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Purpose To assess the outcomes of single-stage surgery following fluoroscopic stent placement for malignant colorectal obstruction. Materials and Methods This retrospective study included 46 patients (28 male and 18 female; mean age, 67.2 years) who had undergone fluoroscopic stent placement followed by laparoscopic resection (n = 31) or open surgery (n = 15) for malignant colorectal obstruction. The surgical outcomes were analyzed and compared. After a mean follow-up of 38.9 months, the recurrence-free and overall survival were estimated, and prognostic factors were evaluated. Results The mean interval between stent placement and surgery was 10.2 days. Primary anastomosis was possible in all patients. The mean postoperative length of hospitalization was 11.0 days. Bowel perforation was detected in six patients (13.0%). During the follow-up, ten patients (21.7%) developed recurrence; these included five of the six patients with bowel perforation. Bowel perforation had a significant effect on recurrence-free survival (p = 0.010). Conclusion Single-stage surgery following fluoroscopic stent placement may be effective for treating malignant colorectal obstruction. Stent-related bowel perforation is a significant predictive factor for tumor recurrence.

Background/Aims: Endoscopic stenting is an evolving treatment for symptomatic Crohn's strictures. Several case series and small studies have reported its efficacy. Future studies can be designed based on a systematic review of the evaluation of efficacy. Hence, this meta-analysis was conducted to assess the critical role of stents in the management of intestinal strictures associated with Crohn's disease (CD). Methods: A literature search of various databases from 2000 to February 2022 was conducted for studies evaluating the outcome of stents in patients with CD-related stricture. The outcomes assessed included technical and clinical success, adverse events, symptom recurrence, and the need for a surgical resection. Pooled event rates across studies were expressed with summative statistics. Results: Ten studies with 170 patients were included in the present analysis. The pooled event rates for technical success, clinical success, stent migration, and post-procedural pain were 98.2% (95% CI, 95.8-100), 71.3% (95% CI, 57.4-85.1), 32% (95% CI, 0.0-65.3) and 20.2% (95% CI, 4.1-36.2), respectively. The cumulative recurrence rate and need for surgery were 40.1% (95% CI, 20.3-59.9) and 8.6% (95% CI, 1.7-15.5), respectively. Subgroup analysis showed that partially-covered (PC) self-expanding metallic stent (SEMS) was significantly better than fully-covered SEMS with a lower stent migration rate and symptom recurrence rate. Conclusions: Overall efficacy of stents in the management of CD-related stricture remains moderate with a low complication rate. Among the stents, PC-SEMS may be associated with a more favorable outcome. Future studies will be needed to determine the long-term benefits of endoscopic stenting.

Purpose To assess the outcomes of single-stage surgery following fluoroscopic stent placement for malignant colorectal obstruction. Materials and Methods This retrospective study included 46 patients (28 male and 18 female; mean age, 67.2 years) who had undergone fluoroscopic stent placement followed by laparoscopic resection (n = 31) or open surgery (n = 15) for malignant colorectal obstruction. The surgical outcomes were analyzed and compared. After a mean follow-up of 38.9 months, the recurrence-free and overall survival were estimated, and prognostic factors were evaluated. Results The mean interval between stent placement and surgery was 10.2 days. Primary anastomosis was possible in all patients. The mean postoperative length of hospitalization was 11.0 days. Bowel perforation was detected in six patients (13.0%). During the follow-up, ten patients (21.7%) developed recurrence; these included five of the six patients with bowel perforation. Bowel perforation had a significant effect on recurrence-free survival (p = 0.010). Conclusion Single-stage surgery following fluoroscopic stent placement may be effective for treating malignant colorectal obstruction. Stent-related bowel perforation is a significant predictive factor for tumor recurrence. [ABSTRACT FROM AUTHOR]

We report a case of an 81-year-old woman with extensive pelvic lymphadenopathy that caused severe stenosis and occlusion of the right common and external iliac veins and proximal common femoral vein. Pelvic lymphadenopathy resulted from the recurrence of a previous right ovarian epithelial tumor. The patient had severe right lower extremity edema, consistent with severe venous insufficiency. She was treated with high-pressure balloon angioplasty (12-14 mm in diameter) and four self-expanding stents (14-10 mm diameter, 80-40 mm length). The postoperative response was dramatic to a near-complete resolution of the edema. The venous clinical severity scores were 10 and 2 at presentation and 6 months after the follow-up, respectively. Balloon angioplasty and stenting are safe and effective methods for providing symptomatic relief for lower extremity venous insufficiency in patients with extensive and unresectable pelvic masses.

Surgery has been the standard treatment for perforated duodenal ulcers, with mostly good results. However, the resolution of postoperative leakage after primary repair of perforated duodenal ulcer remains challenging. There are several choices for re-operation required in persistent leakage from perforated duodenal ulcers. However, many of these choices are complicated surgical procedures requiring prolonged general anesthesia that may increase the chances of morbidity and mortality. Several recent reports have demonstrated postoperative leakage after primary repair of a perforated duodenal ulcer treated with endoscopic insertion using a covered self-expandable metallic stent, with good clinical results. We report a case with postoperative leakage after primary repair of a perforated duodenal ulcer treated using a covered self-expandable metallic stent.

Background/Aims: Dysphagia is encountered in a large proportion of patients with lung cancer and is associated with malnutrition and a poor quality of life. This study compared the clinical outcomes of self-expandable metallic stent (SEMS) insertion and percutaneous gastrostomy (PG) feeding for patients with lung cancer and dysphagia. Methods: A total of 261 patients with lung cancer, who underwent either SEMS insertion (stent group) or PG (gastrostomy group) as an initial treatment procedure for dysphagia between July 1997 and July 2015 at the Samsung Medical Center, were reviewed retrospectively, and 84 patients with esophageal obstruction were identified. The clinical outcomes, including the overall survival, additional intervention, complications, and post-procedural nutritional status in the two groups, were compared. Results : Among the 84 patients finally analyzed, 68 patients received SEMS insertion and 16 had PG. The stent group had less cervical obstruction and more mid-esophageal obstruction than the gastrostomy group. The Kaplan-Meier curves revealed similar overall survival in the two groups. Multivariate analysis showed that the two modalities had similar survival rates (PG compared with SEMS insertion, hazard ratio 0.682, p=0.219). Fifteen patients (22.1%) in the stent group received additional intervention, whereas there was no case in the gastrostomy group (p=0.063). The decrease in the serum albumin level after the procedure was lower in the gastrostomy group than in the stent group (-0.20±0.54 g/dL vs. -0.65±0.57 g/dL, p=0.013) Conclusion : s: SEMS insertion and PG feeding for relieving dysphagia by lung cancer had a comparable survival outcome. On the other hand, PG was associated with a better nutritional status.

Purpose: To evaluate the safety and clinical efficacy of percutaneous intraductal radiofrequency ablation (RFA) followed by dual stent placement in advanced malignant biliary hilar duct obstruction. Materials and Methods: Between September 2013 and August 2015, ten patients with malignant biliary hilar duct obstruction who underwent percutaneous intraductal RFA followed by dual stent placement were included in this retrospective study. Technical success, clinical success, procedure-related complications, stent patency, and patient’s survival durations after treatment were investigated. Results: Percutaneous intraductal RFA followed by dual stent placement was successful in all patients; the technical success rate was 100%. No major complications were identified. After the procedure, serum total bilirubin levels were notably normalized, and therefore, percutaneous transhepatic biliary drainage (PTBD) catheter was successfully removed in 8 patients; the clinical success rate was 80%. Four patients with stent dysfunction associated with tumor ingrowth/overgrowth underwent a repeat PTBD procedure or secondary stent insertion. Mean stent patency and survival durations were 233.8 ± 35.6 days [95% confidence interval (CI), 164.0–303.5 days] and 387.2 ± 114.6 days (95% CI, 162.6–611.8 days), respectively. Conclusion: Percutaneous intraductal RFA combined with dual stent placement in advanced malignant biliary hilar duct obstruction is a safe and feasible palliative treatment option.

Acute complicated type B aortic dissection (TBAD) is a potentially catastrophic, life-threatening condition. If left untreated, there is a high risk of aortic rupture, irreversible organ or limb damage, or death. Several risk factors have been associated with acute complicated TBAD, including age and refractory hypertension. In the acute phase, even uncomplicated patients are more prone to develop complications if hypertension and pain are left medically untreated. Innovations in stent graft technologies have incrementally improved outcomes since their first use for this condition in 1999, though improvement is needed in mitigating periprocedural complications, adverse events, and mortality. In the past decade, endovascular repair has become the preferred treatment because of its superior outcomes to open repair and medical therapy. The Valiant Captivia Thoracic Stent Graft System is a third-generation endovascular stent graft with advancements in minimally invasive delivery, conformability to the anatomy, and the minimization of adverse sequelae. Herein, this stent graft is briefly reviewed and its 3-year outcomes are presented. Freedom from all-cause and dissection- related mortality was 79.1% a nd 9 0.0%, respectiv ely. T he V aliant C aptiv ia S tent G raft r epresents a safe, effective intervention for acute complicated TBAD. Continued surveillance is needed to verify its longer- term durability.

Background/Aims: Dysphagia is encountered in a large proportion of patients with lung cancer and is associated with malnutrition and a poor quality of life. This study compared the clinical outcomes of self-expandable metallic stent (SEMS) insertion and percutaneous gastrostomy (PG) feeding for patients with lung cancer and dysphagia. Methods: A total of 261 patients with lung cancer, who underwent either SEMS insertion (stent group) or PG (gastrostomy group) as an initial treatment procedure for dysphagia between July 1997 and July 2015 at the Samsung Medical Center, were reviewed retrospectively, and 84 patients with esophageal obstruction were identified. The clinical outcomes, including the overall survival, additional intervention, complications, and post-procedural nutritional status in the two groups, were compared. Results: Among the 84 patients finally analyzed, 68 patients received SEMS insertion and 16 had PG. The stent group had less cervical obstruction and more mid-esophageal obstruction than the gastrostomy group. The Kaplan-Meier curves revealed similar overall survival in the two groups. Multivariate analysis showed that the two modalities had similar survival rates (PG compared with SEMS insertion, hazard ratio 0.682, p=0.219). Fifteen patients (22.1%) in the stent group received additional intervention, whereas there was no case in the gastrostomy group (p=0.063). The decrease in the serum albumin level after the procedure was lower in the gastrostomy group than in the stent group (-0.20±0.54 g/dL vs. -0.65±0.57 g/dL, p=0.013) Conclusions: SEMS insertion and PG feeding for relieving dysphagia by lung cancer had a comparable survival outcome. On the other hand, PG was associated with a better nutritional status. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the safety and clinical efficacy of percutaneous intraductal radiofrequency ablation (RFA) followed by dual stent placement in advanced malignant biliary hilar duct obstruction. Materials and Methods: Between September 2013 and August 2015, ten patients with malignant biliary hilar duct obstruction who underwent percutaneous intraductal RFA followed by dual stent placement were included in this retrospective study. Technical success, clinical success, procedure-related complications, stent patency, and patient's survival durations after treatment were investigated. Results: Percutaneous intraductal RFA followed by dual stent placement was successful in all patients; the technical success rate was 100%. No major complications were identified. After the procedure, serum total bilirubin levels were notably normalized, and therefore, percutaneous transhepatic biliary drainage (PTBD) catheter was successfully removed in 8 patients; the clinical success rate was 80%. Four patients with stent dysfunction associated with tumor ingrowth/overgrowth underwent a repeat PTBD procedure or secondary stent insertion. Mean stent patency and survival durations were 233.8 ± 35.6 days [95% confidence interval (CI), 164.0-303.5 days] and 387.2 ± 114.6 days (95% CI, 162.6-611.8 days), respectively. Conclusion: Percutaneous intraductal RFA combined with dual stent placement in advanced malignant biliary hilar duct obstruction is a safe and feasible palliative treatment option. [ABSTRACT FROM AUTHOR]