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Post-Esophagectomy Mediastinal Leak
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
Devayani Niyogi, Virendra Kumar Tiwari, Apurva Ashok, Sabita Jiwnani, George Karimundackal, C.S. Pramesh
Endoscopic stenting in this setting works by diverting contents away from the site of the leak, giving the mucosa a chance to heal. This mandates an adequate seal. Therefore, stenting may work well for small anastomotic leaks and leaks where an intrathoracic anastomosis has been performed using a circular stapler, but has not been found to be of benefit in leaks from the conduit staple line. The gastric tube is too wide to provide an adequate seal in such cases [9].
Malignant strictures of the biliary tree
Published in David Westaby, Martin Lombard, Therapeutic Gastrointestinal Endoscopy A problem-oriented approach, 2019
The elation when a stent is successfully inserted at ERCP should be tempered by the knowledge that the best the endoscopist can ever achieve in malignant biliary obstruction is palliation. There is no problem when decisions about patients are taken in a multidisciplinary team, but endoscopists can forget that surgery may be curative and refer too few patients too late for sufficient to benefit. For the elderly, frail patient, endoscopic stenting can be a godsend, but both hilar cholangiocarcinomas and small pancreatic or periampullary tumours can be curatively resected. In anyone fit for surgery (itself an expanding group as anaesthetics and postoperative care have improved) with such a tumour, work-up for resection should be carried out. If patients are well hydrated, and coagulopathy is corrected, good anaesthetists and surgeons can perform major abdominal surgery safely. What many surgeons do not like operating upon is a bile duct which is inflamed and thickened from an indwelling endoscopic stent. Since it has been estimated that 25% of patients with pancreatic carcinoma will develop duodenal obstruction, it was suggested that, in patients fit for surgery, palliative choledochojejunostomy and gastrojejunostomy should be carried out rather than endoscopic stenting. Trials so far conducted to test this hypothesis have been inconclusive, stenting being safer and cheaper, but requiring more return visits for blocked stents [13] (Fig. 11.4).
Palliative Gastrojejunostomy and the Impact on Nutrition in Cancer
Published in Victor R. Preedy, Handbook of Nutrition and Diet in Palliative Care, 2019
Dorotea Mutabdzic, Poornima B. Rao, Jeffrey M. Farma
Therefore, studies show that both endoscopic stenting and surgical gastrojejunostomy are effective and have similar complication rates. The advantage of endoscopic stenting is decreased length of hospital stay, shorter time to oral intake and not requiring general anesthesia. The advantage of surgical gastrojejunostomy is decreased need for re-intervention. Given the increasing ease of access to skilled endoscopists, the ability to perform the procedure with sedation rather than general anesthesia, and the faster recovery and time to oral intake, endoscopic stenting is likely to become increasingly utilized in this setting.
Endoscopic papillectomy or pancreaticoduodenectomy for ampullary lesions: a single center retrospective cohort study
Published in Scandinavian Journal of Gastroenterology, 2022
Steffen Seyfried, Georg Kähler, Sebastian Belle, Daniela Hirsch, Christoph Reißfelder, Nuh Rahbari, Julia Hardt
There were significantly more major surgical and cardiovascular complications after PD compared to EP. In line with this finding, 90-day mortality was significantly higher in the PD cohort: three patients (7.0%) died within ninety days after PD (hemorrhage n = 1; myocardial infarction n = 1; sepsis n = 1), whereas there was no death after EP within this time interval. Furthermore, significantly more patients in the PD cohort had to undergo endoscopic or surgical reinterventions due to severe complications.: In the endoscopic cohort, there were two cases of cholestasis due to stent occlusion or swelling of the papillary region and one case of hemorrhage. These complications were resolved by endoscopic stenting. Surgical intervention in this cohort occurred because of clinical signs of post-interventional peritonitis. However, the subsequent laparoscopy was unremarkable.
The incidence and long-term outcomes of esophageal perforations in Finland between 1996 and 2017 – a national registry-based analysis of 1106 esophageal perforations showing high early and late mortality rates and better outcomes in patients treated at high-volume centers
Published in Scandinavian Journal of Gastroenterology, 2020
Jahangir Khan, Jari Laurikka, Johanna Laukkarinen, Vesa Toikkanen, Mika Ukkonen
While conclusive evidence guiding the treatment of esophageal perforations from large randomized clinical trials is lacking, endoscopic and other less invasive treatment methods have become more common in clinical practice. The proportion of patients treated by endoscopic stenting in the present analysis significantly increased over the study period. At the same time the number of in-hospital days and overall treatment periods marginally decreased. Similar trends in the treatment of the disease have been reported by other authors as well. For example, in the United States the use of esophageal stents appears to have quadrupled in less than 10 years [14] and other authors have reported increasing percentages of conservatively and decreasing proportions of surgically treated patients during the last decades as well [15].
Zero-adjusted defective regression models for modeling lifetime data
Published in Journal of Applied Statistics, 2019
Vinicius F. Calsavara, Agatha S. Rodrigues, Ricardo Rocha, Francisco Louzada, Vera Tomazella, Ana C. R. L. A. Souza, Rafaela A. Costa, Rossana P. V. Francisco
The proposed model is motivated by two real medical data sets. The first is from a study on the lifetime of endoscopic stenting (the main biliary drainage technique used in distal biliary malignancies) in patients with pancreatic cancer at A.C. Camargo Cancer Center in São Paulo, Brazil. The patients were followed after surgical procedure, and the occlusion of endoscopic stenting was the event of interest. The main goal is to evaluate the effect of insertion the single plastic stent in relation to other techniques (multiple plastic stent or metallic stent) in the time to occlusion of endoscopic stenting. In this experiment, the medical literature recommends a complete successful of procedure after 2 weeks, that is, follow-up should occur only after a period of 2 weeks. However, in our study a proportion of the failures (occlusion of endoscopic stenting) occurred within 14 days after the surgical procedure, and investigating whether the type of stent leads to this is of great interest. In practice, it is common for researchers eliminate these patients who have had an early failure, which leads to erroneous conclusions. In this sense, all patients who had occlusion of endoscopic stenting before 2 weeks were not excluded of the experiment but had the lifetime at time zero-adjusted.