurrent gastric cancer after gastrectomy. Methods: Thirty one patients (36 stents) were treated with SEMS between October 2000 and June 2004; nineteen had inoperable malignant gastric outlet obstruction, ten had recurrent gastric cancer after gastrectomy, and two had metastatic duodenal cancer. We analyzed the technical and clinical success, complication, and outcome. Results: The technical success rate was 88.8% (32/36 stents) in total cases; 95.0% (19/20) in malignant gastric outlet obstruction, 84.6% (11/13) in recurrent gastric cancer after gastrectomy, and 66.7% (2/3) in metastatic duodenal cancer. The success rate of dietary intake was 86.1% (31/36 stents). Complications occurred in 7 of 36 stents (19.4%), including stent migration (1 patient), aspiration pneumonia (1 patient), and recurrent obstruction (5 patients). The mean survival duration period was 118.1⁑180.2 days and mean patency period was 92.2⁑89.9 days. Conclusions: SEMS using TTS is an effective, safe, and less invasive palliative treatment in malignant upper gastrointestinal obstruction including recurrent gastric cancer after surgery. (Korean J Gastrointest Endosc 2005;31:1⁣9)

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