消化道狭窄的内镜治疗课件

消化道狭窄的内镜治疗消化道狭窄的内镜治疗病理类型我国鳞癌为主 97.6% 上1/3段 8.8%

中1/3段65.9%

下1/3段 25.3%西方国家以下段食管为主、主要为腺癌（60％以上）病理类型我国食管癌的治疗

（强调早期发现、早期诊断、早期治疗）手术治疗

-姑息性手术

-根治性手术内镜下治疗-食管扩张，食管支架取代传统的旁路手术

-内镜下电灼切除、Nd:YAG激光切除、光动力疗法等化疗：5-Fu和顺铂为主放疗：外放射为主以手术为主的综合治疗食管癌的治疗

（强调早期发现、早期诊断、早期治疗）手术治疗手术适应证早期食管癌中期（Ⅱ）、中下段食管癌病变在5cm内，上段在3cm内，全身情况好者中期（Ⅲ）、病变在5cm以上，无明显远处转移，全身条件允许，可采用术前放化疗与手术综合疗法放射治疗后复发，病变范围尚不大，无远处转移，全身情况良好者

手术适应证早期食管癌手术禁忌证食管癌病变广泛或累及邻近器官如气管、肺、纵隔等者已有锁骨上窝淋巴结等远处转移者有严重心、肺或肝功能不全者严重恶病质者手术禁忌证食管癌病变广泛或累及邻近器官如气管、肺、纵隔等者Surgicalresectionistheonlycurativetreatmentoptionforinvasiveesophagealcancer.However,despitecarefulstagingandadvancesinadjuvanttherapyandsurgicaltechniques,5-yearsurvivalratesrarelyexceed40%.1,2Manypatientspresentwithlocoregionalrecurrenceanddistantmetastasiswithin2yearsaftercurativeesophagectomy.3TreatmentofpatientswithlocaldiseaserecurrenceaimsatrelievingdysphagiaSurgicalresectionistheonly消化道狭窄的内镜治疗课件消化道狭窄的内镜治疗课件消化道狭窄的内镜治疗课件消化道狭窄的内镜治疗课件消化道狭窄的内镜治疗课件消化道狭窄的内镜治疗课件消化道狭窄的内镜治疗课件消化道狭窄的内镜治疗课件消化道狭窄的内镜治疗课件食管气管瘘金属支架置放术食管气管瘘金属支架置放术复查碘油造影未见造影剂瘘出。复查碘油造影未见造影剂瘘出。EsophagealdiseasesandtypesofSEMSusedUUCUEGZWEsophagealcarcinomaCervical(n=14)77–––Thoracic(n=93)3147735G-Ejunction(n=79)44262–7Locallyrecurrentcarcinoma1236–––(n=48)Achalasia(n=8)–44––UU,UncoveredUltraflex(BostonScientific,Boston,Mass.);CU,coveredUltraflex(BostonScientific);E,Esophacoil(InstentInc.,EdenPrarie,Minn.);GZ,GianturcoZ-stent(CookInc.,Bloomington,Ind.);W,Wallstent(BostonScientific).EsophagealdiseasesandtypesFactorsthatmaypredisposetoesophagealstentmigration:multivariateanalysis

NMigration(%)pvalueGenderFemale588/13(61.5)0.0038StrictureTC802/13(15.4)0.954GEJ679/13(11.4)0.017EAC82/13(25)0.625PrevioustherapyS+B42/13(15.4)0.997R102/13(15.4)0.997Dilation<10mm393/13(23.0)0.047>10mm246/13(46.1)0.000StentGZ32/13(15.4)0.719E124.13(30.7)0.104UU874/13(30.7)0.169CU953/13(23.0)0.166TC,Esophagealthoraciccarcinoma;GEJ,carcinomaofthegastroesophagealjunction;EAC,esophagealachalasia;S+B,surgery&balloondilation;R,radiotherapy;GZ,GianturcoZ-stent;E,Esophacoil;UU,uncoveredUltraflex;CU,coveredUltraflex(GastrointestEndosc2001;53:96-97.)Factorsthatmaypredisposeto消化道狭窄的内镜治疗课件Esophagealstentsformalignantstricturescloseto

theupperesophagealsphincterEsophagealstentsformalignan消化道狭窄的内镜治疗课件GastrointestEndosc2007;66:1082-90GastrointestEndosc2007;66:10消化道狭窄的内镜治疗课件Esophagealstentsforthepalliationof

malignantdysphagiaandfistularecurrenceafteresophagectomyEsophagealstentsforthepallLuminalpatency.Themediansurvivaltimeafterstentingforallpatientswithstenosiswas70days(range1dayto34months).Stentinsertionwastechnicallysuccessfulinallbut1patient(98%)(Fig.1).Mediandurationofprimarystentpatencywas56days(range1dayto33months)(Fig.2).Atotalof20episodesofstentdysfunctionoccurredin18(27%)of66patientsatamedianof38dayspost-SEMSinsertion(range2-406days).Stentdysfunctionwascausedbytissuein-orovergrowth(n8),stentmigration(n9),andfoodimpaction(n3).Tissuein-andovergrowthoccurredatamedianof119dayspost-SEMSinsertion(range33–297days);5patientsweresuccessfullytreatedwithasecondSEMS.Six(24%)of25fullycoveredstentsversus3(7%)of41partiallycoveredSEMSmigrated(P.07)atamediantimeintervalof66daysafterSEMSinsertion(range12-406days).Ofthesepatients,6patientsrequiredasecondSEMS.Foodbolusimpactionoccurredin3(20%)patientsatamediantimeintervalof11daysafterSEMSinsertion;all3weresuccessfullyclearedendoscopically.InsertionofasecondSEMSwassuccessfulinallpatients(100%).Medianpatencyofthesestentswas59days(range5–286days)Luminalpatency.ThemediansuFistulasealing.Themediansurvivaltimeofpatientswithmalignantfistulacausedbytumorrecurrencewas73days(range10daysto91months).Thecoatedsegmentofthestenteffectivelysealedfistulaeinallbut1patient(93%).Thispatientwassuccessfullytreatedwithasecondstent.Stentdysfunctionoccurredin6(40%)of15patients.In5(33%)patients,additionalstentsweresuccessfullyinsertedtomanagestentmigration(n4)andpersistentleakageduringstenttreatment(n1).Two(22%)of9fullycoveredstentsversus2(33%)of6partiallycoveredSEMSsmigratedatamediantimeintervalof5monthspost-SEMSinsertion(range5daysto11months).Foodbolusimpactionoccurredin1patient17dayspost-SEMSinsertion,thispatientwasalsosuccessfullytreatedendoscopicallybystentclearance.Fistulasealing.ThemediansuOverallcomplicationsMildcomplicationsafterstentplacementoccurredin7(9%)patientsincludingretrosternalpainandsymptomaticgastroesophagealreflux.Majorcomplicationsoccurredin9(11%)patients.Stridordevelopedimmediatelyafterinsertionin3patientswithalesionwithin4cmoftheupperesophagealsphincter.Inall3patients,thestentwasremoved,andtheyweremanagedconservatively.ThreepatientshadanupperGIhemorrhagefromthetumorsiteatamediantimeintervalof26daysafterSEMSinsertion(range11daysto10months).Thebleedingsubsidedspontaneouslyin1ofthesepatients;theother2patientsdiedofthepersistentbleeding.Anesophagealfistuladevelopedduringstenttreatmentin2patients,bothofwhichwerelocatedatthedistalfunnelofthepartiallycoveredstentatamediantimeintervalof48dayspost-SEMSinsertion.Thesewalldefectsweresuccessfullysealedwithanadditionalstent.Onepatienthadstent-inducedulcerationafterstentmigrationat7monthsafterSEMSinsertionandrequiredendoscopicstentextraction.OverallcomplicationsSEMSplacementinrecurrentesophagealcanceraftersurgicalresectionoffersadequatepalliationbyrelievingdysphagiaandsealingoffesophagealrespiratoryfistula.Therefore,inthesepatientswhohavearelativelyshortlifeexpectancy,theimplantationofSEMSstoshouldbeconsideredthetreatmentofchoiceSEMSplacementinrecurrentesEsophagealrespiratoryfistulaeoccurin5%to10%ofpatientswithesophagealcancer.Inourseries,19%ofpatientswithrecurrentcanceraftergastrictubeinterpositionpresentedwithafistula.Thisrepresentsadevastatingcomplicationleadingtorecurrentpulmonaryinfectionsandtheinabilitytoeatorevenswallowsaliva.Thisconditionisassociatedwithaveryhighshort-termmortalityrate.ThetechnicalsuccessoffistulasealingbySEMSswas93%,whichiswithintherangeofthe80%to100%reportedbyotherseries.Inthemajorityofpatientswithcancerrecurrenceafteresophagectomy,thefistulaorstenosisislocatedclosetotheupperesophagealsphincter.Atthislocation,SEMSplacementmaycauseforeign-bodysensation,trachealcompression,orrespiratoryfistula.Ithasbeenhypothesizedthatstentsshouldhaveabodydiameterof18mmorlesstoavoidthesecomplications.Inourseries,however,stridordevelopedin3(4%)patientsandafistuladevelopedin2(2%)patientsafterstentplacement,despitetheuseofsmall-diameterstentsin4ofthem.NoneofthepatientsreportedglobussensationEsophagealrespiratoryfistulaGastrointestEndosc2010;72:249-54GastrointestEndosc2010;72:24消化道狭窄的内镜治疗课件消化道狭窄的内镜治疗课件ComparisonofTemporaryandPermanentStent

PlacementwithConcurrentRadiationTherapy

inPatientswithEsophagealCarcinomaJVascIntervRadiol2005;16:67–74ComparisonofTemporaryandPe消化道狭窄的内镜治疗课件MATERIALSANDMETHODS:Coveredretrievableexpandablenitinolstentswereplacedin47patientswithesophagealcarcinoma1weekbeforestartingradiationtherapy;thestentswereelectivelyremoved4weeksafterplacementin24patients(groupA),whilenotelectivelyremovedintheother23patients(groupB).Incasesofcomplications,thestentswerealsoremovedfrompatientsingroupsAandB.Thedysphagiascore,complications(severepain,granulationtissueformation,stentmigration,esophagorespiratoryfistula,andhematemesis),tumorovergrowth/regrowth,reinterventionrates,anddysphagia–progression-freeandoverallsurvivalrateswerecomparedinthetwogroups.MATERIALSANDMETHODS:CoveredRESULTS:Stentplacementorremovalwastechnicallysuccessfulandwelltoleratedinallpatients.Thedysphagiascorewassignificantlyimprovedinbothgroupsafterstentplacement(P<.01).Eachofthestent-relatedcomplicationswaslessingroupAthaningroupBbuttherewasnosignificantdifference.However,thetotalnumberofpatientswithoneormorethanonecomplicationsandwhoneededrelatedreinterventionswassignificantlylessingroupAthaningroupB(P

.042and.030,respectively).Tumorovergrowth/regrowthandthetotalnumberofpatientswhorequiredrelatedreinterventionswasnotsignificantlydifferent(P1.00and.517,respectively).Dysphagia–progression-freeandoverallsurvivalratesweresignificantlylongeringroupAthaningroupB(P

.005and.001,respectively).RESULTS:StentplacementorreCONCLUSION:Temporaryplacementofacoveredretrievableexpandablemetallicstentwithconcurrentradiationtherapyforpatientswithesophagealcarcinomaisbeneficialforreducingcomplicationsandrelatedreinterventionsandforincreasingresultantsurvivalratescomparedwithpermanentesophagealstentplacement.CONCLUSION:TemporaryplacemenUseofself-expandablemetalstentsforthetreatment

ofesophagealperforationsandanastomoticleaksSurgEndosc(2009)23:1526–1530Useofself-expandablemetalsEsophagorespiratoryFistula:

Long-termResultsofPalliativeTreatmentwith

CoveredExpandableMetallicStentsin61PatientsRadiologyVol232

,253-259EsophagorespiratoryFistula:

LMATERIALSANDMETHODS:SixtypatientswithERFsduetoesophagealorbronchogeniccarcinomaandonepatientwithERFduetopressurenecrosiscausedbyinitialesophagealstentplacementforesophagealcarcinomaweretreatedwithcoveredexpandableesophagealortracheobronchialmetallicstents.Informationabouttechnicalsuccessofstentplacement,initialclinicalsuccessandfailure,fistulareopening,andcomplicationswasobtained.SurvivalcurvesforbothpatientgroupswithinitialclinicalsuccessandfailurewereobtainedandcomparedwithKaplan-Meiermethodsandlog-ranktest.MATERIALSANDMETHODS:SixtypRESULTS:Stentplacementwastechnicallysuccessfulinallpatients,withnoimmediateproceduralcomplications.Thestentcompletelysealedoffthefistulain49(80%)of61patientssothattheyhadnofurtheraspirationsymptoms(initialclinicalsuccess).Twelve(20%)of61patientshadpersistentaspirationsymptomsduetoincompleteERFclosure(initialclinicalfailure).Duringfollow-up,thefistulareopenedin17(35%)of49patientswithinitialclinicalsuccess:Ineightpatients,thereopenedERFwassealedoffsuccessfullywithstentplacementorballoondilation.IntwopatientswithreopenedERFcausedbyfoodimpaction,thereopenedfistularesolvedspontaneously.Sevenpatientsdidnotundergofurthertreatment.Allpatientsdiedduringfollow-up,andmeansurvivalwas13.4weeks(range,1–56weeks)afterstentplacement.Meansurvivalinpatientswithinitialclinicalsuccesswassignificantlylongerthanthatinpatientswithinitialclinicalfailure(15.1vs6.2weeks,P.05).RESULTS:StentplacementwastCONCLUSION:Coveredexpandablemetallicstentswereplacedin61patientswithERFs,buttheinitialclinicalsuccessratewaspoorandtherateofreopeningwashigh;however,interventionaltreatmentwaseffectiveforsealingoffreopenedERFs.CONCLUSION:CoveredexpandableUseofself-expandablemetalstentsforthetreatment

ofesophagealperforationsandanastomoticleaksP.SalminenSurgEndosc(2009)23:1526–1530Useofself-expandablemetals10(6.4%)weretreatedwithSEMSforsealingofaniatrogenicesophagealperforation(n=4),aspontaneousesophagealruptureinBoerhaave’ssyndrome(n=4),orananastomoticleakage(n=2).ResultsThemediantimefromperforationoranastomoticleaktostentinsertionwas13days(range,2hto48days).Theesophagealleakwastotallysealedfor8(80%)of10patients.Theoverallmortalityratewas50%(n=5),andthree(30%)ofthefivedeathswererelatedtotheperforation(n=2)orleakage(n=1).Inbothoftheperforationcases,thediagnosisandtreatmentweresubstantiallydelayed.OnepatientwithananastomoticleakaftergastrectomydiedofthecomplicationdespitesuccessfuloperativeandSEMStreatment.Twoofthedeathswereunrelatedtotheperforation.Inbothcases,thecauseofdeathwasadisseminatedmalignantdisease.10(6.4%)wereConclusionsTraumaticperforationsandanastomoticleakscanbetreatedeffectivelywithcoveredSEMStogetherwithadequatedrainageofthethoraciccavityevenincasesofseverelyillpatientswithinveterateesophagealperforationsandleaks.ConclusionsTraumaticperforatPostoperativeesophagealleakmanagementwiththe

PolyflexesophagealstentJThoracCardiovascSurg2007;133:333-8PostoperativeesophagealleakObjective:Leakafteresophagealanastomosisorperforationrepairprolongshospitalization,preventsoralhydrationandnutrition,andcanproducelocalizedinfectionorsepsis.ThisinvestigationreviewsourexperiencetreatingpostoperativeesophagealleakswiththePolyflexesophagealstent(BostonScientific,Natick,Mass).Objective:LeakafteresophageMethods:Overa30-monthperiod,patientswithapostoperativeesophagealleakweretreatedwiththePolyflexstentforleakocclusion.Leakocclusionwasconfirmedbymeansofesophagraphy.Patientswerefolloweduntiltheirstentwasremovedandtheiresophagealleakhadresolved.Results:Twenty-onepatientshad27stentsplacedforleakocclusionafteresophagectomyMethods:Overa30-monthperioResults:Twenty-onepatientshad27stentsplacedforleakocclusionafteresophagectomy(n5),esophagealperforation(n5),surgical(n4)orendoscopic(n2)antirefluxprocedure,andesophagealdiverticulectomy(n3)ormyotomy(n2).Themeanintervalbetweensurgicalinterventionandstentplacementwas128days(range,3–31days).Occlusionoftheleakoccurredin20patients.Onepatientexperiencedadehiscenceofthesurgicalesophagealperforationrepairrequiringesophagealdiversion.Stentmigrationrequiringrepositioning(n3)orreplacement(n4)occurredin5(24%)patients.Twenty(95%)stentswereremovedwithoutresidualleak(mean,5143days;range,15–175days).Onepatienthadastrictureafterstentremovalthatrequiredendoscopicdilatation.Onepatientinthisseriesdied.Results:Twenty-onepatientshConclusions:ThePolyflexesophagealstentisaneffectivemethodforoccludingapostoperativeesophagealleak.Itrapidlyeliminatescontaminationofthemediastinum,pleura,andperitoneum;allowsoralhydrationandnutrition;andiseasilyremovable.Thesestentsalsoofferanappealingalternativetotraditionalesophagealdiversionandsubsequentreconstructioninpatientswithapersistentesophagealleak.Conclusions:ThePolyflexesop消化道狭窄的内镜治疗消化道狭窄的内镜治疗病理类型我国鳞癌为主 97.6% 上1/3段 8.8%

中1/3段65.9%

下1/3段 25.3%西方国家以下段食管为主、主要为腺癌（60％以上）病理类型我国食管癌的治疗

（强调早期发现、早期诊断、早期治疗）手术治疗

-姑息性手术

-根治性手术内镜下治疗-食管扩张，食管支架取代传统的旁路手术

-内镜下电灼切除、Nd:YAG激光切除、光动力疗法等化疗：5-Fu和顺铂为主放疗：外放射为主以手术为主的综合治疗食管癌的治疗

（强调早期发现、早期诊断、早期治疗）手术治疗手术适应证早期食管癌中期（Ⅱ）、中下段食管癌病变在5cm内，上段在3cm内，全身情况好者中期（Ⅲ）、病变在5cm以上，无明显远处转移，全身条件允许，可采用术前放化疗与手术综合疗法放射治疗后复发，病变范围尚不大，无远处转移，全身情况良好者

手术适应证早期食管癌手术禁忌证食管癌病变广泛或累及邻近器官如气管、肺、纵隔等者已有锁骨上窝淋巴结等远处转移者有严重心、肺或肝功能不全者严重恶病质者手术禁忌证食管癌病变广泛或累及邻近器官如气管、肺、纵隔等者Surgicalresectionistheonlycurativetreatmentoptionforinvasiveesophagealcancer.However,despitecarefulstagingandadvancesinadjuvanttherapyandsurgicaltechniques,5-yearsurvivalratesrarelyexceed40%.1,2Manypatientspresentwithlocoregionalrecurrenceanddistantmetastasiswithin2yearsaftercurativeesophagectomy.3TreatmentofpatientswithlocaldiseaserecurrenceaimsatrelievingdysphagiaSurgicalresectionistheonly消化道狭窄的内镜治疗课件消化道狭窄的内镜治疗课件消化道狭窄的内镜治疗课件消化道狭窄的内镜治疗课件消化道狭窄的内镜治疗课件消化道狭窄的内镜治疗课件消化道狭窄的内镜治疗课件消化道狭窄的内镜治疗课件消化道狭窄的内镜治疗课件食管气管瘘金属支架置放术食管气管瘘金属支架置放术复查碘油造影未见造影剂瘘出。复查碘油造影未见造影剂瘘出。EsophagealdiseasesandtypesofSEMSusedUUCUEGZWEsophagealcarcinomaCervical(n=14)77–––Thoracic(n=93)3147735G-Ejunction(n=79)44262–7Locallyrecurrentcarcinoma1236–––(n=48)Achalasia(n=8)–44––UU,UncoveredUltraflex(BostonScientific,Boston,Mass.);CU,coveredUltraflex(BostonScientific);E,Esophacoil(InstentInc.,EdenPrarie,Minn.);GZ,GianturcoZ-stent(CookInc.,Bloomington,Ind.);W,Wallstent(BostonScientific).EsophagealdiseasesandtypesFactorsthatmaypredisposetoesophagealstentmigration:multivariateanalysis

NMigration(%)pvalueGenderFemale588/13(61.5)0.0038StrictureTC802/13(15.4)0.954GEJ679/13(11.4)0.017EAC82/13(25)0.625PrevioustherapyS+B42/13(15.4)0.997R102/13(15.4)0.997Dilation<10mm393/13(23.0)0.047>10mm246/13(46.1)0.000StentGZ32/13(15.4)0.719E124.13(30.7)0.104UU874/13(30.7)0.169CU953/13(23.0)0.166TC,Esophagealthoraciccarcinoma;GEJ,carcinomaofthegastroesophagealjunction;EAC,esophagealachalasia;S+B,surgery&balloondilation;R,radiotherapy;GZ,GianturcoZ-stent;E,Esophacoil;UU,uncoveredUltraflex;CU,coveredUltraflex(GastrointestEndosc2001;53:96-97.)Factorsthatmaypredisposeto消化道狭窄的内镜治疗课件Esophagealstentsformalignantstricturescloseto

theupperesophagealsphincterEsophagealstentsformalignan消化道狭窄的内镜治疗课件GastrointestEndosc2007;66:1082-90GastrointestEndosc2007;66:10消化道狭窄的内镜治疗课件Esophagealstentsforthepalliationof

malignantdysphagiaandfistularecurrenceafteresophagectomyEsophagealstentsforthepallLuminalpatency.Themediansurvivaltimeafterstentingforallpatientswithstenosiswas70days(range1dayto34months).Stentinsertionwastechnicallysuccessfulinallbut1patient(98%)(Fig.1).Mediandurationofprimarystentpatencywas56days(range1dayto33months)(Fig.2).Atotalof20episodesofstentdysfunctionoccurredin18(27%)of66patientsatamedianof38dayspost-SEMSinsertion(range2-406days).Stentdysfunctionwascausedbytissuein-orovergrowth(n8),stentmigration(n9),andfoodimpaction(n3).Tissuein-andovergrowthoccurredatamedianof119dayspost-SEMSinsertion(range33–297days);5patientsweresuccessfullytreatedwithasecondSEMS.Six(24%)of25fullycoveredstentsversus3(7%)of41partiallycoveredSEMSmigrated(P.07)atamediantimeintervalof66daysafterSEMSinsertion(range12-406days).Ofthesepatients,6patientsrequiredasecondSEMS.Foodbolusimpactionoccurredin3(20%)patientsatamediantimeintervalof11daysafterSEMSinsertion;all3weresuccessfullyclearedendoscopically.InsertionofasecondSEMSwassuccessfulinallpatients(100%).Medianpatencyofthesestentswas59days(range5–286days)Luminalpatency.ThemediansuFistulasealing.Themediansurvivaltimeofpatientswithmalignantfistulacausedbytumorrecurrencewas73days(range10daysto91months).Thecoatedsegmentofthestenteffectivelysealedfistulaeinallbut1patient(93%).Thispatientwassuccessfullytreatedwithasecondstent.Stentdysfunctionoccurredin6(40%)of15patients.In5(33%)patients,additionalstentsweresuccessfullyinsertedtomanagestentmigration(n4)andpersistentleakageduringstenttreatment(n1).Two(22%)of9fullycoveredstentsversus2(33%)of6partiallycoveredSEMSsmigratedatamediantimeintervalof5monthspost-SEMSinsertion(range5daysto11months).Foodbolusimpactionoccurredin1patient17dayspost-SEMSinsertion,thispatientwasalsosuccessfullytreatedendoscopicallybystentclearance.Fistulasealing.ThemediansuOverallcomplicationsMildcomplicationsafterstentplacementoccurredin7(9%)patientsincludingretrosternalpainandsymptomaticgastroesophagealreflux.Majorcomplicationsoccurredin9(11%)patients.Stridordevelopedimmediatelyafterinsertionin3patientswithalesionwithin4cmoftheupperesophagealsphincter.Inall3patients,thestentwasremoved,andtheyweremanagedconservatively.ThreepatientshadanupperGIhemorrhagefromthetumorsiteatamediantimeintervalof26daysafterSEMSinsertion(range11daysto10months).Thebleedingsubsidedspontaneouslyin1ofthesepatients;theother2patientsdiedofthepersistentbleeding.Anesophagealfistuladevelopedduringstenttreatmentin2patients,bothofwhichwerelocatedatthedistalfunnelofthepartiallycoveredstentatamediantimeintervalof48dayspost-SEMSinsertion.Thesewalldefectsweresuccessfullysealedwithanadditionalstent.Onepatienthadstent-inducedulcerationafterstentmigrationat7monthsafterSEMSinsertionandrequiredendoscopicstentextraction.OverallcomplicationsSEMSplacementinrecurrentesophagealcanceraftersurgicalresectionoffersadequatepalliationbyrelievingdysphagiaandsealingoffesophagealrespiratoryfistula.Therefore,inthesepatientswhohavearelativelyshortlifeexpectancy,theimplantationofSEMSstoshouldbeconsideredthetreatmentofchoiceSEMSplacementinrecurrentesEsophagealrespiratoryfistulaeoccurin5%to10%ofpatientswithesophagealcancer.Inourseries,19%ofpatientswithrecurrentcanceraftergastrictubeinterpositionpresentedwithafistula.Thisrepresentsadevastatingcomplicationleadingtorecurrentpulmonaryinfectionsandtheinabilitytoeatorevenswallowsaliva.Thisconditionisassociatedwithaveryhighshort-termmortalityrate.ThetechnicalsuccessoffistulasealingbySEMSswas93%,whichiswithintherangeofthe80%to100%reportedbyotherseries.Inthemajorityofpatientswithcancerrecurrenceafteresophagectomy,thefistulaorstenosisislocatedclosetotheupperesophagealsphincter.Atthislocation,SEMSplacementmaycauseforeign-bodysensation,trachealcompression,orrespiratoryfistula.Ithasbeenhypothesizedthatstentsshouldhaveabodydiameterof18mmorlesstoavoidthesecomplications.Inourseries,however,stridordevelopedin3(4%)patientsandafistuladevelopedin2(2%)patientsafterstentplacement,despitetheuseofsmall-diameterstentsin4ofthem.NoneofthepatientsreportedglobussensationEsophagealrespiratoryfistulaGastrointestEndosc2010;72:249-54GastrointestEndosc2010;72:24消化道狭窄的内镜治疗课件消化道狭窄的内镜治疗课件ComparisonofTemporaryandPermanentStent

PlacementwithConcurrentRadiationTherapy

inPatientswithEsophagealCarcinomaJVascIntervRadiol2005;16:67–74ComparisonofTemporaryandPe消化道狭窄的内镜治疗课件MATERIALSANDMETHODS:Coveredretrievableexpandablenitinolstentswereplacedin47patientswithesophagealcarcinoma1weekbeforestartingradiationtherapy;thestentswereelectivelyremoved4weeksafterplacementin24patients(groupA),whilenotelectivelyremovedintheother23patients(group