학술논문
TECHNICAL DIFFICULTIES AND PROCEDURAL COMPLICATIONS IN CLOSING MALIGNANT ESOPHAGEAL-RESPIRATORY FISTULAS/TEHNICKE POTESKOCE I PROCEDURALNE KOMPLIKACIJE ZATVARANJA MALIGNIH EZOFAGUSNIH RESPIRACIJSKIH FISTULA
Original Scientific Paper
Original Scientific Paper
Document Type
Report
Author
Source
Acta Clinica Croatica. December 2021, Vol. 60 Issue 4, p703, 8 p.
Subject
Language
English
ISSN
0353-9466
Abstract
Introduction Locally advanced esophageal cancer, advanced bronchogenic cancer or mediastinal tumors can become complicated with esophageal-respiratory fstulas (ERFs). ERFs represent a pathology characterized by the presence of an abnormal communication [...]
The aim of the study was to outline technical difficulties and procedural complications of using partially covered esophageal self-expandable metal stents (SEMSs) in malignant esophageal respiratory fstulas (ERFs) as a palliative treatment option. In this study, 150 patients with malignant dysphagia underwent treatment with SEMSs. A total of 36 ERFs were detected through endoscopic or clinical assessment. Complete fstula sealing with SEMSs was possible in 35 of the 36 patients. The majority of fstulas were diagnosed in male patients with advanced esophageal cancer. All of them presented with prolonged dysphagia and cachexia. Stent migration or tumoral overgrowth was identified in 6 cases with recurrent dysphagia, and required a second stent insertion. SEMSs were highly efficient in 98% of the patients studied with ERFs, with successfully sealed ERFs after the first attempt, with an overall median survival rate of 92 days. The technique of esophageal SEMS placement is simple and can be rapidly mastered. Patients with ERFs have a respiratory shunt that makes intubation difficult and is often avoided. Restoring oral feeding increased the patient quality of life. SEMS placement is generally safe, but has few associated postoperative complications. Key words: Esophageal respiratory fstulas (ERFs); Covered self-expandable esophageal metal stents; Stenting complications Cilj istrazivanja bio je utvrditi tehnicke poteskoce i proceduralne komplikacije povezane s primjenom djelomice pokrivenih ezofagusnih samosirecih metalnih stentova (self-expandable metal stent, SEMS) kod malignih ezofagusnih respiracijskih fstula (ERF) kao opcije palijativne skrbi. U ovom istrazivanju je lijecenje pomocu SEMS-a primijenjeno u 150 bolesnika s malignom disfagijom. Endoskopskom ili klinickom procjenom otkriveno je ukupno 36 ERF-a. Potpuno zatvaranje fstule pomocu SEMS-a bilo je moguce u 35 od 36 bolesnika. Vecina fstula dijagnosticirana je u muskaraca s uznapredovalim rakom jednjaka. Svi su patili od dugotrajne disfagije i kaheksije. Migriranje stenta ili njegovo prerastanje tumorom utvrdeno je u 6 slucajeva opetovane disfagije i zahtijevalo je uvodenje drugog stenta. SEMS se pokazao visoko ucinkovitim u 98% ukljucenih bolesnika s ERF-om, ERF su uspjesno zatvorene u prvom pokusaju, a sveukupni medijan stope prezivljenja bio je 92 dana. Tehnika postavljanja ezofagusnog SEMS-a je jednostavna i moze se brzo usvojiti. U bolesnika s ERF-om respiracija je skrenuta pa je intubacija teska i cesto se izbjegava. Ponovno uspostavljanje hranjenja na usta poboljsava bolesnikovu kvalitetu zivota. Postavljanje SEMS-a uglavnom je sigurno, ali povezano s nekim poslijeoperacijskim komplikacijama. Kljucne rijeci: Ezofagusne respiracijske fstule (ERF); Pokriveni samosireci ezofagusni metalni stentovi; Komplikacije postavljanja stenta
The aim of the study was to outline technical difficulties and procedural complications of using partially covered esophageal self-expandable metal stents (SEMSs) in malignant esophageal respiratory fstulas (ERFs) as a palliative treatment option. In this study, 150 patients with malignant dysphagia underwent treatment with SEMSs. A total of 36 ERFs were detected through endoscopic or clinical assessment. Complete fstula sealing with SEMSs was possible in 35 of the 36 patients. The majority of fstulas were diagnosed in male patients with advanced esophageal cancer. All of them presented with prolonged dysphagia and cachexia. Stent migration or tumoral overgrowth was identified in 6 cases with recurrent dysphagia, and required a second stent insertion. SEMSs were highly efficient in 98% of the patients studied with ERFs, with successfully sealed ERFs after the first attempt, with an overall median survival rate of 92 days. The technique of esophageal SEMS placement is simple and can be rapidly mastered. Patients with ERFs have a respiratory shunt that makes intubation difficult and is often avoided. Restoring oral feeding increased the patient quality of life. SEMS placement is generally safe, but has few associated postoperative complications. Key words: Esophageal respiratory fstulas (ERFs); Covered self-expandable esophageal metal stents; Stenting complications Cilj istrazivanja bio je utvrditi tehnicke poteskoce i proceduralne komplikacije povezane s primjenom djelomice pokrivenih ezofagusnih samosirecih metalnih stentova (self-expandable metal stent, SEMS) kod malignih ezofagusnih respiracijskih fstula (ERF) kao opcije palijativne skrbi. U ovom istrazivanju je lijecenje pomocu SEMS-a primijenjeno u 150 bolesnika s malignom disfagijom. Endoskopskom ili klinickom procjenom otkriveno je ukupno 36 ERF-a. Potpuno zatvaranje fstule pomocu SEMS-a bilo je moguce u 35 od 36 bolesnika. Vecina fstula dijagnosticirana je u muskaraca s uznapredovalim rakom jednjaka. Svi su patili od dugotrajne disfagije i kaheksije. Migriranje stenta ili njegovo prerastanje tumorom utvrdeno je u 6 slucajeva opetovane disfagije i zahtijevalo je uvodenje drugog stenta. SEMS se pokazao visoko ucinkovitim u 98% ukljucenih bolesnika s ERF-om, ERF su uspjesno zatvorene u prvom pokusaju, a sveukupni medijan stope prezivljenja bio je 92 dana. Tehnika postavljanja ezofagusnog SEMS-a je jednostavna i moze se brzo usvojiti. U bolesnika s ERF-om respiracija je skrenuta pa je intubacija teska i cesto se izbjegava. Ponovno uspostavljanje hranjenja na usta poboljsava bolesnikovu kvalitetu zivota. Postavljanje SEMS-a uglavnom je sigurno, ali povezano s nekim poslijeoperacijskim komplikacijama. Kljucne rijeci: Ezofagusne respiracijske fstule (ERF); Pokriveni samosireci ezofagusni metalni stentovi; Komplikacije postavljanja stenta