Saligram S, Lim D, Pena L, Friedman M, Harris C, Klapman J
GI Tumor Program, Section of Endoscopic Oncology, Moffitt Cancer Center, Tampa, Florida, USA.
Department of Gastroenterology, Kansas University Medical Center, Kansas City, Kansas, USA.
Dis Esophagus. 2017 Aug 1;30(8):1-6. doi: 10.1093/dote/dox030.
Self-expandable metal stents (SEMSs) are used for the management of certain esophageal conditions such as strictures, perforations, and fistulae. These can be placed using fluoroscopic control, endoscopic control, or a combination of both. We evaluated our institutional experience of placing a SEMS using only endoscopy without the aid of fluoroscopy to determine safety and feasibility using this technique. A retrospective review was performed to identify all patients who underwent esophageal SEMS from January 2010 to June 2015. Placement of SEMS was accomplished under direct endoscopic visualization without the aid of fluoroscopy. Esophageal lesion was initially identified during endoscopy and a fully covered SEMS was passed over the guide wire and deployed under direct vision. Misplacement of the SEMS during the procedure that required replacement with another new SEMS was considered as a failed procedure. Other periprocedural complications caused by placement of SEMS were noted. A total of 172 patients underwent 280 procedures for SEMS placement. Mean age was 66 years. The most common indication for SEMS placement was stricture in 248 (88%) procedures. Periprocedure SEMS misplacement occurred in 12 (4%) patients. However, only 8 (3%) patients needed to have a new SEMS placed during the same procedure. A total of 64 (23%) patients had migration of SEMS. There were no other periprocedure complications leading to adverse events. Self-expandable metal stent can be placed accurately and safely under direct endoscopic visualization without the aid of fluoroscopy.
自膨式金属支架（SEMS）用于治疗某些食管疾病，如狭窄、穿孔和瘘管。这些支架可以在透视控制、内镜控制或两者结合的情况下放置。我们评估了仅在内镜检查下不借助透视放置SEMS的机构经验，以确定该技术的安全性和可行性。进行了一项回顾性研究，以确定2010年1月至2015年6月期间所有接受食管SEMS置入术的患者。SEMS的放置是在直接内镜观察下完成的，无需借助透视。在内镜检查期间最初识别食管病变，然后将完全覆盖的SEMS通过导丝并在直视下展开。手术过程中SEMS放置错误需要用另一个新的SEMS替换被视为手术失败。记录了由SEMS放置引起的其他围手术期并发症。共有172例患者接受了280次SEMS放置手术。平均年龄为66岁。SEMS放置最常见的指征是狭窄，共248例（88%）手术。围手术期SEMS放置错误发生在12例（4%）患者中。然而，只有8例（3%）患者在同一手术过程中需要放置新的SEMS。共有64例（23%）患者出现SEMS移位。没有其他导致不良事件的围手术期并发症。自膨式金属支架可以在不借助透视的直接内镜观察下准确、安全地放置。
