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Esophageal Cancer
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Jennifer Kahan, Carys Morgan, Kieran Foley, Thomas Crosby
Palliative external beam radiotherapy can be offered to patients with symptomatic primary esophageal tumors in the context of metastatic or inoperable disease. Palliative dose and fractionation options are varied depending on patient fitness and extent of disease. It should be borne in mind that radiotherapy does not work immediately, and following treatment, it can take up to 6 weeks to see a benefit; therefore, severe symptoms or complete dysphagia are better managed with insertion of an esophageal stent if feasible. The addition of RT following insertion of an esophageal stent has recently been investigated in a randomized trial.110 Results are awaited.
Esophageal Perforation
Published in Stephen M. Cohn, Peter Rhee, 50 Landmark Papers, 2019
Ben-David's group in Florida has an algorithm in place for the management of esophageal perforations. They conducted a retrospective review of 76 patients with acute esophageal perforation and confirmed leak occlusion in 68 patients within 48 hours of esophageal stent placement. Although they do not have a comparison to other management options such as definitive reconstruction, they do show that with a strict algorithm, stenting is feasible with minimal mortality, and perhaps most interestingly, none of the patients in this study required conversion to operative management (Ben-David et al., 2014).
Aortoesophageal Fistula, a Complication of Esophageal Stent Placement
Published in Wickii T. Vigneswaran, Thoracic Surgery, 2019
Adrian E. Rodrigues, James L. Lubawski, Wickii T. Vigneswaran
At our facility, the patient rejected surgical management and was therefore treated with an esophageal stent and endoscopic clip closure. Her stay was complicated by respiratory failure and was subsequently intubated, and subsequently a tracheotomy was performed due to failed attempts to wean her off the ventilator. A gastrostomy tube was also placed, and after a 10-day hospital course, the patient was discharged.
Outcome after iatrogenic esophageal perforation
Published in Scandinavian Journal of Gastroenterology, 2019
Tobias Hauge, Ole Christian Kleven, Egil Johnson, Bjørn Hofstad, Hans-Olaf Johannessen
Characteristics of the patient material and etiology of the perforations are depicted in Tables 1 and 2. The perforations were initially diagnosed during an upper endoscopy in eight patients (38.1%) and with a CT scan in 13 patients (61.9%). After perforation, 16 of the patients (76.2%) were treated within less than 24 hours, two (9.5%) during 24–48 hours and three (14.3%) beyond 48 hours. The initial treatment is summarized in Table 3. Most patients (71.4%) had non-surgical treatment, of whom 11 (73.3%) received an esophageal stent. The remaining four patients were treated solely with antibiotics in two patients and supplemented percutaneous drainage in two, respectively. After initial treatment and restenting in this group, the healing rate increased from 73.3% to 100%.
Massive purulent pericarditis presenting as cardiac tamponade
Published in Baylor University Medical Center Proceedings, 2020
Azka Latif, Apurva D. Patel, Toufik Mahfood Haddad, Chetan Lokhande, Michael Del Core, Dennis Esterbrooks
Once the patient’s condition stabilized, he underwent endoscopic suturing of the perforation and esophageal stent placement. However, he was kept on broad-spectrum coverage with intravenous ceftriaxone 2 g daily, daptomycin 500 mg daily, oral itraconazole 200 mg twice daily, and metronidazole 500 mg every 8 h, as the infection was thought to be due to pericardial-esophageal fistula. Human immunodeficiency virus antigen/antibody, syphilis screen, and acid-fast bacilli smear were negative. Further testing for tuberculosis, Histoplasma, tularemia, brucella, and Q fever was also unremarkable. Upon stabilization, the patient was discharged home on intravenous antibiotics, which he continued for 6 weeks.
OverStitch Sx Endoscopic suturing system in minimally invasive endoscopic procedures: overview of its safety and efficacy and comparison to oversticthTM
Published in Expert Review of Medical Devices, 2022
Tara Keihanian, Mohamed O Othman
Krishnan et al., in a single center retrospective trial, reported the outcomes of 37 patients who underwent endoscopic stenting for management of anastomotic leak post bariatric surgery. The incidence of stent migration without anchoring was 41.18% versus 15% only with OverStitchTM stent anchoring [29]. There are multiple case reports demonstrating OverStitchTM success in stent fixation in the esophagus and stomach for uncommon indications such as relieving malignant gastric outlet obstruction with a stent-within-stent approach with OverStitchTM fixation [30]. Figure 5 shows esophageal stent fixation using OverStitchTM device.