Self-expanding nitinol stent in combined treatment of bleeding from esophageal varices

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Abstract

Aim. To assess the capabilities of endoscopic hemostasis using self-expanding nitinol stents as an alternative to balloon tamponade using Sengstaken-Blakemore probe-obturator in the combined treatment program of patients with acute bleeding from esophageal varices.

Methods. In 15 of the 266 patients with portal hypertension of various origins and with high risk of rebleeding (or at the height of the latter) endoscopic hemostasis with Danis self-expanding nitinol stents was performed instead of the traditional balloon tamponade using Sengstaken-Blakemore probe-obturator.

Results. In all 15 cases, the Danis stent was inserted under intravenous general anesthesia with preservation of spontaneous breathing, using direct laryngoscopy. 5 of the 15 inserted by the manufacturer’s instructions stents (33.3%) migrated into the stomach: 1 did not deploy at all, 4 were in the expanded form. 10 (66.7%) stents were successfully inserted in a standard position in the esophagus without any complications. This was confirmed endoscopically immediately after the delivery device removal. In 2 of 4 patients who was inserted Danis stent at the height of esophageal bleeding, a reliable hemostasis was achieved. In none of the 15 cases, we did not observe any complications associated with the presence of the stent in the esophagus or its removal procedure. 4 of 15 patients (26.7%) died, despite the achieved endoscopic hemostasis, against the background of progressive multiple organ failure.

Conclusion. Endoscopic hemostasis in a combined treatment program of patients with bleeding from esophageal varices using Danis self-expanding nitinol stents can be considered as a reasonable alternative to balloon tamponade using Sengstaken-Blakemore probe-obturator.

About the authors

A V Loginov

City Clinical Hospital №7

Author for correspondence.
Email: 613310@bk.ru

E Kh Mamkeev

Kazan State Medical Academy

Email: 613310@bk.ru

A Yu Anisimov

Kazan State Medical Academy

Email: 613310@bk.ru

References

  1. Анисимов А.Ю. Совершенствование диагностики и хирургического лечения больных с портальной гипертензией. Анн. хир. гепатол. 2015; 20 (2): 59-65.
  2. Анисимов А.Ю., Вёрткин А.Л., Девятов А.В. и др. Практические рекомендации по лечению кровотечений из варикозно расширенных вен пищевода и желудка. Московск. хир. ж. 2013; (6): 41-54.
  3. Ерамишанцев А.К., Киценко Е.А., Шерцингер А.Г., Жигалова С.Б. Кровотечения из ВРВ пищевода и желудка: диагностика, лечебная тактика (лекция). Анн. хир. гепатол. 2006; XI (2): 105-111.
  4. Ерамишанцев А.К., Шерцингер А.Г., Киценко Е.А. Портальная гипертензия. Клиническая хирургия: национальное руководство. М.: ГЭОТАР-Медиа. 2008; 626-665.
  5. Киценко Е.А., Анисимов А.Ю., Андреев А.И. Современное состояние проблемы кровотечений из варикозно расширенных вен пищевода и желудка. Вестн. соврем. клин. мед. 2014; 7 (5): 89-98.
  6. Шерцингер А.Г., Чжао А.В., Ивашкин В.Т. и др. Лечение кровотечений из варикозно расширенных вен пищевода и желудка. Анн. хир. гепатол. 2013; 18 (3): 110-129.
  7. Angels Escorsell, Jaime Bosch. Self-expandable metal stents in the treatment of acute esophageal variceal bleeding. Gastroenterol. Res Pract. Vol. 2011, 5 (7): 152-158. http://dx.doi.org/10.1155/2011/910986
  8. Bosch J., Abraldes J.G., Berzigotti A., Garcia-Pagan J.C. Portal hypertension and gastrointestinal bleeding. Semin. Liver Dis. 2008; 28 (5): 3-25. http://dx.doi.org/10.1055/s-2008-1040318
  9. Cook D., Laine L. Indications, technique and complications of balloon tamponade for variceal gastrointestinal bleeding. J. Intens. Care Med. 1992; 7: 212-218. http://dx.doi.org/10.1177/088506669200700408
  10. De Franchis R. Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J. Hepatol. 2010; 53: 762-768. http://dx.doi.org/10.1016/j.jhep.2010.06.004
  11. Garcia-Tsao G., Bosch J. Management of varices and variceal hemorrhage in cirrhosis. N. Engl. J. Med. 2010; 362 (5): 823-832. http://dx.doi.org/10.1056/NEJMra0901512
  12. Wright G., Lewis H., Hogan B. et al. A self-expanding metal stent for complicated variceal hemorrhage: experience at a single center. Gastrointest. Endosc. 2010; 71 (1): 71-78. http://dx.doi.org/10.1016/j.gie.2009.07.028
  13. Zehetner J., Shamiyeh A., Wayand W., Hubmann R. Results of a new method to stop acute bleeding from esophageal varices: implantation of a self-expanding stent. Surg. Endosc. 2008; 22 (11): 2149-2152. http://dx.doi.org/10.1007/s00464-008-0009-7

© 2016 Loginov A.V., Mamkeev E.K., Anisimov A.Y.

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