• Journal of Digestive Cancer Research
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• 제12권1호
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• pp.15-22
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• 2024

Malignant colorectal obstructions urgently require decompression therapy to prevent the severe risks of intestinal ischemia and bowel perforation. In managing malignant colonic strictures endoscopically, the use of self-expandable metal stents (SEMS) is the predominant approach. Colonic SEMs are primarily used in preoperative decompression therapy before curative surgery and palliative treatment in patients with advanced disease stages. Furthermore, the stenting process, which requires rigorous clinical supervision, can lead to complications. This review endeavors to concisely review the clinical considerations associated with the SEMS procedure, with a focus on its indications, technical aspects, and potential complications that may arise during the procedure.

• Clinical Endoscopy
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• 제56권2호
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• pp.135-142
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• 2023

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.

• Journal of Digestive Cancer Research
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• 제10권2호
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• pp.92-98
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• 2022

Self-expandable metal stent (SEMS) is effective for biliary drainage, especially in pancreaticobiliary cancer. The mechanical properties, material, and design of SEMS are important in preventing recurrent biliary obstruction and complication. Radial and chronic expansion forces play roles in preventing stent migration and collapse. Complications, such as stent impaction, cholecystitis, and pancreatitis, were related to the axial force. The nickel-titanium alloy shows more flexibility, conformability, and optimal axial force compared to previously used stainless steel. Additionally, the stent structure affected the mechanical properties of SEMS. Therefore, understanding the mechanical properties, material, and design of SEMS will provide the best outcome for biliary drainage, as well as better SEMS development.

• Clinical Endoscopy
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• 제55권3호
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• pp.369-371
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• 2022

• Clinical Endoscopy
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• 제57권4호
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• pp.515-526
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• 2024

Background/Aims: The optimal length of the uncovered portion of partially covered self-expandable metal stents (PCSEMSs) used in endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) remains unclear. This study investigated the safety and efficacy of PCSEMSs with different uncovered lengths, with a focus on stent migration and time to recurrent biliary obstruction (RBO). Methods: Outcomes of patients undergoing EUS-HGS using PCSEMSs with 5-mm and 20-mm uncovered portions at our institution from January 2016 to December 2021 were compared. Results: Sixty-two patients underwent EUS-HGS using PCSEMS (5/20-mm uncovered portions: 32/30). Stent migration occurred only in the 5-mm group. There were no differences in RBO rates (28.1% vs. 40.0%) or median time to RBO (6.8 vs. 7.1 months) between the two groups. Median overall survival (OS) was longer in the 20-mm group (3.1 vs. 4.9 months, p=0.037) due to the higher number of patients that resumed chemotherapy after EUS-HGS (56.7% vs. 28.1%, p=0.029). Good performance status, absence of hepatic metastases, and chemotherapy after EUS-HGS were independent predictors of longer OS. Conclusions: No migration was observed in patients treated with PCSEMS with 20-mm uncovered portions. Patients treated with PCSEMS with 20-mm uncovered portions performed at least as well as those treated with 5-mm uncovered portions in all material respects.

• Clinical Endoscopy
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• 제55권6호
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• pp.793-800
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• 2022

Background/Aims: Fully covered self-expanding metal stents (FCSEMSs) are a relatively novel option for treating painful main pancreatic duct refractory strictures in patients with chronic pancreatitis. Herein, we aimed to assess the efficacy, feasibility, and safety of FCSEMSs in this patient group. Methods: This prospective single-center study included patients who underwent endoscopic retrograde pancreatography with FCSEMS placement. The primary endpoints were the technical and clinical success rates. A reduction in visual analog scale pain score of >50% compared with that before stent placement was defined as clinical success. Secondary endpoints were resolution of pancreatic strictures on fluoroscopy during endoscopic retrograde pancreatography and the development of stent-related adverse events. Results: Thirty-six patients were included in the analysis. The technical success rate was 100% (n=36) and the clinical success rate was 86.1% (n=31). There was a significant increase in stricture diameter from 1.7 mm to 3.5 mm (p<0.001) after stent removal. The mean visual analog scale pain score showed statistically significant improvement. At 19 months of follow-up, 55.6% of the patients were asymptomatic. Stent migration (16.7%), intolerable abdominal pain (8.3%), development of de novo strictures (8.3%), and mild pancreatitis (2.8%) were the most common adverse events. Conclusions: FCSEMS placement showed good technical and clinical success rates for achieving pain relief in patients with refractory main pancreatic duct strictures.

• Clinical Endoscopy
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• 제55권1호
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• pp.150-155
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• 2022

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

• Clinical Endoscopy
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• 제55권4호
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• pp.564-569
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• 2022

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.

• Tuberculosis and Respiratory Diseases
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• 제39권4호
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• pp.318-324
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• 1992

기관지내 팽창성 금속 스텐트의 사용은, 아직은 외국의 경우에서도, 추적 관찰기간이 짧고 시술받은 환자의 수도 많지 않으며 장기간 삽입후의 변화에 대하여는 그 결과가 예측하기 힘들다는 점등을 생각할 때는 현재 이의 시행은 아직은 실험적 단계라 할 수 있다. 그러나 내과적 혹은 외과적인 문제로 수술적 기관지 보존술등을 시행받기 어려운 상태에 있는 기관지 협착환자에서는 단독으로, 혹은 laser therapy, electrocoagulation, cryotherapy, balloon dilatation 및 다른 tracheal devices (예(例): Montgomery T-tube)등 의 치료방법들과 같이 병행하여, 팽창성 금속 스텐트의 삽입은 기관기관지 협착증의 치료에 도움이 되리라 생각된다. 또 국내에서는 아직도 유병율이 높은 폐결핵환자에서 충분한 기간동안 약물치료후에도 일부 환자에서는 기관지 결핵에 의하여 기관지 협착이 발생하는데 이때 수술적 치료외에는 적절한 치료방법이 없는 실정이다. 이러한 환자에서 만약 협착부위가 한쪽 주 기관지에 부분적으로 국한 되어 있으며 그 이하의 폐실질파괴가 심하지 않다면 스텐트 삽입은 수술적 치료이전에 시도하여 볼 수 있으리라 사료된다.

• Journal of Hospice and Palliative Care
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• 제12권2호
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• pp.49-55
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• 2009

상부 위장관 스텐트 삽입술은 근치적 수술이 불가능한 상부 악성 종양에 의한 상부 위장관 협착 환자의 폐쇄 증상 완화를 위한 보존적 치료로서 확립되었으며 내시경 개발 기술이 발달하고 임상 경험이 축적됨에 따라서 여러 상부 위장관 질환에서 스텐트 삽입술을 보다 편리하고 안전하게 시행할 수 있게 되었다. 그러나 스텐트 삽입술 이후에는 동통, 출혈, 천공과 같은 조기 합병증이나 스텐트 일탈, 스텐트 폐쇄 등의 후기 합병증이 발생할 수 있으므로 사후 관리 또한 중요하다.