• Journal of Gastric Cancer
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• v.9 no.1
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• pp.1-5
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• 2009

In the past, conservative bypass surgery was usually performed for palliation of malignant obstruction of the gastrointestinal tract. However, endoscopic stenting was developed recently, and technical advances and clinical experience have made it possible to establish stent implantation as one of the main treatment options. There are several advantages in stent implantation over bypass surgery, such as high feasibility and technical success rate, non-invasiveness, rapid symptomatic response, short hospitalization, and cost-effect benefits. Complications, such as stent ingrowth, stent injury by bile or acid, and migration, may occur and early re-insertion is frequently needed. Recently, diverse novel stents which are powered to predict stent migration or ingrowth have been developed and are being used in the clinical setting. In general, stent implantation is known to be beneficial in patients who are expected to survive <6 months, and surgical bypass may be more effective in patients who can survive >6 months. In this review, we have compared the technical feasibility, clinical outcomes, complications, and cost-benefit between stent implantation and bypass surgery, and determined the optimal treatment strategy in malignant upper gastrointestinal obstruction.

• Journal of Periodontal and Implant Science
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• v.46 no.5
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• pp.329-336
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• 2016

Purpose: The aim of this study was to clinically assess the impact of a prefabricated implant-retained stent clipped over healing abutments on the preservation of keratinized mucosa around implants after implant surgery, and to compare it with horizontal external mattress sutures. Methods: A total of 50 patients were enrolled in this study. In the test group, a prefabricated implant-retained stent was clipped on the healing abutment after implant surgery to replace the keratinized tissue bucco-apically. In the control group, horizontal external mattress sutures were applied instead of using a stent. After the surgical procedure, the width of the buccal keratinized mucosa was measured at the mesial, middle, and distal aspects of the healing abutment. The change in the width of the buccal keratinized mucosa was assessed at 1 and 3 months. Results: Healing was uneventful in both groups. The difference of width between baseline and 1 month was $-0.26{\pm}0.85mm$ in the test group, without any statistical significance (P=0.137). Meanwhile, the corresponding difference in the control group was $-0.74{\pm}0.73mm$ and it showed statistical significance (P<0.001). The difference of width between baseline and 3 months was $-0.57{\pm}0.97mm$ in the test group and $-0.86{\pm}0.71mm$ in the control group. These reductions were statistically significant (P<0.05); however, there was no difference between the 2 groups. Conclusions: Using a prefabricated implant-retained stent was shown to be effective in the preservation of the keratinized mucosa around implants and it was simple and straightforward in comparison to the horizontal external mattress suture technique.

• Clinical and Experimental Pediatrics
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• v.48 no.11
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• pp.1256-1256
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• 2005

Pulmonary atresia with intact ventricular septum (PAIVS) is rare, less than 1% of congenital heart disease. It needs a therapeutic approach according to its individual morphologic feature. Surgical treatment of valvotomy and modified Blalock-Taussig shunt or non-surgical interventional catheter balloon valvuloplasty can be used for mild to moderate hypoplasia of right ventricle. Fontan operation can be considered for less optimum morphological substrate of two ventricular repair. A 3-day-old male neonate was admitted with cyanosis and cardiac murmur. On echocardiogram, he had membranous pulmonary atresia with intact ventricular septum, normal sized tripartite right ventricle, large atrial septal defect with right-to-left shunt, small sized patent ductus arteriosus, and moderate tricuspid regurgitation. He was treated with intravenous continuous infusion of prostaglandin $E_1$ ($PGE_1$) at once. On the third day of hospitalization, Balloon valvuloplasty was performed. After insertion of patent ductus arteriosus stent on the tenth day, $PGE_1$ infusion was discontinued. On the fifteenth day, he was discharged. Now, he is 9 months old and has nearly normal cardiac structure and function with 97% of percutaneous oxygen saturation.

• Journal of Gastric Cancer
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• v.24 no.1
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• pp.108-121
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• 2024

Anastomotic leaks and fistulas are significant complications of gastric surgery that potentially lead to increased postoperative morbidity and mortality. Surgical intervention is reserved for cases with severe symptoms or hemodynamic instability; however, surgery carries a higher risk of complications. With advancements in endoscopic treatment options, endoscopic approaches have emerged as the primary choice for managing these complications. Endoscopic clipping is a traditional method comprising 2 main categories: through-the-scope clips and over-the-scope clips. Through-the-scope clips are user friendly and adaptable to various clinical scenarios, whereas over-the-scope clips can close larger defects. Another promising approach is endoscopic stent insertion, which has shown a high success rate for leak closure, although vigilant monitoring is required to monitor stent migration. Infection control is essential in post-surgical leakage cases, and endoscopic internal drainage provides a relatively safe and noninvasive means to manage fluids, contributing to infection control and wound healing promotion. Endoscopic suturing offers full-thickness wound closure, but requires additional training and endoscopic versatility. As a promising tool, endoscopic vacuum therapy potentially surpasses stent therapy by draining inflammatory materials and closing defects. Furthermore, the use of tissue sealants, such as fibrin glue and cyanoacrylate, has been reported to be effective in selected situations. The choice of endoscopic device should be tailored to individual cases and specific patient conditions, with careful consideration of the nature of the defect. Further extensive studies involving larger patient populations are required to provide more robust evidence on the efficacy of endoscopic approach in managing post-gastric anastomotic leaks.

• Korean Journal of Bronchoesophagology
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• v.14 no.2
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• pp.10-16
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• 2008

Surgical resection and reanastomosis has been the treatment of choice in patients with tracheobronchial stenosis. Recent development of bronchoscopic intervention has been replacing the role of surgery in these patients. After summarizing the upto date data of bronchoscopic intervention, the proper management of tracheobronchial stenosis will be presented. Bronchoscopic intervention would be much effective when performed under rigid bron- choscopy, due to the stable patients' condition and endoscopic view. The usual method of intervention includes ballooning, Nd-YAG laser resection, bougienation, mechanical airway dilatation, stenting and photodynamic therapy. Silicone stents are very effective in patients with tracheobronchial stenosis to maintain airway patency. Bronchoscopic intervention provided immediate symptomatic relief and improved lung function in most of patients. After airway stabilization, stents were removed successfully in 2/3 of the patients at a 12-18 months post-insertion. Less than 5% of patients eventually needs surgical management. Acute complications, including excessive bleeding, pneumothorax, and pneumomediastinum develops in less than 5% of patients but managed without mortality. Stent-related late complications, such as, migration, granuloma formation, mucostasis, and restenosis are relatively high but usually controlled by follow-up bronchoscopy. In conclusion, bronchoscopic intervention, including silicone stenting could be a useful and safe method for treating tracheobronchial stenosis.

• The Korean Journal of Gastroenterology
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• v.72 no.5
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• pp.262-266
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• 2018

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

• Tuberculosis and Respiratory Diseases
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• v.86 no.4
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• pp.245-250
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• 2023

The healing process of tracheobronchial tuberculosis (TB) results in tracheobronchial fibrosis causing airway stenosis in 11% to 42% of patients. In Korea, where pulmonary TB is still prevalent, post-TB tracheobronchial stenosis (PTTS) is one of the main causes of benign airway stenosis causing progressive dyspnea, hypoxemia, and often life-threatening respiratory insufficiency. The development of rigid bronchoscopy replaced surgical management 30 years ago, and nowadays PTTS is mainly managed by bronchoscopic intervention in Korea. Similar to pulmonary TB, tracheobronchial TB is treated with combination of anti-TB medications. The indication of rigid bronchoscopy is more than American Thoracic Society (ATS) grade 3 dyspnea in PTTS patients. First, the narrowed airway is dilated by multiple techniques including ballooning, laser resection, and bougienation under general anesthesia. Then, most of the patients need silicone stenting to maintain the patency of dilated airway; 1.5 to 2 years after indwelling, the stent could be removed, this has shown a 70% success rate. Acute complications without mortality develop in less than 10% of patients. Subgroup analysis showed successful removal of the stent was significantly associated with male sex, young age, good baseline lung function and absence of complete one lobe collapse. In conclusion, rigid bronchoscopy could be applied to PTTS patients with acceptable efficacy and tolerable safety.

• Journal of Chest Surgery
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• v.49 no.6
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• pp.465-467
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• 2016

The intrinsic structural failure of a Dacron graft resulting from the loss of structural integrity of the graft fabric can cause late graft complications. Late non-anastomotic rupture has traditionally been treated surgically via open thoracotomy. We report a case of the successful use of thoracic endovascular repair to treat a Dacron graft rupture in the descending aorta. The rupture occurred 20 years after the graft had been placed. Two stent grafts were placed at the proximal portion of the surgical graft, covering almost its entire length.

• Korean Journal of Bronchoesophagology
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• v.14 no.1
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• pp.8-13
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• 2008

Malignant esophagorespiratory fistula is a devastating and life-threatening complication of esophageal and bronchogenic carcinomas. As a non-surgical treatment, peroral stent placement into the esophagus or airway can close-off the fistula and prevent progression of the pneumonia. Although reopening of the fistula is not uncommon despite stent placement, interventional treatment is effective for sealing off reopened ERFs. Bronchopleural fistula is a well-recognized complication of pneumonectomy. There have been several reports to occlude the fistula with use of stents and much more experience is required.

• Journal of Chest Surgery
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• v.33 no.7
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• pp.601-604
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• 2000

Actinomycosis is an indolent, suppurative infection caused by an anaerobic gram-positive organism(usually actinomyces israelii) which usually causes infection in the face, mediastitum, lung, and abdomen. Primary esophageal actinomycosis which is not related with pulmonary or mediastinal actinomycosis, is very rare, especially in immunocompetent host. A 58-year-old woman has been suffered from dysphagia, odynophagia, and chest pain after insertion of esophageal stent in esophageal acid stricture. She underwent a esophagectomy with esophagogastrostomy for above mentioned symptoms. Pathologic diagnosis was a esophageal actinomycosis.