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Surgical Endoscopy

, 22:2149 | Cite as

Results of a new method to stop acute bleeding from esophageal varices: implantation of a self-expanding stent

  • J. Zehetner
  • A. Shamiyeh
  • W. Wayand
  • R. Hubmann
Article

Abstract

Background

Acute bleeding from nontreated esophageal varices is associated with a mortality rate of 30% to 50%. Various pharmacologic and interventional methods to stop acute bleeding are available. However, for 10% to 20% of patients, therapy fails to stop the bleeding. This study aimed to assess the SX-ELLA Stent Danis Set (which has a self-expanding metal stent) instead of a balloon probe for compression of esophageal varices.

Methods

Using a multidisciplinary approach, a self-expanding stent was placed in 39 patients between January 2003 and August 2007. For 34 of these patients with ongoing bleeding from esophageal varices, stent implantation was performed with the SX-ELLA Stent Danis Set, and the patients were included in this study. For all these patients, common methods failed to stop hemorrhage. With the SX-ELLA Stent Danis Set, the stent was implanted with a positioning balloon that enabled delivery without X-ray control. After implantation of the stent, its position was controlled by endoscopy and computed tomography (CT) scan.

Results

For all 34 patients, the implantation of the esophageal stent succeeded in stopping ongoing bleeding. No stent-related complications occurred during or after stent implantation. No bleeding recurrence was observed during the stent implantation (median time, 5 days; range 1–14 days). For all the patients, the stent could be extracted by endoscopy without any complications using an extractor. Nine patients died of hepatic failure within 30 days after the procedure. No rebleeding occurred.

Conclusions

The use of a self-expanding stent to stop acute bleeding from esophageal varices is a new therapeutic method. The authors’ initial experience, which involved no method-related mortality or complications, is encouraging. More data are necessary to confirm their results.

Keywords

Endoluminal therapy Esophageal varices Stent implantation 

References

  1. 1.
    Stokkeland K, Brandt L, Ekbom A, Hultcrantz R (2006) Improved prognosis for patients hospitalized with esophageal varices in Sweden 1969–2002. Hepatology 43:500–505PubMedCrossRefGoogle Scholar
  2. 2.
    D'Amico G, Pagliaro L, Bosch J (1995) The treatment of portal hypertension: a meta-analytic review. Hepatology 22:332–354PubMedCrossRefGoogle Scholar
  3. 3.
    Hubmann R, Bodlaj G, Czompo M, Benko L, Pichler P, Al-Kathib S, Kiblbock P, Shamyieh A, Biesenbach G (2006) The use of self-expanding metal stents to treat acute esophageal variceal bleeding. Endoscopy 38:896–901PubMedCrossRefGoogle Scholar
  4. 4.
    Karsan HA, Morton SC, Shekelle PG, Spiegel BM, Suttorp MJ, Edelstein MA, Gralnek IM (2005) Combination endoscopic band ligation and sclerotherapy compared with endoscopic band ligation alone for the secondary prophylaxis of esophageal variceal hemorrhage: a meta-analysis. Dig Dis Sci 50:399–406PubMedCrossRefGoogle Scholar
  5. 5.
    D’Amico G, Pietrosi G, Tarantino I, Pagliaro L (2003) Emergency sclerotherapy versus vasoactive drugs for variceal bleeding in cirrhosis: a Cochrane meta-analysis. Gastroenterology 124:1277–1291PubMedCrossRefGoogle Scholar
  6. 6.
    Garcia-Pagan JC, Bosch J (2005) Endoscopic band ligation in the treatment of portal hypertension. Nat Clin Pract Gastroenterol Hepatol 2:526–535PubMedCrossRefGoogle Scholar
  7. 7.
    Svoboda P, Kantorova I, Ochmann J, Kozumplik L, Marsova J (1999) A prospective randomized controlled trial of sclerotherapy vs ligation in the prophylactic treatment of high-risk esophageal varices. Surg Endosc 13:580–584PubMedCrossRefGoogle Scholar
  8. 8.
    Baroncini D, Milandri GL, Borioni D, Piemontese A, Cennamo V, Billi P, Dal Monte PP, D’Imperio N (1997) A prospective randomized trial of sclerotherapy versus ligation in the elective treatment of bleeding esophageal varices. Endoscopy 29:235–240PubMedCrossRefGoogle Scholar
  9. 9.
    Masci E, Stigliano R, Mariani A, Bertoni G, Baroncini D, Cennamo V, Micheletti G, Casetti T, Tansini P, Buscarini E, Ranzato R, Norberto L (1999) Prospective multicenter randomized trial comparing banding ligation with sclerotherapy of esophageal varices. Hepatogastroenterology 46:1769–1773PubMedGoogle Scholar
  10. 10.
    Lo GH, Chen WC, Chen MH, Hsu PI, Lin CK, Tsai WL, Lai KH (2002) Banding ligation versus nadolol and isosorbide mononitrate for the prevention of esophageal variceal rebleeding. Gastroenterology 123:728–734PubMedCrossRefGoogle Scholar
  11. 11.
    Sarin SK, Wadhawan M, Gupta R, Shahi H (2005) Evaluation of endoscopic variceal ligation (EVL) versus propanolol plus isosorbide mononitrate/nadolol (ISMN) in the prevention of variceal rebleeding: comparison of cirrhotic and noncirrhotic patients. Dig Dis Sci 50:1538–1547PubMedCrossRefGoogle Scholar
  12. 12.
    de Franchis R (2005) Evolving consensus in portal hypertension: report of the Baveno IV consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol 43:167–176PubMedCrossRefGoogle Scholar
  13. 13.
    Zhang CQ, Liu FL, Liang B, Sun ZQ, Xu HW, Xu L, Feng K, Liu ZC (2007) A modified percutaneous transhepatic variceal embolization with 2-octyl cyanoacrylate versus endoscopic ligation in esophageal variceal bleeding management: randomized controlled trial. Dig Dis Sci [Epub ahead of print]Google Scholar
  14. 14.
    Harewood GC, Baron TH, Song LM (2006) Factors predicting success of endoscopic variceal ligation for secondary prophylaxis of esophageal variceal bleeding. J Gastroenterol Hepatol 21(1 Pt 2):237–241PubMedCrossRefGoogle Scholar
  15. 15.
    Lo GH, Liang HL, Chen WC, Chen MH, Lai KH, Hsu PI, Lin CK, Chan HH, Pan HB (2007) A prospective, randomized controlled trial of transjugular intrahepatic portosystemic shunt versus cyanoacrylate injection in the prevention of gastric variceal rebleeding. Endoscopy 39:679–685PubMedCrossRefGoogle Scholar
  16. 16.
    Sorbi D, Gostout CJ, Peura D, Johnson D, Lanza F, Foutch PG, Schleck CD, Zinsmeister AR (2003) An assessment of the management of acute bleeding varices: a multicenter prospective member-based study. Am J Gastroenterol 98:2424–2434PubMedCrossRefGoogle Scholar
  17. 17.
    Dormann A, Meisner S, Verin N, Wenk Lang A (2004) Self-expanding metal stents for gastroduodenal malignancies: systematic review of their clinical effectiveness. Endoscopy 36:543–550PubMedCrossRefGoogle Scholar
  18. 18.
    Danis J, Hubmann R, Pichler P, Shamiyeh A, Wayand WU (2004) Novel technique of laparoscopic azygoportal disconnection for treatment of esophageal varicosis: preliminary experience with five patients. Surg Endosc 18:702–705PubMedCrossRefGoogle Scholar
  19. 19.
    Cook D, Laine L (1992) Indications, technique, and complications of balloon tamponade for variceal gastrointestinal bleeding. J Intensive Care Med 7:212–218PubMedGoogle Scholar
  20. 20.
    Avgerinos A, Armonis A (1994) Balloon tamponade technique and efficacy in variceal haemorrhage. Scand J Gastroenterol Suppl 207:11–16PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • J. Zehetner
    • 1
  • A. Shamiyeh
    • 1
  • W. Wayand
    • 1
  • R. Hubmann
    • 2
  1. 1.Surgical Department, Academic Teaching Hospital, AKH LinzLudwig Boltzmann Institute for Operative LaparoscopyLinzAustria
  2. 2.Internal Medicine Department, Academic Teaching Hospital, AKH LinzLudwig Boltzmann Institute for Operative LaparoscopyLinzAustria

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