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Esophageal Occlusive Disease: Endolumenal Therapy

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Abstract

Intrinsic esophageal occlusion is associated with locally advanced esophageal neoplasia and benign stricturing conditions. Complications of esophagectomy conduit include fistula development, anastomotic leaks, and strictures, while perforation and strictures are iatrogenic complications of endoscopic therapeutic interventions. The use of self-expandable stents has been well-established for the successful palliative management of unresectable malignant esophageal strictures, fistulas, and postoperative complications of an esophageal conduit. Stent complications are not uncommon, with most series reporting 30–35% overall complication rate including chest pain, stent migration, tracheoesophageal fistula, or severe reflux symptoms. Recently newer endotherapies, including endoscopic suturing and over-the-scope clips, have become more popular as an alternative primary therapy or adjunctive therapy to stenting for anastomotic dehiscence with leaks, perforations, or fistulas.

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References

  1. Sharma P, Kozarek R, Practice Parameters Committee of American College of G. Role of esophageal stents in benign and malignant diseases. Am J Gastroenterol. 2010;105(2):258–73; quiz 74.

    Article  PubMed  Google Scholar 

  2. Spaander MC, Baron TH, Siersema PD, et al. Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy. 2016;48(10):939–48.

    Article  PubMed  Google Scholar 

  3. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68(1):7–30.

    Article  PubMed  Google Scholar 

  4. Lagergren J, Mattsson F. Diverging trends in recent population-based survival rates in oesophageal and gastric cancer. PLoS One. 2012;7(7):e41352.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Crane SJ, Locke GR 3rd, Harmsen WS, Zinsmeister AR, Romero Y, Talley NJ. Survival trends in patients with gastric and esophageal adenocarcinomas: a population-based study. Mayo Clin Proc. 2008;83(10):1087–94.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Ajani JA, D’Amico TA, Almhanna K, et al. Esophageal and esophagogastric junction cancers, version 1.2015. J Natl Compr Cancer Netw. 2015;13(2):194–227.

    Article  CAS  Google Scholar 

  7. Shaheen NJ, Falk GW, Iyer PG, Gerson LB. ACG clinical guideline: diagnosis and Management of Barrett’s esophagus. Am J Gastroenterol. 2016;111(1):30–50.

    Article  CAS  PubMed  Google Scholar 

  8. Sharma P, Katzka DA, Gupta N, et al. Quality indicators for the management of Barrett’s esophagus, dysplasia, and esophageal adenocarcinoma: international consensus recommendations from the American Gastroenterological Association symposium. Gastroenterology. 2015;149(6):1599–606.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Yimcharoen P, Heneghan HM, Tariq N, Brethauer SA, Kroh M, Chand B. Endoscopic stent management of leaks and anastomotic strictures after foregut surgery. Surg Obes Relat Dis. 2011;7(5):628–36.

    Article  PubMed  Google Scholar 

  10. Cassivi SD. Leaks, strictures, and necrosis: a review of anastomotic complications following esophagectomy. Semin Thorac Cardiovasc Surg. 2004;16(2):124–32.

    Article  PubMed  Google Scholar 

  11. Kobayashi S, Kanetaka K, Nagata Y, et al. Predictive factors for major postoperative complications related to gastric conduit reconstruction in thoracoscopic esophagectomy for esophageal cancer: a case control study. BMC Surg. 2018;18(1):15.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Licht E, Markowitz AJ, Bains MS, et al. Endoscopic management of esophageal anastomotic leaks after surgery for malignant disease. Ann Thorac Surg. 2016;101(1):301–4.

    Article  PubMed  Google Scholar 

  13. Ruigomez A, Garcia Rodriguez LA, Wallander MA, Johansson S, Eklund S. Esophageal stricture: incidence, treatment patterns, and recurrence rate. Am J Gastroenterol. 2006;101(12):2685–92.

    Article  PubMed  Google Scholar 

  14. El H II, Imperiale TF, Rex DK, et al. Treatment of esophageal leaks, fistulae, and perforations with temporary stents: evaluation of efficacy, adverse events, and factors associated with successful outcomes. Gastrointest Endosc. 2014;79(4):589–98.

    Article  Google Scholar 

  15. Crews NR, Johnson ML, Schleck CD, et al. Prevalence and predictors of gastroesophageal reflux complications in community subjects. Dig Dis Sci. 2016;61(11):3221–8.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Shin HJ, Moon HS, Kang SH, et al. Endoscopic traversability in patients with locally advanced esophageal squamous cell carcinoma: is it a significant prognostic factor? Medicine (Baltimore). 2017;96(51):e9441.

    Article  Google Scholar 

  17. Thosani N, Singh H, Kapadia A, et al. Diagnostic accuracy of EUS in differentiating mucosal versus submucosal invasion of superficial esophageal cancers: a systematic review and meta-analysis. Gastrointest Endosc. 2012;75(2):242–53.

    Article  PubMed  Google Scholar 

  18. Bergeron EJ, Lin J, Chang AC, Orringer MB, Reddy RM. Endoscopic ultrasound is inadequate to determine which T1/T2 esophageal tumors are candidates for endoluminal therapies. J Thorac Cardiovasc Surg. 2014;147(2):765–71; Discussion 71–3.

    Article  PubMed  Google Scholar 

  19. Bulsiewicz WJ, Dellon ES, Rogers AJ, et al. The impact of endoscopic ultrasound findings on clinical decision making in Barrett’s esophagus with high-grade dysplasia or early esophageal adenocarcinoma. Dis Esophagus. 2014;27(5):409–17.

    Article  CAS  PubMed  Google Scholar 

  20. Rana SS, Bhasin DK, Singh K. Role of endoscopic ultrasonography (EUS) in management of benign esophageal strictures. Ann Gastroenterol. 2011;24(4):280–4.

    PubMed  PubMed Central  Google Scholar 

  21. Verschuur EM, Repici A, Kuipers EJ, Steyerberg EW, Siersema PD. New design esophageal stents for the palliation of dysphagia from esophageal or gastric cardia cancer: a randomized trial. Am J Gastroenterol. 2008;103(2):304–12.

    Article  PubMed  Google Scholar 

  22. Conio M, Repici A, Battaglia G, et al. A randomized prospective comparison of self-expandable plastic stents and partially covered self-expandable metal stents in the palliation of malignant esophageal dysphagia. Am J Gastroenterol. 2007;102(12):2667–77.

    Article  PubMed  Google Scholar 

  23. Knyrim K, Wagner HJ, Bethge N, Keymling M, Vakil N. A controlled trial of an expansile metal stent for palliation of esophageal obstruction due to inoperable cancer. N Engl J Med. 1993;329(18):1302–7.

    Article  CAS  PubMed  Google Scholar 

  24. Acunas B, Rozanes I, Akpinar S, Tunaci A, Tunaci M, Acunas G. Palliation of malignant esophageal strictures with self-expanding nitinol stents: drawbacks and complications. Radiology. 1996;199(3):648–52.

    Article  CAS  PubMed  Google Scholar 

  25. Saxon RR, Morrison KE, Lakin PC, et al. Malignant esophageal obstruction and esophagorespiratory fistula: palliation with a polyethylene-covered Z-stent. Radiology. 1997;202(2):349–54.

    Article  CAS  PubMed  Google Scholar 

  26. Ell C, May A, Hahn EG. Gianturco-Z stents in the palliative treatment of malignant esophageal obstruction and esophagotracheal fistulas. Endoscopy. 1995;27(7):495–500.

    Article  CAS  PubMed  Google Scholar 

  27. Siersema PD, Hop WC, van Blankenstein M, et al. A comparison of 3 types of covered metal stents for the palliation of patients with dysphagia caused by esophagogastric carcinoma: a prospective, randomized study. Gastrointest Endosc. 2001;54(2):145–53.

    Article  CAS  PubMed  Google Scholar 

  28. Dai Y, Li C, Xie Y, et al. Interventions for dysphagia in oesophageal cancer. Cochrane Database Syst Rev. 2014;10:CD005048.

    Google Scholar 

  29. So H, Ahn JY, Han S, et al. Efficacy and safety of fully covered self-expanding metal stents for malignant esophageal obstruction. Dig Dis Sci. 2018;63(1):234–41.

    Article  PubMed  Google Scholar 

  30. Im JP, Kang JM, Kim SG, Kim JS, Jung HC, Song IS. Clinical outcomes and patency of self-expanding metal stents in patients with malignant upper gastrointestinal obstruction. Dig Dis Sci. 2008;53(4):938–45.

    Article  PubMed  Google Scholar 

  31. Hu Y, Zhao YF, Chen LQ, et al. Comparative study of different treatments for malignant tracheoesophageal/bronchoesophageal fistulae. Dis Esophagus. 2009;22(6):526–31.

    Article  CAS  PubMed  Google Scholar 

  32. Shin JH, Song HY, Ko GY, Lim JO, Yoon HK, Sung KB. Esophagorespiratory fistula: long-term results of palliative treatment with covered expandable metallic stents in 61 patients. Radiology. 2004;232(1):252–9.

    Article  PubMed  Google Scholar 

  33. Balazs A, Kupcsulik PK, Galambos Z. Esophagorespiratory fistulas of tumorous origin. Non-operative management of 264 cases in a 20-year period. Eur J Cardiothorac Surg. 2008;34(5):1103–7.

    Article  PubMed  Google Scholar 

  34. Van Heel NC, Haringsma J, Spaander MC, Didden P, Bruno MJ, Kuipers EJ. Esophageal stents for the palliation of malignant dysphagia and fistula recurrence after esophagectomy. Gastrointest Endosc. 2010;72(2):249–54.

    Article  PubMed  Google Scholar 

  35. Saranovic D, Djuric-Stefanovic A, Ivanovic A, Masulovic D, Pesko P. Fluoroscopically guided insertion of self-expandable metal esophageal stents for palliative treatment of patients with malignant stenosis of esophagus and cardia: comparison of uncovered and covered stent types. Dis Esophagus. 2005;18(4):230–8.

    Article  PubMed  Google Scholar 

  36. Verschuur EM, Kuipers EJ, Siersema PD. Esophageal stents for malignant strictures close to the upper esophageal sphincter. Gastrointest Endosc. 2007;66(6):1082–90.

    Article  PubMed  Google Scholar 

  37. Verschuur EM, Steyerberg EW, Kuipers EJ, Siersema PD. Effect of stent size on complications and recurrent dysphagia in patients with esophageal or gastric cardia cancer. Gastrointest Endosc. 2007;65(4):592–601.

    Article  PubMed  Google Scholar 

  38. Rozanes I, Poyanli A, Acunas B. Palliative treatment of inoperable malignant esophageal strictures with metal stents: one center’s experience with four different stents. Eur J Radiol. 2002;43(3):196–203.

    Article  PubMed  Google Scholar 

  39. Vakil N, Morris AI, Marcon N, et al. A prospective, randomized, controlled trial of covered expandable metal stents in the palliation of malignant esophageal obstruction at the gastroesophageal junction. Am J Gastroenterol. 2001;96(6):1791–6.

    Article  CAS  PubMed  Google Scholar 

  40. Lagattolla NR, Rowe PH, Anderson H, Dunk AA. Restenting malignant oesophageal strictures. Br J Surg. 1998;85(2):261–3.

    Article  CAS  PubMed  Google Scholar 

  41. Irani S, Baron TH, Gluck M, Gan I, Ross AS, Kozarek RA. Preventing migration of fully covered esophageal stents with an over-the-scope clip device (with videos). Gastrointest Endosc. 2014;79(5):844–51.

    Article  PubMed  Google Scholar 

  42. Watanabe K, Hikichi T, Nakamura J, et al. Feasibility of esophageal stent fixation with an over-the-scope-clip for malignant esophageal strictures to prevent migration. Endosc Int Open. 2017;5(11):E1044–E9.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Sharaiha RZ, Kumta NA, DeFilippis EM, et al. A large multicenter experience with endoscopic suturing for Management of Gastrointestinal Defects and Stent Anchorage in 122 patients: a retrospective review. J Clin Gastroenterol. 2016;50(5):388–92.

    PubMed  Google Scholar 

  44. Yang J, Siddiqui AA, Kowalski TE, et al. Esophageal stent fixation with endoscopic suturing device improves clinical outcomes and reduces complications in patients with locally advanced esophageal cancer prior to neoadjuvant therapy: a large multicenter experience. Surg Endosc. 2017;31(3):1414–9.

    Article  PubMed  Google Scholar 

  45. Bick BL, Imperiale TF, Johnson CS, DeWitt JM. Endoscopic suturing of esophageal fully covered self-expanding metal stents reduces rates of stent migration. Gastrointest Endosc. 2017;86(6):1015–21.

    Article  PubMed  Google Scholar 

  46. Law R, Prabhu A, Fujii-Lau L, Shannon C, Singh S. Stent migration following endoscopic suture fixation of esophageal self-expandable metal stents: a systematic review and meta-analysis. Surg Endosc. 2018;32(2):675–81.

    Article  PubMed  Google Scholar 

  47. Nagaraja V, Cox MR, Eslick GD. Safety and efficacy of esophageal stents preceding or during neoadjuvant chemotherapy for esophageal cancer: a systematic review and meta-analysis. J Gastrointest Oncol. 2014;5(2):119–26.

    PubMed  PubMed Central  Google Scholar 

  48. Mariette C, Gronnier C, Duhamel A, et al. Self-expanding covered metallic stent as a bridge to surgery in esophageal cancer: impact on oncologic outcomes. J Am Coll Surg. 2015;220(3):287–96.

    Article  PubMed  Google Scholar 

  49. Shin JH, Song HY, Kim JH, et al. Comparison of temporary and permanent stent placement with concurrent radiation therapy in patients with esophageal carcinoma. J Vasc Interv Radiol. 2005;16(1):67–74.

    Article  PubMed  Google Scholar 

  50. Siddiqui AA, Loren D, Dudnick R, Kowalski T. Expandable polyester silicon-covered stent for malignant esophageal strictures before neoadjuvant chemoradiation: a pilot study. Dig Dis Sci. 2007;52(3):823–9.

    Article  CAS  PubMed  Google Scholar 

  51. Kim JY, Kim SG, Lim JH, Im JP, Kim JS, Jung HC. Clinical outcomes of esophageal stents in patients with malignant esophageal obstruction according to palliative additional treatment. J Dig Dis. 2015;16(10):575–84.

    Article  PubMed  Google Scholar 

  52. Bower M, Jones W, Vessels B, Scoggins C, Martin R. Nutritional support with endoluminal stenting during neoadjuvant therapy for esophageal malignancy. Ann Surg Oncol. 2009;16(11):3161–8.

    Article  PubMed  Google Scholar 

  53. Lai A, Lipka S, Kumar A, et al. Role of esophageal metal stents placement and combination therapy in inoperable esophageal carcinoma: a systematic review and meta-analysis. Dig Dis Sci. 2018;63(4):1025–34.

    Article  PubMed  Google Scholar 

  54. Adler DG, Fang J, Wong R, Wills J, Hilden K. Placement of Polyflex stents in patients with locally advanced esophageal cancer is safe and improves dysphagia during neoadjuvant therapy. Gastrointest Endosc. 2009;70(4):614–9.

    Article  PubMed  Google Scholar 

  55. Brown RE, Abbas AE, Ellis S, et al. A prospective phase II evaluation of esophageal stenting for neoadjuvant therapy for esophageal cancer: optimal performance and surgical safety. J Am Coll Surg. 2011;212(4):582–8; discussion 8–9.

    Article  PubMed  Google Scholar 

  56. Chang J, Sharma G, Boules M, Brethauer S, Rodriguez J, Kroh MD. Endoscopic stents in the management of anastomotic complications after foregut surgery: new applications and techniques. Surg Obes Relat Dis. 2016;12(7):1373–81.

    Article  PubMed  Google Scholar 

  57. Eisendrath P, Cremer M, Himpens J, Cadiere GB, Le Moine O, Deviere J. Endotherapy including temporary stenting of fistulas of the upper gastrointestinal tract after laparoscopic bariatric surgery. Endoscopy. 2007;39(7):625–30.

    Article  CAS  PubMed  Google Scholar 

  58. Haito-Chavez Y, Law JK, Kratt T, et al. International multicenter experience with an over-the-scope clipping device for endoscopic management of GI defects (with video). Gastrointest Endosc. 2014;80(4):610–22.

    Article  PubMed  Google Scholar 

  59. Ahmed Z, Elliott JA, King S, Donohoe CL, Ravi N, Reynolds JV. Risk factors for anastomotic stricture post-esophagectomy with a standardized sutured anastomosis. World J Surg. 2017;41(2):487–97.

    Article  PubMed  Google Scholar 

  60. Rostas JW, Graffree BD, Scoggins CR, McMasters KM, Martin RCG. Long-term outcomes after hand-sewn versus circular-stapled (25 and 29 mm) anastomotic technique after esophagogastrectomy for esophageal cancer. J Surg Oncol. 2018;117(3):469–72.

    Article  PubMed  Google Scholar 

  61. Tanaka K, Makino T, Yamasaki M, et al. An analysis of the risk factors of anastomotic stricture after esophagectomy. Surg Today. 2018;48(4):449–54.

    Article  CAS  PubMed  Google Scholar 

  62. Mendelson AH, Small AJ, Agarwalla A, Scott FI, Kochman ML. Esophageal anastomotic strictures: outcomes of endoscopic dilation, risk of recurrence and refractory stenosis, and effect of foreign body removal. Clin Gastroenterol Hepatol. 2015;13(2):263–71.e1.

    Article  PubMed  Google Scholar 

  63. van Halsema EE, Noordzij IC, van Berge Henegouwen MI, Fockens P, Bergman JJ, van Hooft JE. Endoscopic dilation of benign esophageal anastomotic strictures over 16 mm has a longer lasting effect. Surg Endosc. 2017;31(4):1871–81.

    Article  PubMed  Google Scholar 

  64. Park JY, Song HY, Kim JH, et al. Benign anastomotic strictures after esophagectomy: long-term effectiveness of balloon dilation and factors affecting recurrence in 155 patients. AJR. 2012;198(5):1208–13.

    Article  PubMed  Google Scholar 

  65. Eubanks S, Edwards CA, Fearing NM, et al. Use of endoscopic stents to treat anastomotic complications after bariatric surgery. J Am Coll Surg. 2008;206(5):935–8; discussion 8–9.

    Article  PubMed  Google Scholar 

  66. Vanbiervliet G, Filippi J, Karimdjee BS, et al. The role of clips in preventing migration of fully covered metallic esophageal stents: a pilot comparative study. Surg Endosc. 2012;26(1):53–9.

    Article  PubMed  Google Scholar 

  67. Blackmon SH, Santora R, Schwarz P, Barroso A, Dunkin BJ. Utility of removable esophageal covered self-expanding metal stents for leak and fistula management. Ann Thorac Surg. 2010;89(3):931–6; discussion 6–7.

    Article  PubMed  Google Scholar 

  68. Babor R, Talbot M, Tyndal A. Treatment of upper gastrointestinal leaks with a removable, covered, self-expanding metallic stent. Surg Laparosc Endosc Percutan Tech. 2009;19(1):e1–4.

    Article  PubMed  Google Scholar 

  69. Swinnen J, Eisendrath P, Rigaux J, et al. Self-expandable metal stents for the treatment of benign upper GI leaks and perforations. Gastrointest Endosc. 2011;73(5):890–9.

    Article  PubMed  Google Scholar 

  70. Wilson JL, Louie BE, Farivar AS, Vallieres E, Aye RW. Fully covered self-expanding metal stents are effective for benign esophagogastric disruptions and strictures. J Gastrointest Surg. 2013;17(12):2045–50.

    Article  PubMed  Google Scholar 

  71. Sharaiha RZ, Kim KJ, Singh VK, et al. Endoscopic stenting for benign upper gastrointestinal strictures and leaks. Surg Endosc. 2014;28(1):178–84.

    Article  PubMed  Google Scholar 

  72. Ngamruengphong S, Sharaiha R, Sethi A, et al. Fully-covered metal stents with endoscopic suturing vs. partially-covered metal stents for benign upper gastrointestinal diseases: a comparative study. Endosc Int Open. 2018;6(2):E217–E23.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Mennigen R, Senninger N, Laukoetter MG. Novel treatment options for perforations of the upper gastrointestinal tract: endoscopic vacuum therapy and over-the-scope clips. World J Gastroenterol. 2014;20(24):7767–76.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Lee HL, Cho JY, Cho JH, et al. Efficacy of the over-the-scope clip system for treatment of gastrointestinal fistulas, leaks, and perforations: a Korean Multi-Center Study. Clin Endosc. 2018;51(1):61–5.

    Article  PubMed  Google Scholar 

  75. Baron TH, Song LM, Ross A, Tokar JL, Irani S, Kozarek RA. Use of an over-the-scope clipping device: multicenter retrospective results of the first U.S. experience (with videos). Gastrointest Endosc. 2012;76(1):202–8.

    Article  PubMed  Google Scholar 

  76. Stavropoulos SN, Modayil R, Friedel D. Current applications of endoscopic suturing. World J Gastrointest Endosc. 2015;7(8):777–89.

    Article  PubMed  PubMed Central  Google Scholar 

  77. Goenka MK, Goenka U. Endotherapy of leaks and fistula. World J Gastrointest Endosc. 2015;7(7):702–13.

    Article  PubMed  PubMed Central  Google Scholar 

  78. Felsher J, Farres H, Chand B, Farver C, Ponsky J. Mucosal apposition in endoscopic suturing. Gastrointest Endosc. 2003;58(6):867–70.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA

    Nicholas R. Crews, Mark A. Gromski & Mohammad A. Al-Haddad

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  1. Nicholas R. Crews
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  2. Mark A. Gromski
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  3. Mohammad A. Al-Haddad
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Correspondence to Mohammad A. Al-Haddad .

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  1. Department of Surgery, Tripler Army Medical Center, Honolulu, HI, USA

    Robert Lim

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Crews, N.R., Gromski, M.A., Al-Haddad, M.A. (2019). Esophageal Occlusive Disease: Endolumenal Therapy. In: Lim, R. (eds) Multidisciplinary Approaches to Common Surgical Problems. Springer, Cham. https://doi.org/10.1007/978-3-030-12823-4_34

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