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Several techniques exist to maintain oral and/or enteral feeding among esophageal cancer (EC) patients, but their impact on patient-reported outcomes (PROs) remains unclear. This systematic review aimed to assess the impact of nutritional support techniques on PROs in EC patients. We searched Medline, Web of Science, and CINAHL Complete from inception to 3 April 2024. Eligible studies included those evaluating EC patients, reporting PROs using standardized measures, and providing data on different nutritional support techniques or comparing them to no intervention. The reference lists of the included studies were also screened for additional eligible articles. The Mixed Methods Appraisal Tool was used to evaluate the quality of the included studies. Of the 694 articles identified from databases and 224 from backward citation, 11 studies met the inclusion criteria. Nine studies evaluated the overall quality of life (QoL), four assessed pain, and one evaluated depression. Among those submitted to esophagectomy, jejunostomy may be associated with higher QoL scores and less postoperative pain, compared to a nasojejunal tube, but no significant differences were found when compared to no intervention. For patients undergoing chemotherapy or receiving palliative/symptomatic treatment, expandable metal stents (SEMSs) were associated with higher levels of emotional functioning when compared with laparoscopic gastrostomy. Moreover, percutaneous endoscopic gastrostomy or SEMSs were associated with a higher QoL compared with nasogastric tubes. This review underscores the importance of considering PRO measures when evaluating nutritional support techniques in cancer patients, though further robust evidence is needed to fully understand these associations. [ABSTRACT FROM AUTHOR]

Malignant gastric outlet obstruction (GOO) is a condition characterized by blockage or narrowing where the stomach empties its contents into the small intestine due to primary malignant tumors or metastatic diseases. This condition leads to various symptoms such as nausea, vomiting, abdominal pain, and weight loss. To manage malignant GOO, different treatment options have been employed, including surgical gastrojejunostomy (SGJ), gastroduodenal stenting (GDS) using self-expandable metallic stent (SEMS), and endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ). This review focuses on comparing the clinical outcomes of endoscopic stenting (GDS and EUS-GJ) with SGJ for malignant GOO. Studies have shown that GDS with SEMS provides comparable clinical outcomes and safety for the palliation of obstructive symptoms. The choice between covered and uncovered SEMS remains controversial, as different studies have reported varying results. EUS-GJ, performed via endoscopic ultrasound guidance, has shown promising efficacy and safety in managing malignant GOO, but further studies are needed to establish it as the primary treatment option. Comparative analyses suggest that GDS has higher recurrence and reintervention rates compared to EUS-GJ and SGJ, with similar overall procedural complications. However, bleeding rates were lower with GDS than with SGJ. Randomized controlled trials are required to determine the optimal treatment approach for malignant GOO. [ABSTRACT FROM AUTHOR]

Several techniques exist to maintain oral and/or enteral feeding among esophageal cancer (EC) patients, but their impact on patient-reported outcomes (PROs) remains unclear. This systematic review aimed to assess the impact of nutritional support techniques on PROs in EC patients. We searched Medline, Web of Science, and CINAHL Complete from inception to 3 April 2024. Eligible studies included those evaluating EC patients, reporting PROs using standardized measures, and providing data on different nutritional support techniques or comparing them to no intervention. The reference lists of the included studies were also screened for additional eligible articles. The Mixed Methods Appraisal Tool was used to evaluate the quality of the included studies. Of the 694 articles identified from databases and 224 from backward citation, 11 studies met the inclusion criteria. Nine studies evaluated the overall quality of life (QoL), four assessed pain, and one evaluated depression. Among those submitted to esophagectomy, jejunostomy may be associated with higher QoL scores and less postoperative pain, compared to a nasojejunal tube, but no significant differences were found when compared to no intervention. For patients undergoing chemotherapy or receiving palliative/symptomatic treatment, expandable metal stents (SEMSs) were associated with higher levels of emotional functioning when compared with laparoscopic gastrostomy. Moreover, percutaneous endoscopic gastrostomy or SEMSs were associated with a higher QoL compared with nasogastric tubes. This review underscores the importance of considering PRO measures when evaluating nutritional support techniques in cancer patients, though further robust evidence is needed to fully understand these associations.

Colonic stent placement is a commonly used bridging strategy for surgery in patients with obstructive colorectal cancer. The procedure involves the placement of a self-expandable metallic stent (SEMS) across the obstructive lesion to restore intestinal patency and alleviate the symptoms of obstruction. By allowing patients to receive surgery in a planned and staged manner with time for preoperative optimization and bowel preparation, stent placement may reduce the need for emergency surgery, which is associated with higher complication rates and poorer outcomes. This review focuses on the role of colon stenting as a bridge to surgery in the management of obstructive colorectal cancer. SEMS as a bridge to surgery for left-sided colon cancer has been demonstrated to be particularly useful; however, further research is needed for its application in cases of right-sided colon cancer. Colon stent placement also has limitations and potential complications including stent migration, re-obstruction, and perforation. However, the timing of curative surgery after SEMS placement remains inconclusive. Considering the literature to date, performing surgery at an interval of approximately 2 weeks is considered appropriate. Therefore, colonic stent placement may be an effective strategy as a bridge to surgery in patients with obstructive colorectal cancer.

Background and aims: Endoscopic multiple plastic stents are an established first-line treatment for anastomotic biliary stricture (ABS) management after liver transplantation (LT). Fully covered self-expandable metallic stents (FCSEMSs) have recently been used with favorable outcomes, but long-term treatment outcomes remain an issue for ABS. We evaluated the long-term outcomes of FCSEMS for the management of refractory ABS after LT. Methods: We reviewed the prospectively collected and maintained endoscopic retrograde cholangiography database at Asan Medical Center to retrieve consecutive post-LT ABS cases that underwent an endoscopic FCSEMS placement between August 2009 and August 2019 after MPS placement failure. Results: A total of 34 patients were enrolled in this study. Technical success had been achieved in all subjects (100%). The median stent placement duration was 3.1 months (IQR 2.7–6.1). Stricture resolution was achieved in 26 patients (clinical success 76.5%, 95% confidence interval 62–91). Early adverse events developed in 3 patients (8.8%), including distal stent migration. Late adverse events occurred in 9 patients (26.5%), including cholangitis (n = 7, 20.6%) and asymptomatic distal stent migration (n = 2, 5.9%). The median follow-up period was 57.9 months (IQR 51.9–64.3). Stricture recurrence occurred in 3 of 26 patients who achieved clinical success (11.5%). Conclusions: FCSEMS placement appears to be an effective and advisable intervention for refractory ABS as it can provide persistent stricture improvement over the long-term. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the expansion effect of self-expandable stents during the first week after carotid artery stenting (CAS) procedure and to examine the variation of the effect according to the carotid plaque type. Methods: Seventy stenotic carotid arteries of 69 patients were stented by using self-expanding Wallstents with diameters of 7 and 9 mm, after detection of stenosis and plaque type by Doppler ultrasonography. Post-stent aggressive ballooning was avoided and residual stenosis rates were measured with digital subtraction angiography. After the stenting procedure, the caudal, narrowest, and cranial diameters of stents were measured with ultrasonography at 30 min, first day and first week. Stent diameter increase and change according to plaque type were evaluated. Two-way repeated measure ANOVA test was used for statistical analysis. Results: A significant increase was observed in the mean stent diameter in the three stent regions (caudal, narrow, and cranial) from the 30th minute to the first and seventh days (p < 0.001). The most prominent stent expansion occurred in the cranial and narrow segments within the first day. In the narrow stent region; Stent diameter increase between 30th minute-first day, 30th minute-first week, and first day-first week were all significant (p < 0.001). At 30 min, first day, and first week, no significant difference was detected between plaque type and stent expansion in caudal, narrow, and cranial regions (p = 0.286). Conclusion: We think that keeping the lumen patency limited to 30% residual stenosis after CAS procedure by applying minimal post-stenting balloon dilatation and leaving the remaining lumen expansion to the self-expanding feature of the Wallstent might be a sensible approach in order to avoid embolic events and excessive carotid sinus reactions (CSR). [ABSTRACT FROM AUTHOR]

Abstract Background To assess the feasibility and tissue response of using a gold nanoparticle (AuNP)-integrated silicone-covered self-expandable metal stent (SEMS) for local hyperthermia in a rat esophageal model. Methods The study involved 42 Sprague–Dawley rats. Initially, 6 animals were subjected to near-infrared (NIR) laser irradiation (power output from 0.2 to 2.4 W) to assess the in vitro heating characteristics of the AuNP-integrated SEMS immediately after its placement. The surface temperature of the stented esophagus was then measured using an infrared thermal camera before euthanizing the animals. Subsequently, the remaining 36 animals were randomly divided into 4 groups of 9 each. Groups A and B received AuNP-integrated SEMS, while groups C and D received conventional SEMS. On day 14, groups A and C underwent NIR laser irradiation at a power output of 1.6 W for 2 min. By days 15 (3 animals per group) or 28 (6 animals per group), all groups were euthanized for gross, histological, and immunohistochemical analysis. Results Under NIR laser irradiation, the surface temperature of the stented esophagus quickly increased to a steady-state level. The surface temperature of the stented esophagus increased proportionally with power outputs, being 47.3 ± 1.4 °C (mean ± standard deviation) at 1.6 W. Only group A attained full circumferential heating through all layers, from the epithelium to the muscularis propria, demonstrating marked apoptosis in these layers without noticeable necroptosis. Conclusions Local hyperthermia using the AuNP-integrated silicone-covered SEMS was feasible and induced cell death through apoptosis in a rat esophageal model. Relevance statement A gold nanoparticle-integrated silicone-covered self-expanding metal stent has been developed to mediate local hyperthermia. This approach holds potential for irreversibly damaging cancer cells, improving the sensitivity of cancer cells to therapies, and triggering systemic anticancer immune responses. Key points • A gold nanoparticle-integrated silicone-covered self-expanding metal stent was placed in the rat esophagus. • Upon near-infrared laser irradiation, this stent quickly increased the temperature of the stented esophagus. • Local hyperthermia using this stent was feasible and resulted in cell death through apoptosis. Graphical Abstract

Airway stents, first developed in the 1980s, have become fundamental in managing a multitude of airway pathologies and complications within the field of interventional pulmonology. The primary function of an airway stent is to re-establish airway patency and integrity when obstruction, stenosis, anastomotic dehiscence, or fistulae develop as a result of various malignant or benign conditions. Nevertheless, airway stents are foreign bodies that can result in complications. In this review article, we will discuss airway stents and their ongoing role in the management of several malignant and benign diseases. We will describe indications for airway stenting and review the elements that must be taken into consideration for optimal patient and stent selection. Given the prevalence of data regarding therapeutic bronchoscopy and airway stenting in malignant airway obstruction, much of the discussion in this review will focus on stent placement for that indication. We will also review the data as it pertains to safety, efficacy, and complications after stent placement, and conclude with a discussion of the future applications and research avenues related to airway stents.

Background: To assess the feasibility and tissue response of using a gold nanoparticle (AuNP)-integrated silicone-covered self-expandable metal stent (SEMS) for local hyperthermia in a rat esophageal model. Methods: The study involved 42 Sprague–Dawley rats. Initially, 6 animals were subjected to near-infrared (NIR) laser irradiation (power output from 0.2 to 2.4 W) to assess the in vitro heating characteristics of the AuNP-integrated SEMS immediately after its placement. The surface temperature of the stented esophagus was then measured using an infrared thermal camera before euthanizing the animals. Subsequently, the remaining 36 animals were randomly divided into 4 groups of 9 each. Groups A and B received AuNP-integrated SEMS, while groups C and D received conventional SEMS. On day 14, groups A and C underwent NIR laser irradiation at a power output of 1.6 W for 2 min. By days 15 (3 animals per group) or 28 (6 animals per group), all groups were euthanized for gross, histological, and immunohistochemical analysis. Results: Under NIR laser irradiation, the surface temperature of the stented esophagus quickly increased to a steady-state level. The surface temperature of the stented esophagus increased proportionally with power outputs, being 47.3 ± 1.4 °C (mean ± standard deviation) at 1.6 W. Only group A attained full circumferential heating through all layers, from the epithelium to the muscularis propria, demonstrating marked apoptosis in these layers without noticeable necroptosis. Conclusions: Local hyperthermia using the AuNP-integrated silicone-covered SEMS was feasible and induced cell death through apoptosis in a rat esophageal model. Relevance statement: A gold nanoparticle-integrated silicone-covered self-expanding metal stent has been developed to mediate local hyperthermia. This approach holds potential for irreversibly damaging cancer cells, improving the sensitivity of cancer cells to therapies, and triggering systemic anticancer immune responses. Key points: • A gold nanoparticle-integrated silicone-covered self-expanding metal stent was placed in the rat esophagus. • Upon near-infrared laser irradiation, this stent quickly increased the temperature of the stented esophagus. • Local hyperthermia using this stent was feasible and resulted in cell death through apoptosis. [ABSTRACT FROM AUTHOR]

Purpose: Management of obstructive colorectal cancer (OCRC) can be achieved through either emergent resection of the primary tumor (single operation), or the creation of temporary decompression stoma or self-expandable metallic stents (SEMS) insertion followed by tumor resection (staged procedure). The aim of the study was to compare the short-term outcomes of single and staged surgery in acute non-metastatic elderly OCRC patients. Methods: Twenty-two elderly patients (aged over 75) scheduled to receive either single surgery (n ​= ​14) or staged surgery (n ​= ​8) for the management of acute OCRC were enrolled from 2012 to 2017. The stoma rate, postoperative complications were compared. Results: The stoma rate was 42.9% in single surgery group and 25% in SEMS group. No difference was found in the rate of total complications (50% vs 25%, P ​= ​0.25). In the single surgery group, four patients (28.6%) experienced SSIs, and pneumonia occurred in three patients (21.4%), whereas none of the patient in staged surgery had infection related complication. Overall, the rate of infection related complication in single surgery group (50%) was significantly higher than that in staged surgery group (P ​= ​0.015). Conclusions: Either single or stage surgery is feasible for acute elderly OCRC patients. However, single surgery is associated with significant increase in infection related complication.

Abstract Background Knowledge of the characteristics of self-expanding metal stents (SEMSs) is essential during selection process to ensure the best therapeutic outcomes for patients with malignant biliary obstruction. The aim of this study was to evaluate the characteristics of four commonly used SEMSs. Methods This in vitro study analyzed the radial force (RF), crush resistance (CR), axial force (AF), conformability, surface quality, foreshortening, and radiopacity of the following SEMSs: uncovered Wallflex™, EGIS single bare, Zilver 635®, and E-Luminexx™. Two samples of each SEMS type were included in this study, all having identical specifications with a diameter of 10 mm and a length of 6 cm. One sample from each type was analyzed for surface quality, followed by CR, conformability, and foreshortening. The other sample was analyzed for radiopacity, followed by RF and AF. Results The uncovered Wallflex™ exhibited low RF, high CR, high AF, good conformability, poor surface quality, high foreshortening, and good radiopacity. The EGIS single bare demonstrated high RF, high CR, low AF, moderate conformability, good surface quality, high foreshortening, and poor radiopacity. The Zilver 635® displayed moderate RF, low CR, low AF, moderate conformability, moderate surface quality, no foreshortening, and good radiopacity. The E-Luminexx™ showed high RF, moderate CR, high AF, poor conformability, poor surface quality, no foreshortening, and good radiopacity. Conclusions There was considerable variation in the characteristics among the four evaluated SEMSs. These characteristics should be carefully considered during selection to ensure optimal therapeutic outcomes for patients. Relevance statement The selection of self-expanding metal stents for treating malignant biliary obstruction requires careful consideration of various characteristics, including their radial force, crush resistance, axial force, conformability, surface quality, foreshortening, and radiopacity. Key points • The characteristics of self-expanding metal stents (SEMSs) can vary considerably. • Specific situations may warrant the use of SEMSs with particular characteristics over others. • Characteristics of SEMSs must be considered during selection for optimal outcomes. Graphical Abstract

Background: Knowledge of the characteristics of self-expanding metal stents (SEMSs) is essential during selection process to ensure the best therapeutic outcomes for patients with malignant biliary obstruction. The aim of this study was to evaluate the characteristics of four commonly used SEMSs. Methods: This in vitro study analyzed the radial force (RF), crush resistance (CR), axial force (AF), conformability, surface quality, foreshortening, and radiopacity of the following SEMSs: uncovered Wallflex™, EGIS single bare, Zilver 635®, and E-Luminexx™. Two samples of each SEMS type were included in this study, all having identical specifications with a diameter of 10 mm and a length of 6 cm. One sample from each type was analyzed for surface quality, followed by CR, conformability, and foreshortening. The other sample was analyzed for radiopacity, followed by RF and AF. Results: The uncovered Wallflex™ exhibited low RF, high CR, high AF, good conformability, poor surface quality, high foreshortening, and good radiopacity. The EGIS single bare demonstrated high RF, high CR, low AF, moderate conformability, good surface quality, high foreshortening, and poor radiopacity. The Zilver 635® displayed moderate RF, low CR, low AF, moderate conformability, moderate surface quality, no foreshortening, and good radiopacity. The E-Luminexx™ showed high RF, moderate CR, high AF, poor conformability, poor surface quality, no foreshortening, and good radiopacity. Conclusions: There was considerable variation in the characteristics among the four evaluated SEMSs. These characteristics should be carefully considered during selection to ensure optimal therapeutic outcomes for patients. Relevance statement: The selection of self-expanding metal stents for treating malignant biliary obstruction requires careful consideration of various characteristics, including their radial force, crush resistance, axial force, conformability, surface quality, foreshortening, and radiopacity. Key points: • The characteristics of self-expanding metal stents (SEMSs) can vary considerably. • Specific situations may warrant the use of SEMSs with particular characteristics over others. • Characteristics of SEMSs must be considered during selection for optimal outcomes. [ABSTRACT FROM AUTHOR]

Background/Aims Self-expandable metallic stents (SEMSs) are widely adopted for the palliation of dysphagia in patients with malignant esophageal strictures. An important adverse event is the development of SEMS-induced esophagorespiratory fistulas (SEMS-ERFs). This study aimed to assess the risk factors related to the development of SEMS-ERF after SEMS placement in patients with esophageal cancer. Methods This retrospective study was performed at the Instituto do Cancer do Estado de São Paulo. All patients with malignant esophageal strictures who underwent esophageal SEMS placement between 2009 and 2019 were included in the study. Results Of the 335 patients, 37 (11.0%) developed SEMS-ERF, with a median time of 129 days after SEMS placement. Stent flare of 28 mm (hazard ratio [HR], 2.05; 95% confidence interval [CI], 1.15–5.51; p=0.02) and post-stent chemotherapy (HR, 2.0; 95% CI, 1.01–4.00; p=0.05) were associated with an increased risk of developing SEMS-ERF, while lower-third tumors were a protective factor (HR, 0.5; 95% CI, 0.26–0.85; p=0.01). No difference was observed in overall survival. Conclusions The incidence of SEMS-ERFs was 11%, with a median time of 129 days after SEMS placement. Post-stent chemotherapy and a 28 mm stent flare were associated with a higher risk of SEMS-ERF.

Abstract Aim To compare the oncological outcomes between self‐expandable metallic stent (SEMS) as a bridge to surgery and transanal decompression tube (TDT) placement for malignant large bowel obstruction (MLBO). Methods A total of 287 MLBO patients who underwent SEMS (n = 137) or TDT placement (n = 150) were enrolled in this multicenter retrospective study. Overall survival (OS) and disease‐free survival (DFS) between the two groups were compared. A meta‐analysis was performed using random‐effects models to calculate odd ratios (OR) with 95% confidence intervals (CIs). Results Postoperative complications of Clavien–Dindo grade ≥II and ≥III occurred frequently in the TDT group compared with the SEMS group (P = 0.002 and 0.005, respectively). The 3‐y OS in the overall cohort and 3‐y DFS in the pathological stage II/III cohort in the SEMS and TDT groups were 68.6% and 71.4%, and 71.0% and 72.6%, respectively. The survival differences were not significantly different in the OS and DFS analyses (P = 0.819 and P = 0.892, respectively). A meta‐analysis of nine studies (including our cohort data) demonstrated no significant difference between the SEMS and TDT groups for 3‐y OS and DFS (OR = 0.96, 95% CI = 0.57–1.62, P = 0.89 and OR = 0.69, 95% CI = 0.46–1.04, P = 0.07, respectively). Conclusion Our study demonstrated that SEMS placement had no inferiority regarding long‐term outcomes, including OS and DFS, compared with TDT placement. Considering the short‐term benefits of SEMS placement, this could be a preferable preoperative decompression method for MLBO.

Background/Aims: Self-expandable metallic stents (SEMSs) are widely adopted for the palliation of dysphagia in patients with malignant esophageal strictures. An important adverse event is the development of SEMS-induced esophagorespiratory fistulas (SEMSERFs). This study aimed to assess the risk factors related to the development of SEMS-ERF after SEMS placement in patients with esophageal cancer. Methods: This retrospective study was performed at the Instituto do Cancer do Estado de São Paulo. All patients with malignant esophageal strictures who underwent esophageal SEMS placement between 2009 and 2019 were included in the study. Results: Of the 335 patients, 37 (11.0%) developed SEMS-ERF, with a median time of 129 days after SEMS placement. Stent flare of 28 mm (hazard ratio [HR], 2.05; 95% confidence interval [CI], 1.15-5.51; p=0.02) and post-stent chemotherapy (HR, 2.0; 95% CI, 1.01-4.00; p=0.05) were associated with an increased risk of developing SEMS-ERF, while lower-third tumors were a protective factor (HR, 0.5; 95% CI, 0.26-0.85; p=0.01). No difference was observed in overall survival. Conclusions: The incidence of SEMS-ERFs was 11%, with a median time of 129 days after SEMS placement. Post-stent chemotherapy and a 28 mm stent flare were associated with a higher risk of SEMS-ERF. [ABSTRACT FROM AUTHOR]

We report the case of a 65-year-old man who experienced hemobilia due to rupture of a pseudoaneurysm of the left hepatic artery after endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS). The patient was diagnosed with pancreatic cancer and underwent endoscopic retrograde cholangiopancreatography for obstructive jaundice. Biliary drainage was converted to EUS-HGS due to tumor invasion in the superior duodenal angle. A partially covered metal stent was placed in the B3 intrahepatic bile duct. The procedure was completed without early complications, but 50 days later, the patient developed fever, elevated hepatobiliary enzymes, and shock. Contrast-enhanced computed tomography (CT) showed that the hepatic end of the HGS stent had moved slightly toward the stomach compared to the previous CT. A 6-mm pseudoaneurysm was also observed near the A3 and A4 branches of the left hepatic artery, coinciding with the hepatic end of the EUS-HGS stent. Hemostasis was achieved with coil embolization. Biliary hemorrhage due to rupture of a pseudoaneurysm should be considered in the differential diagnosis of biliary obstruction accompanied by bleeding after EUS-HGS. [ABSTRACT FROM AUTHOR]

Endoscopic biliary drainage strategies for managing unresectable malignant hilar biliary obstruction differ in terms of stent type, drainage area, and deployment method. However, the optimal endoscopic drainage strategy remains unclear. Uncovered self-expandable metal stents (SEMS) are the preferred type because of their higher functional success rate, longer time to recurrent biliary obstruction (RBO), and fewer cases of reintervention than plastic stents (PS). Other PS subtypes and covered SEMS, which feature a longer time to RBO than PS, can be removed during reintervention for RBO. Bilateral SEMS placement is associated with a longer time to RBO and a longer survival time than unilateral SEMS placement. Unilateral drainage is acceptable if a drainage volume of greater than 50% of the total liver volume can be achieved. In terms of deployment method, no differences were observed in clinical outcomes between side-by-side (SBS) and stent-in-stent deployment. Simultaneous SBS boasts a shorter procedure time and higher technical success rate than sequential SBS. This review of previous studies aimed to clarify the optimal endoscopic biliary drainage strategy for unresectable malignant hilar biliary obstruction.

Hepatic caval stenosis is managed with stenting; however, stent placement can be complicated by migration, which can be life-threatening. The risk of migration can be mitigated by increasing the length of the stent, which increases contact with the vessel wall. We describe the cases of three patients with hepatic caval stenosis treated with two Z-stents sutured together. Each had an uncomplicated postoperative course and demonstrated clinical improvement. The use of sutured Z-stents can increase the stability of the stent and, therefore, decrease the morbidity associated with stent placement for hepatic caval stenosis.

Femoropopliteal disease comprises more than one half of lesions in peripheral vascular disease. The treatment modalities for stenosis or occlusion of this anatomic region include femoropopliteal bypass and percutaneous transluminal angioplasty with or without stenting. Our patient developed acute leg ischemia 3 years after stenting, secondary to stent fracture, with distal embolization of stent fragments. Using mechanical thromboembolectomy and superficial femoral artery to below-the-knee popliteal in situ saphenous vein bypass, we were able to restore perfusion to the limb and retrieve fragments of the fractured stent.

Self-expandable metallic stents (SEMSs) are widely accepted as a less-invasive treatment for malignant gastric outlet obstruction (GOO). However, the factors related to prognosis and stent dysfunction after SEMS placement are not well known, and we aimed to investigate them. This was a single-center retrospective cohort study of 212 malignant strictures in 207 patients. Factors related to prolonged overall survival (OS) and time to recurrent GOO (TRGOO) after SEMS placement were evaluated. Improvement of oral intake was confirmed in 179 patients (86%). The median OS was 65 days. A Cox proportional hazards model revealed that lower cancer stage, lower performance status score at the time of SEMS placement, and administration of chemotherapy after SEMS placement were significant predictive factors for prolonged OS. The median OS was 182 days in the group of SEMS followed by chemotherapy (group A) and 43 days in the group of SEMS alone (group B) (p<.0001). Chemotherapy after SEMS implantation contributed to the prolongation of survival in gastric cancer (hazard ratio (HR), 0.12) and pancreatic cancer (HR, 0.41). Furthermore, the cumulative incidence rates of stent dysfunction on day 120 after SEMS placement were 30% in group A and 61% in group B (p=.03). Notably, the preventive effect of chemotherapy on stent dysfunction was significant in pancreatic cancer. SEMS is a treatment with high technical and clinical success rate for malignant GOO. Furthermore, subsequent chemotherapy prolongs OS especially in gastric cancer, and TRGOO in pancreatic cancer. [ABSTRACT FROM AUTHOR]

This study evaluated the prevalence and risk factors of early- (within 7 days of placement) and late-onset (after 7 days of placement) cholecystitis after Y-configured metal stent placement. Between June 2005 and August 2020, 109 patients who had been treated with Y-configured metal stents for malignant hilar obstruction were enrolled in the study. We retrospectively analyzed the potential risk factors for post-stent cholecystitis. The presence of diabetes (p = 0.042), the length of the common part of the Y-stent (p = 0.017), filling of the gallbladder with contrast medium during the procedure (p = 0.040), and tumor invasion of the cystic duct accompanied by filling the gallbladder with contrast medium during metal stent placement (p = 0.001) were identified as important risk factors. In cases of late-onset cholecystitis, stent obstruction (p = 0.004) and repeated endoscopic procedures due to stent malfunction (p = 0.024) were significant risk factors. In the multivariate logistic regression analysis, significant risk factors were the length of the common part of the Y-stent (p = 0.032) in early-onset cholecystitis and stent obstruction (p = 0.007) in late-onset cholecystitis. This study demonstrated that early-onset cholecystitis may occur in patients according to the length of the common portion of the Y-stent. In contrast, late-onset cholecystitis may occur in patients with stent obstruction. [ABSTRACT FROM AUTHOR]

Aim: To compare the oncological outcomes between self‐expandable metallic stent (SEMS) as a bridge to surgery and transanal decompression tube (TDT) placement for malignant large bowel obstruction (MLBO). Methods: A total of 287 MLBO patients who underwent SEMS (n = 137) or TDT placement (n = 150) were enrolled in this multicenter retrospective study. Overall survival (OS) and disease‐free survival (DFS) between the two groups were compared. A meta‐analysis was performed using random‐effects models to calculate odd ratios (OR) with 95% confidence intervals (CIs). Results: Postoperative complications of Clavien–Dindo grade ≥II and ≥III occurred frequently in the TDT group compared with the SEMS group (P = 0.002 and 0.005, respectively). The 3‐y OS in the overall cohort and 3‐y DFS in the pathological stage II/III cohort in the SEMS and TDT groups were 68.6% and 71.4%, and 71.0% and 72.6%, respectively. The survival differences were not significantly different in the OS and DFS analyses (P = 0.819 and P = 0.892, respectively). A meta‐analysis of nine studies (including our cohort data) demonstrated no significant difference between the SEMS and TDT groups for 3‐y OS and DFS (OR = 0.96, 95% CI = 0.57–1.62, P = 0.89 and OR = 0.69, 95% CI = 0.46–1.04, P = 0.07, respectively). Conclusion: Our study demonstrated that SEMS placement had no inferiority regarding long‐term outcomes, including OS and DFS, compared with TDT placement. Considering the short‐term benefits of SEMS placement, this could be a preferable preoperative decompression method for MLBO. [ABSTRACT FROM AUTHOR]

Background/Aims: Bilateral endoscopic drainage with self-expanding metallic stent (SEMS) can be used to effectively manage hilar malignant biliary obstruction. However, the benefits of using a trisegment drainage method remain unknown. Methods: This study retrospectively reviewed the data of 125 patients with Bismuth type IIIa or IV unresectable malignant strictures who underwent bilateral endoscopic drainage using SEMSs at four tertiary centers. The patients were divided into the bilateral and trisegment drainage groups for comparison. The primary endpoint was stent patency and the secondary endpoints were technical success, technical and clinical success of reintervention, and overall survival. Results: The technical success rates of the bilateral and trisegment drainage groups were 95% (34/36) and 90% (80/89) (p=0.41), respectively, with median stent patency durations of 226 and 170 days (p=0.26), respectively. Although the technical success of reintervention was not significantly different between the two groups (p=0.51), the clinical success rate of reintrvention was significantly higher in the trisegment drainage group (73% [11/15] vs 96% [47/49], p=0.009). The median survival times were 324 and 323 days in the bilateral and trisegment drainage groups, respectively (p=0.72). Multivariate Cox hazards model revealed no stent patency-associated factor; however, chemotherapy was associated with longer survival. Conclusions: Although no significant difference was noted with respect to stent patency, significantly higher clinical success rates were achieved with reintervention using the trisegment drainage method than using the bilateral drainage method alone.

A lumen-apposing metal stent (LAMS) is a saddle-shaped stent with large flanges at both ends, thereby preventing stent migration and helping with approximation of the adjacent structures. We report the case of a 25-year-old female with remnant choledochal cyst which was successfully treated with LAMS after initial treatment failure with a plastic stent. Although complete excision of the cyst is the definite treatment of choledochal cysts, endoscopic ultrasonography-guided cystoduodenostomy can be considered in cases wherein surgery is not feasible and dysplasia is not present. LAMS may be preferred to plastic stents for effective resolution of remnant choledochal cyst and prevention of ascending infection.

Abstract Background The insertion of self-expandable metallic stents (SEMS) for post-tuberculosis tracheobronchial stenosis (PTTS) was controversial. This study aimed to evaluate the efficacy and safety of SEMS for treating PTTS, and developed a scoring system for predicting the occurrence of restenosis after stenting in PTTS patients. Methods We conducted a retrospective review of 87 patients who were diagnosed with PTTS and experienced SEMS insertion between January 2000 and December 2017. All procedures were performed via flexible bronchoscopy under conscious sedation and local anesthesia. Results A total of 85 SEMS were successfully placed in 77 patients. Comparing with pre-stenting, there were significant improvements in the lumen diameters of the stenotic segment, mMRC scale and lung function after short-term SEMS placement. During the long-term (average 163.32 months) follow-up, 48 patients (62.3%) did not develop restenosis after stenting; the other 29 patients (37.7%) developed and eventually, 12 remained under interventional therapies and 11 had bronchial atresia. Multivariate Cox regression analysis revealed that the difference value between SEMS length and the stenosis-segment length, stenosis type, and the number of pre-stenting thermal ablation were independently related to restenosis occurrence and were subsequently used to establish the Restenosis Score. The model’s development group (0.83, 95% CI 0.74–0.92) and external validation set (0.94, 95% CI 0.77–1.00) showed excellent discrimination. Conclusion SEMS placement could serve as a safe and effective treatment option for most patients with PTTS. Further, we built a prediction model depending on the independent predictors of restenosis occurrence, the Restenosis Score. This validated tool might provide a decision support and a better management for PTTS patients who underwent SEMS implantation.

Background: An electrocautery‐enhanced delivery system with a lumen‐apposing metal stent (LAMS) is available for one‐step endoscopic ultrasound‐guided transmural drainage (EUS‐TD). Bipolar electrosurgery has several potential clinical advantages, including reduced collateral thermal damage, enhanced hemostasis, and no requirement for a return electrode plate. In this study, we compared the technical feasibility and safety of a newly developed bipolar electrocautery‐enhanced delivery system with a conventional delivery system for EUS‐TD using a LAMS in a porcine model. Method: Ten days before the study, 12 mini pigs underwent common bile duct ligation for EUS‐guided gallbladder drainage. Transenteric puncture was performed, followed by placement of a guidewire. In six pigs, a bipolar electrocautery‐enhanced delivery system with LAMS (Hot SPAXUS) was inserted over the guidewire and advanced into the gallbladder, without prior dilation of the tract, by applying a bipolar cut current. In the remaining six pigs, a conventional delivery system with LAMS (Cold SPAXUS) was inserted after tract dilatation using a cystotome. The stent was removed after 4 weeks. Results: In all pigs, the stent was successfully inserted and deployed in the gallbladder without adverse events. The mean procedure time of EUS‐TD was significantly lower in the Hot SPAXUS group than that of the Cold SPAXUS group (mean ± standard deviation: 188.7 ± 5.2 vs 449.5 ± 97.5 s, P =.0019). Stent migration was not observed, and all stents were removed successfully. Conclusions: Endoscopic ultrasound‐guided transmural drainage using a bipolar electrocautery‐enhanced LAMS is feasible for reducing the procedure time while maintaining the high success rate and safety of conventional LAMS. [ABSTRACT FROM AUTHOR]

Objectives: Management of malignant gastrointestinal (GI) obstruction presents a significant challenge. Most patients are in a profoundly decompensated state due to underlying malignancy and are not ideal candidates for invasive surgical procedures. Self-expandable metallic stents (SEMSs) are used to provide permanent or temporary patency in all endoscopically accessible stenosis of the GI tract. In this study, it is aimed to analyse the characteristics and the efficacy of patients with malignant stenosis treated with SEMS, in all segments of the GI tract. Material and Methods: The sample consisted of 60 patients who underwent SEMS replacement, between 10 March 2014 and 16 December 2020, to treat malignant-related strictures in the GI tract at the Gastroenterology Department of the Health Sciences University Umraniye Training and Research Hospital. The data of the patients, hospital data processing database and electronic endoscopic database records were retrospectively scanned and recorded. The general characteristics of the patients and the treatment-related features were analysed. Results: The mean age of patients who were placed SEMS was 69.7 ± 13.7 years. Uncovered (15%, n: 9), fully covered (13.3%, n: 8), or partially covered (71.6%, n: 43) SEMS were successfully placed in all patients. Clinical success in patients with SEMS was 85.7% in the esophagus, 100% in the small intestine and 90.9% in the stomach and colon. About 11.4% migration, 14.2% pain, 11.4% overgrowth and 5.7% ingrowth were detected in patients who had SEMS placed in the oesophagus. Pain was detected in 9.1% and ingrowth in 18.2% of patients who had SEMS placed in the stomach. Pain was detected in 18.2% of the patients who had SEMS placed in the colon and migration was found in 9.1%. Conclusion: SEMS implant is a minimally invasive effective method in the palliative treatment of malignant strictures of the GI tract. [ABSTRACT FROM AUTHOR]

Background/Aims Covered self-expandable metallic stents (CMSs) are widely used for malignant distal biliary obstructions (MDBOs) caused by pancreatic carcinoma. This study compared the efficacy and safety of the laser-cut-type and braided-type CMSs. Methods To palliate MDBOs caused by pancreatic carcinoma, the laser-cut-type CMSs was used from April 2014 to March 2017, and the braided-type CMSs was used from April 2017 to March 2019. The tested self-expandable metallic stents were equipped with different anti-migration systems. Results In total, 47 patients received CMSs for MDBOs (24 laser-cut type, 23 braided-type). The time to recurrent biliary obstruction (TRBO) was significantly longer in the braided-type CMSs (p=0.0008), and the median time to stent dysfunction or patient death was 141 and 265 days in the laser-cut-type CMSs and braided-type CMSs, respectively (p=0.0023). Stent migration was the major cause of stent dysfunction in both groups, which occurred in 37.5% of the laser-cut-type CMSs and 13.0% of the braided-type CMSs. There were no differences in the survival duration between the groups. Conclusions The TRBO was significantly longer for the braided-type CMSs with an anti-migration system than for the laser-cut-type. Stent migration tended to be less frequent with the braided-type CMSs than with the laser-cut-type CMSs.

Background/Aims Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is effective and safe for poor surgical candidates; however, it remains technically challenging with potential serious adverse events. This study evaluated the learning curve for EUS-GBD for safe and effective procedures. Methods From January 2016 to January 2024, 146 patients underwent EUS-GBD performed by three endosonographers. We analyzed the baseline characteristics, procedural outcomes, and learning curves using cumulative sum (CUSUM) analysis. Results No significant differences were found among the three operators regarding technical success (96.4% vs. 94% vs. 95.1%; p=0.85), clinical success (96.4% vs. 92% vs. 95.1%; p=0.61), mean procedure time (8.0±5.7 vs. 9.9±7.9 vs. 9.9±5.1 min; p=0.24), or procedural adverse events (12.7% vs. 20% vs. 9.8%; p=0.35). CUSUM analysis revealed that proficiency in procedure time was achieved after performing 27 procedures. Comparing procedure time before and after achieving technical proficiency, technical success (90.6% vs. 98.8%, p=0.04), clinical success (89.1% vs. 98.8%, p=0.02), and procedure time (14.45±6.13 min vs. 5.09±2.23 min, p<0.01) were improved. Adverse event proficiency was reached in 23 procedures, with notable improvements post-proficiency; technical success (87.5% vs. 99%, p=0.02), clinical success (85.4% vs. 99%, p=0.01), and procedure time were also improved (15.04±6.43 min vs. 6.33±3.99 min, p<0.01). Conclusion Based on CUSUM analysis, approximately 23 procedures may be required to achieve technical proficiency in EUS-GBD with regard to minimizing adverse events, while 27 procedures are necessary to reach proficiency in terms of procedure time. [ABSTRACT FROM AUTHOR]

Background/Aims Colonic stenting using self-expandable metallic stents (SEMS) as a bridge to surgery offers an effective alternative to emergency surgery for the management of malignant colorectal obstruction. However, the optimal timing of elective surgery after stenting remains controversial. Methods This retrospective multicenter cohort study analyzed 380 patients with obstructive colorectal cancer who were treated with SEMS as a bridge to surgery. Patients were categorized into four groups based on the time from stent insertion to surgery: within 7 d, 8–14 d, 15–21 d, and 22 d or more. Results The study cohort had a slight male predominance (55.8%), with an average age of 65.8 years. Most surgeries (74.2%) were laparoscopically performed. No significant differences were observed in stoma formation rates or postoperative complications between the different timing groups. Similarly, recurrence-free survival, overall survival, locoregional recurrence, and distant metastasis rates showed no significant variations with the timing of post-stenting surgery. A restricted cubic spline curve indicated that surgery within the 15–21-d period post-SEMS insertion resulted in the lowest incidence of stoma formation. Conclusion Delaying elective surgery for up to 3 weeks post-SEMS placement for obstructive colorectal cancer is recommended, particularly within the 15–21-d period, to minimize stoma formation rates without compromising on long-term outcomes [ABSTRACT FROM AUTHOR]

Purpose: To compare the long-term outcomes of percutaneous balloon dilation versus temporary covered stent placement in treating benign bilioenteric anastomotic strictures., Materials and Methods: Eighty-three patients with benign bilioenteric anastomotic stricture from December 2014 to May 2023 were included in the study. Balloon dilation was performed up to 3 times in 46 patients (balloon group) and temporary covered stent placement aiming at spontaneous migration was performed in 23 patients (stent group). Technical and clinical success, primary patency rates, percutaneous transhepatic biliary drainage (PTBD) indwelling times, and complications were compared between the two groups., Results: The median follow-up was 963 days for the balloon group and 1151 days for the stent group (p = 0.775). Short-term stricture resolution was achieved in 46 of 60 patients (76.7 %) in the balloon group and in all patients in the stent group. Clinical success was achieved in all patients with short-term stricture resolution. The stent group showed higher primary patency rates (90.2 %, 83.3 %, 74.0 %, and 74.0 % vs. 72.9 %, 56.8 %, 39.7 %, and 39.7 % at 1, 3 5, and 7 years; p = 0.033) and a shorter median PTBD indwelling time (4 days vs. 6 days; p = 0.031) compared to the balloon group. Spontaneous migration of the stent was found in 19 of 23 patients (82.6 %), with a median stent indwelling time of 3 months (range, 3-12 months)., Conclusion: Percutaneous temporary covered stent placement is an effective treatment option for patients with benign bilioenteric anastomotic strictures, offering higher primary patency rates and shorter PTBD indwelling times, compared to balloon dilation over a long-term period., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Malignant gastric outlet obstruction (GOO) is a condition characterized by blockage or narrowing where the stomach empties its contents into the small intestine due to primary malignant tumors or metastatic diseases. This condition leads to various symptoms such as nausea, vomiting, abdominal pain, and weight loss. To manage malignant GOO, different treatment options have been employed, including surgical gastrojejunostomy (SGJ), gastroduodenal stenting (GDS) using self-expandable metallic stent (SEMS), and endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ). This review focuses on comparing the clinical outcomes of endoscopic stenting (GDS and EUS-GJ) with SGJ for malignant GOO. Studies have shown that GDS with SEMS provides comparable clinical outcomes and safety for the palliation of obstructive symptoms. The choice between covered and uncovered SEMS remains controversial, as different studies have reported varying results. EUS-GJ, performed via endoscopic ultrasound guidance, has shown promising efficacy and safety in managing malignant GOO, but further studies are needed to establish it as the primary treatment option. Comparative analyses suggest that GDS has higher recurrence and reintervention rates compared to EUS-GJ and SGJ, with similar overall procedural complications. However, bleeding rates were lower with GDS than with SGJ. Randomized controlled trials are required to determine the optimal treatment approach for malignant GOO.

Background: Palliative biliary drainage in patients with unresectable malignant biliary obstruction (MBO) frequently leads to biliary stent infection (BI), which could impact medical care. The aim of this study was to assess the risk factors for BI occurrence in patients after stenting procedure and the impact of BI on patient survival. Methods: All consecutive patients hospitalized from 2014 to 2018 for MBO and biliary stenting were retrospectively included. Demographic, clinical, and microbiological characteristics of each BI episode during a 1-year follow-up were described. Documented BI was defined as the association of BI episode and confirmed blood stream infection (BSI). Univariate and multivariate analyses were performed to evaluate risk factors for the first BI occurrence. Results: Among 180 patients, 56% were men (mean age of 69±12), and 54% have pancreatic cancer, 16% biliary cancer, 2% hepatic cancer, and 28% lymph node or metastatic compression; metallic stent was placed in 92%. A total of 113 BI episodes occurred in 74 patients, 55% of the first episodes occurring within 3 months after stenting. BI was documented in 56% of the episodes. Enterobacteriaceae were the most frequent pathogens found, while no yeasts were documented. Mortality rate in patients with BI was 64%. Multivariate analysis showed a significant difference in BI occurrence for two criteria: WHO score 3–4 (OR=8.79 [1.79–42.89]; p=0.007) and transpapillary stenting location (OR=3.72 [1.33–10.44]; p=0.013). Conclusion: Since transpapillary stenting is a risk factor for BI, preserving the papilla as much as possible is a priority so as to avoid BI. [ABSTRACT FROM AUTHOR]

Background: The insertion of self-expandable metallic stents (SEMS) for post-tuberculosis tracheobronchial stenosis (PTTS) was controversial. This study aimed to evaluate the efficacy and safety of SEMS for treating PTTS, and developed a scoring system for predicting the occurrence of restenosis after stenting in PTTS patients. Methods: We conducted a retrospective review of 87 patients who were diagnosed with PTTS and experienced SEMS insertion between January 2000 and December 2017. All procedures were performed via flexible bronchoscopy under conscious sedation and local anesthesia. Results: A total of 85 SEMS were successfully placed in 77 patients. Comparing with pre-stenting, there were significant improvements in the lumen diameters of the stenotic segment, mMRC scale and lung function after short-term SEMS placement. During the long-term (average 163.32 months) follow-up, 48 patients (62.3%) did not develop restenosis after stenting; the other 29 patients (37.7%) developed and eventually, 12 remained under interventional therapies and 11 had bronchial atresia. Multivariate Cox regression analysis revealed that the difference value between SEMS length and the stenosis-segment length, stenosis type, and the number of pre-stenting thermal ablation were independently related to restenosis occurrence and were subsequently used to establish the Restenosis Score. The model's development group (0.83, 95% CI 0.74–0.92) and external validation set (0.94, 95% CI 0.77–1.00) showed excellent discrimination. Conclusion: SEMS placement could serve as a safe and effective treatment option for most patients with PTTS. Further, we built a prediction model depending on the independent predictors of restenosis occurrence, the Restenosis Score. This validated tool might provide a decision support and a better management for PTTS patients who underwent SEMS implantation. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to investigate the safety and efficacy of self-expandable metallic stent (SEMS) placement in patients with prior radiotherapy (RT) using the Niti-S stent, which is characterized by low radial force, in comparison to patients without prior RT. Methods: A consecutive series of 83 patients who were treated by SEMS placement using Niti-S stent for severe malignant esophageal obstruction or fistula were enrolled. The adverse event rates and efficacy were retrospectively compared between patients with/without prior RT before SEMS placement (RT group [n = 32] versus non-RT group [n = 51]). Results: The incidence rate of major adverse events in the RT group was 6.3% and was not significantly different from that in the non-RT group (5.9%, p = 0.95). Among the RT group, 84.4% were able to resume oral intake within a median of 2 days. Among the patients with fistula, 78.6% could resume oral intake and survive for 73 days after SEMS placement. Cox proportional hazard regression analysis identified significant factors affecting overall survival to be prior RT (hazard ratio [HR]: 1.96), low performance status (HR: 3.87), and subsequent anticancer treatment after SEMS placement (HR: 0.41). However, compared to the non-RT group, the RT group had received longer duration of anticancer treatment before SEMS placement and a lower rate of subsequent anticancer treatment after SEMS placement. Conclusions: With the Niti-S stent, the incidence of major adverse events was sufficiently low even for patients after RT. SEMS with low radial force would be an effective palliative treatment option for patients, regardless of prior RT. [ABSTRACT FROM AUTHOR]

Purpose: The feasibility of using a compressed interwoven Supera stent as a flow diverting device for popliteal aneurysms was recently demonstrated in patients. It is unclear, however, what the optimal flow diverting strategy is, because of the fusiform shape of popliteal aneurysms and their exposure to triphasic flow. To assess this flow diverting strategy for popliteal aneurysms, flow profiles and thrombus formation likelihood were investigated in popliteal aneurysm models. Materials and Methods: Six popliteal aneurysm models were created and integrated into a pulsatile flow set-up. These models covered a bent and a straight anatomy in three configurations: control, single-lined and dual-lined Supera stents. Two-dimensional flow velocities were visualized by laser particle image velocimetry. In addition, the efficacy of the stent configurations for promoting aneurysm thrombosis was assessed by simulations of residence time and platelet activation. Results: On average for the two anatomies, the Supera stent led to a twofold reduction of velocities in the aneurysm for single-lined stents, and a fourfold reduction for dual-lined stents. Forward flow was optimally diverted, whereas backward flow was generally deflected into the aneurysm. The dual-lined configuration led to residence times of 15–20 s, compared to 5–15 s for the single stent configurations. Platelet activation potential was not increased by the flow diverting stents. Conclusion: A compressed Supera stent was successfully able to divert flow in a popliteal aneurysm phantom. A dual-lined configuration demonstrated superior hemodynamic characteristics compared to its single-lined counterpart. [ABSTRACT FROM AUTHOR]

Background/Aims Cholecystitis can occur after the placement of covered self-expandable metallic stents for distal malignant biliary obstructions. We aimed to identify risk factors for cholecystitis following covered self-expandable metallic stent placement. Methods We investigated risk factors related to cholecystitis following covered self-expandable metallic stent placement in 118 patients with distal malignant biliary obstructions between January 1, 2015 and April 30, 2019. Endoscopic assessments and tumor invasion to the arteries feeding the gallbladder were determined by a pancreaticobiliary endoscopist and a radiologist, respectively. Results The median patient age was 72 years (men, 61.0%). The flow of the contrast agent into the gallbladder and tumor involvement in the orifice of the cystic duct were observed in 35 (29.7%) and 35 (29.7%) patients, respectively. During the observation period (median, 179 days), cholecystitis occurred in 18 (15.3%) patients. Multivariate analysis revealed the flow of the contrast agent into the gallbladder (p=0.023) and tumor involvement in the orifice of the cystic duct (p=0.005) as significant independent risk factors associated with cholecystitis. Conclusions The flow of the contrast agent into the gallbladder and tumor involvement in the orifice of the cystic duct are potential independent risk factors for cholecystitis following the placement of covered self-expandable metallic stents. A follow-up prospective study is warranted to validate their influence.

Abstract Objectives The endoscopic bilateral stent‐in‐stent (SIS) deployment is a challenging procedure. Such difficulty is mainly caused by sticking of the tip of the delivery sheath into the self‐expandable metal stents (SEMSs) mesh, requiring an additional dilating procedure. Herein, we assessed the clinical results of using cross‐wired metal stent for endoscopic bilateral SIS deployment (BONASTENT M‐Hilar) in patients with malignant hilar biliary obstruction (MHBO) in both high‐volume and non‐high‐volume centers. Methods We prospectively enrolled consecutive patients with MHBO between February 2016 and December 2018 at eight centers. Results Forty‐six patients were enrolled during the study period. The proportions of technical success were 93.5% (43/46) and clinical success (CS) on intention‐to‐treat and per‐protocol analyses were 91.3% (42/46) and 93.0% (40/43), respectively. The proportion of an additional dilating procedure during the primary procedure was 50.0% (23/46). Recurrent biliary obstruction (RBO) on intention‐to‐treat analysis occurred in 32.6% (15/46) of cases. Almost all of the events were caused by stent ingrowth (14/15). The median survival time and time to RBO were 255 and 349 days, respectively. The probability of stent patency at 3, 6, and 12 months was 86.5%, 63.9%, and 47.6%, respectively. Conclusions The cross‐wired metal stent had excellent technical and CS, although non‐high‐volume centers were included in this study (UMIN000021441).

Abstract Objectives Early obstruction of a self‐expandable metal stent placed for distal malignant biliary obstruction is more likely to occur in the presence of duodenal invasion. An anti‐reflux self‐expandable metal stent (ARMS) has been developed for the purpose of preventing duodenal fluid reflux into the bile duct. In this study, we evaluated the usefulness and safety of a duckbill‐type ARMS (D‐ARMS) in the situation of duodenal invasion. Methods We retrospectively analyzed 10 consecutive patients who received D‐ARMS for distal malignant biliary obstruction with duodenal invasion. We evaluated non‐occlusion cholangitis, recurrent biliary obstruction (RBO), and adverse events after D‐ARMS placement. Results There were no cases of non‐occlusion cholangitis. RBO was observed in 2 patients (20%), and time to RBO was 236 days and 117 days, respectively. The causes of RBO were overgrowth and sludge formation. The median time to RBO was 382 days (range, 117–382 days). Only one adverse event was observed (cholecystitis). Conclusions D‐ARMS shows potential as an optimal ARMS.

Objectives: The colonic self-expandable metallic stent (C-SEMS) with a 9-French (Fr) delivery system allows for a small-caliber endoscope (SCE) to be used to treat malignant colonic obstruction. Despite the lack of evidence, the SCE has become popular because it is considered easier to insert than the large-caliber endoscope (LCE). We aimed to determine whether the SCE is more suitable than the LCE for C-SEMS placement. Methods: Between July 2018 and November 2019, 50 consecutive patients who were scheduled to undergo C-SEMS for colon obstruction were recruited in this study. Patients were randomized to the SCE or LCE group. The SCE and LCE were used with 9-Fr and 10-Fr delivery systems, respectively. The primary outcome was the total procedure time. Secondary outcomes were the technical success rate, complication rate, clinical success rate, insertion time, guidewire-passage time, stent-deployment time, and colonic obstruction-scoring-system score. Results: Forty-five patients (SCE group, n = 22; LCE group, n = 23) were analyzed. The procedure time in the LCE group (median, 20.5 min) was significantly (p = 0.024) shorter than that in the SCE group (median, 25.1 min). The insertion time in the LCE group (median, 2.0 min) was significantly (p = 0.0049) shorter than that in the SCE group (median, 6.0 min). A sub-analysis of the procedure difficulties showed that the insertion time in the LCE group (median, 5.0 min) was significantly shorter than that in the SCE group (median, 8.5 min). Conclusion: Both LCE and SCE can be used for C-SEMS; however, LCE is more suitable than SCE as it achieved a faster and equally efficacious C-SEMS placement as that of SCE. Clinical trial registration number: University Hospital Medical Information Network Clinical Trials Registry (UMIN 32748) [ABSTRACT FROM AUTHOR]

Background/Aims: Endoscopic vacuum-assisted closure (EVAC) has been attempted as new nonsurgical treatment for anastomotic leakage. We aimed to evaluate the clinical outcomes of EVAC and compare its efficacy with the self-expandable metallic stent (SEMS) for postgastrectomy leakage. Methods: Between January 2007 and February 2018, 39 patients underwent endoscopic treatment for anastomotic leakage after gastric cancer surgery. Of them, 28 patients were treated with SEMS, seven with EVAC after SEMS failure, and four with EVAC. We retrospectively compared the clinical characteristics and therapeutic outcomes between EVAC (n=11) and SEMS (n=28). Results: The median followup duration was 17 months (interquartile range, 9 to 26 months) in both groups. In comparison of clinical characteristics between two groups, only the median size of the leak was larger in the EVAC group than in the SEMS group (2.1 cm vs 1.0 cm; p

Abstract Background The clinical significance of pre-sarcopenia in colorectal cancer obstruction has not yet been described. The present study aimed to determine the short- and long-term oncologic impacts of pre-sarcopenia in obstructive colorectal cancer. Methods We retrospectively analyzed 214 patients with obstructive colon cancer between January 2004 and December 2013. Initial staging computed tomography (CT) scans identified pre-sarcopenia and visceral obesity by measuring the muscle and visceral fat areas at the third lumbar vertebra level. Both short-term postoperative and long-term oncologic outcomes were analyzed. Results Among all 214 patients, 71 (33.2%) were diagnosed with pre-sarcopenia. Pre-sarcopenia had a negative oncologic impact in both disease-free survival (DFS) and overall survival (OS), (hazard ratio [HR] = 1.86, 95% confidence interval [CI] 1.04–3.13, p = 0.037, and HR = 1.92, CI 1.02–3.60, p = 0.043, respectively). Visceral adiposity, body mass index (BMI), and neutrophil-lymphocyte ratio (NLR) did not significantly impact DFS and OS. Conclusion Pre-sarcopenia is a clinical factor significantly associated with OS and DFS but not with short-term complications in obstructive colorectal cancer. In future, prospective studies should incorporate body composition data in patient risk assessments and oncologic prediction tools.

Background/Aims Endoscopic ultrasound-guided transmural drainage and necrosectomy employing lumen-apposing metal stent (LAMS) are used for treating pancreatic fluid collections (PFCs) with excellent results from academic centers. Herein, we report the efficacy and safety of LAMS in the treatment of PFCs at a community hospital. Methods We retrospectively reviewed the etiology of pancreatitis, type and size of PFCs, length of procedure, technical success, clinical success, adverse events, and stent removal. The primary outcome was the rate of clinical success, and secondary outcomes were technical success and adverse events. Results Twenty-seven patients with a mean age of 54.1±6.5 years were included, 44% of which were men. The mean size of the PFCs was 9.7±5.0 cm (range, 3–21). The most common etiology of pancreatitis was alcohol (44%) followed by idiopathic causes (30%) and presence of gallstones (22%). The diagnosis was pseudocyst in 44.4% (12/27) and walled off necrosis in 55.6% (15/27) of patients. There was 100% technical success without any complications. Clinical success was achieved in 22 of 27 patients (81.5%) who underwent stent removal. Conclusions Our study is the first to report that endoscopic therapy of PFCs using LAMS is safe and effective even in a community hospital setting with limited resources and support compared to large academic centers.

Walled-off pancreatic necrosis (WOPN) is defined as encapsulated necrotic tissue after severe acute pancreatitis. Treatment strategies for WOPN can be challenging. Although open surgical necrosectomy is the standard treatment for WOPN, it is associated with high rates of morbidity and mortality. Endoscopic necrosectomy, introduced recently, is a treatment option that produces lower rates of morbidity than does open surgery. We report a case of severe WOPN that could not be treated with the usual procedures. Although endoscopic necrosectomy of the left subphrenic and prepancreatic spaces was technically impossible, these spaces could be percutaneously drained. Finally, sufficient drainage of these spaces was achieved with endoscopic necrosectomy through the internal lumen of the self-expandable metallic stent placed percutaneously. This procedure was performed by an endoscopist and an interventional radiologist, and the multidisciplinary approach was useful.

Abstract Background Endoscopic retrograde biliary drainage (ERBD) is the treatment of choice for patients with malignant distal common bile duct (CBD) obstruction. Self-expandable metal stents (SEMS), which are commonly used in unresectable cases, have many clinical advantages, including longer stent patency. Although the expected patency of SEMS is around 8 months, it has recently been reported that the duration of SEMS’ patency in patients using aspirin is prolonged. Our study, therefore, aims to investigate the effect of aspirin on SEMS’ patency. Methods/design This is an investigator-initiated, prospective, multicenter, double-blind, randomized placebo-controlled trial that will be conducted from November 2017 in four tertiary centers in South Korea. We intend to include in our study 184 adult (aged ≥ 20 years) patients with malignant distal CBD obstruction for whom ERBD with SEMS was successfully performed. The patients will be randomly allocated to two groups, which will comprise patients who have either taken 100 mg aspirin or a placebo for 6 months after index ERBD. The primary outcome will be the rate of stent dysfunction, and the secondary outcomes will be the duration of patency, the rate of reintervention, and the occurrence of adverse events. Discussion The aspirin for metal stents in malignant distal common bile duct obstruction (AIMS) study should determine the efficacy of aspirin in maintaining metal-stent patency in patients with malignant distal CBD obstructive. Trial registration ClinicalTrials.gov, ID: NCT03279809. Registered on 5 September 2017.

Relapsing polychondritis (RP) is a rare multisystem condition. Nearly 50% of patients are suffering from airway involvement in RP and it can be fatal. Besides immunotherapies, endobronchial stenting has been found to be useful in the treatment. Insertion of endobronchial stents in patients with RP has it’s own complications and has been associated with increasing morbidity and mortality.We describe placement of multiple endobronchial stents to prevent airway closure in a 76-year-old man with RP due to recurrent dyspnea. Insertion of multiple stents (6th stent) in the left main bronchus was necessary due to severe narrowing of the left main bronchus.Recurrence of airway involvement in RP is common. Early diagnosis and prompt treatment are essential to reduce the risk of life-threatening airway collapse. The insertion of multiple stents in this patient has resulted in improving symptoms, spirometry, and a return to daily activities.

Colonic stent placement is a commonly used bridging strategy for surgery in patients with obstructive colorectal cancer. The procedure involves the placement of a self-expandable metallic stent (SEMS) across the obstructive lesion to restore intestinal patency and alleviate the symptoms of obstruction. By allowing patients to receive surgery in a planned and staged manner with time for preoperative optimization and bowel preparation, stent placement may reduce the need for emergency surgery, which is associated with higher complication rates and poorer outcomes. This review focuses on the role of colon stenting as a bridge to surgery in the management of obstructive colorectal cancer. SEMS as a bridge to surgery for left-sided colon cancer has been demonstrated to be particularly useful; however, further research is needed for its application in cases of right-sided colon cancer. Colon stent placement also has limitations and potential complications including stent migration, re-obstruction, and perforation. However, the timing of curative surgery after SEMS placement remains inconclusive. Considering the literature to date, performing surgery at an interval of approximately 2 weeks is considered appropriate. Therefore, colonic stent placement may be an effective strategy as a bridge to surgery in patients with obstructive colorectal cancer.