13 P Palliation of malignant upper gastrointestinal obstruction using two different types of metal stent
Alessandro RepiciD. ReggioNico PaganoC. De AngelisC. BarlettiAlessandro MussoLaura HermidaM. RizzettoGiorgio Maria Saracco
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Palliative Treatment
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Seperti pada dewasa, teknik regional anestesi pada pediatrik kini makin popular digunakan oleh ahli anestesikarena keuntungannya. Namun demikian selalu ada risiko dan kemungkinan timbulnya komplikasi dari setiap tindakan yang dilakukan, termasuk tindakan anestesi regional pada pediatrik. Insidensi komplikasi anestesi regional pada pediatrik tidak banyak, dan kalaupun terjadi komplikasi adalah minor. Komplikasi bisa diakibatkan dari identifikasi ruang saraf, alat, obat, teknis tindakan anestesi regionalnya dan komplikasi lainnya.Walaupun tidak banyak kejadian komplikasi regional anestesi yang dilaporkan pada pediatrik, dan bukanlah komplikasi yang fatal, teknik regional anestesi pada pediatrik harus dilakukan dengan lebih hatihati, pertimbangan risiko dan keuntungannya untuk menghindari terjadinya komplikasi, terlebih karena kebanyakan komplikasi dapat dihindari dengan mempelajari teknik yang benar, menggunakan peralatan yang sesuai, dan sangat menerapkan prinsip keamanan pada pasien dengan baik.
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Colorectal Obstruction: Use of Covered and Uncovered StentsObjective: We wanted to evaluate usefulness of uncovered stent in comparison with covered stent for the palliative treatment of malignant colorectal obstruction.Materials and Methods: Covered (n = 52, type 1 and type 2) and uncovered (n = 22, type 3) stents were placed in 74 patients with malignant colorectal obstruction.Stent insertion was performed for palliative treatment in 37 patients (covered stent: n = 23 and uncovered stent: n = 14).In the palliative group, the data on the success of the procedure, the stent patency and the complications between the two groups (covered versus uncovered stents) were compared. Results:The technical success rate was 89% (33/37).Symptomatic improvement was achieved in 86% (18/21) of the covered stent group and in 92% (11/12) of the uncovered stent group patients.The period of follow-up ranged from three to 319 days (mean period: 116 85 days).The mean period of stent patency was 157 33 days in the covered stent group and 165 25 days in the uncovered stent group.In the covered stent group, stent migration (n = 11), stent fracture (n = 2) and poor expansion of the stent (n = 2) were noted.In the uncovered stent group, tumor ingrowth into the stents (n = 3) was noted. Conclusion:Self-expanding metallic stents are effective for relieving malignant colorectal obstruction.The rate of complications is lower in the uncovered stent group than in the covered stent group.alliative treatment of malignant colorectal obstruction should be considered for the patients suffering with primary disseminated or recurrent cancer.The treatment options depend on the patient's condition, the site of obstruction, the extent of disease and the life expectancy.In many cases and particularly for palliative surgery, creation of colostomy is inevitable, and it may result in increased patient discomfort (1).Various non-surgical treatment procedures such as balloon dilatation, laser photoablation and electrocoagulation have been performed (2 4).However, their effectiveness is limited by the need for repeated treatments that are time-consuming and they increase the patient's discomfort and the medical costs, and these repeated treatments are associated with complications.Metallic stents have been used for the palliative treatment of malignant obstruction of the biliary and gastrointestinal tracts (5 7).Application of metallic stents for the treatment of acute malignant colonic obstruction was first reported by Dohmoto in 1991, and it has become a promising treatment option (8), although the number of reported cases is only 600 throughout the world (9, 10).According to the reports, stent implantation is the best final palliative treatment for some cases that are in an advanced stage of disease.
Palliative Treatment
Covered stent
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Genentech is partnering with the German cancer company Affimed to develop immunotherapies for multiple kinds of solid and blood cancers. Affimed is developing therapies that engage natural killer cells of the innate immune system to help direct them to attack cancer cells. Genentech will pay Affimed $96 million up front and up to $5 billion more in potential payments.
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The aim of this study was to evaluate the efficacy, effects on survival and complications of self-expandable metal stent applications in patients with malignant gastroduodenal obstruction.Twenty-five patients undergoing metal stent insertion due to malignant gastroduodenal obstruction between February 2005 and July 2009 were included in the present study. In all patients, self-expandable metal stent 22 mm in diameter was inserted under scopic guidance. The patients were evaluated regarding age, gender, etiology, efficacy of stent insertion, complications, and duration of patency of the stent.Of the 25 patients included in the study, 15 were female and 10 were male. Their mean age was 65.9 years (57-81 years). The most common etiological causes were duodenal tumor (n=10, 40%) and pancreatic tumor (n=8, 32%). Duodenal stent was inserted successfully in all patients. In 4 patients, percutaneous biliary metal stent was inserted at the same time due to concomitant obstructive jaundice. No mortality occurred during the procedure. A second stent was inserted in 4 patients due to stent migration. The patients were followed for a mean of 92 days (7 to 258 days) after the procedure. The stents remained clinically patent in all patients during the follow-up period until death.Insertion of duodenal metal stent is an effective and safe therapeutic approach in the palliative treatment of malignant gastric outlet obstruction.
Gastric Outlet Obstruction
Etiology
Palliative Treatment
Concomitant
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Herein, we report a case of early in-stent occlusion due to the ingrowth of soft oedematous mucosal tissue through the lattices of an uncovered stent, which was used for palliation of a postoperative gastrojejunal anastomotic stricture.The in-stent occulsion was treated with the deployment of a second stent, which was covered, within the first stent.This led to successful resolution of the occlusion.
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PURPOSE: To investigate the technical feasibility and clinical effectiveness of a polyurethane-covered expandable nitinol stent in the treatment of malignant gastroduodenal obstructions. MATERIALS AND METHODS: The stent was constructed in-house by weaving a single thread of 0.2-mm nitinol wire in a tubular configuration and was covered with polyurethane solution by means of a dipping method. With fluoroscopic guidance, the stent was placed in 19 consecutive patients with malignant gastric outlet obstruction (n = 15) or duodenal obstruction (n = 4). All patients had severe nausea and recurrent vomiting, and their obstructions were inoperable. RESULTS: Stent placement was technically successful in all but one patient. After stent placement, symptoms improved in all but one patient, who had another stenosis at the proximal jejunum. One patient with stent placement in the second portion of the duodenum became jaundiced. During the mean follow-up of 11 weeks, stent migration occurred in five patients 1–4 days after the procedure. All patients with stent migration were treated by means of placing a second, uncovered nitinol stent. Two of these five patients showed recurrence of stricture because of tumor ingrowth; they underwent coaxial placement of a third, covered nitinol stent with good results. CONCLUSION: Placement of a polyurethane-covered expandable nitinol stent seems to be technically feasible and effective for palliative treatment of inoperable malignant gastroduodenal obstructions. Stent migration, however, is problematic and requires further investigation.
Gastric Outlet Obstruction
Palliative Treatment
Covered stent
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