Top

CardioVascular and Interventional Radiology

Published in:

01-10-2012 | Laboratory Investigation

Development of a New Hanging-Type Esophageal Stent for Preventing Migration: A Preliminary Study in an Animal Model of Esophagotracheal Fistula

Authors: Masayuki Endo, Toshio Kaminou, Yasufumi Ohuchi, Kimihiko Sugiura, Shinsaku Yata, Akira Adachi, Tsuyoshi Kawai, Syohei Takasugi, Shuichi Yamamoto, Kensuke Matsumoto, Masayuki Hashimoto, Takashi Ihaya, Toshihide Ogawa

Published in: CardioVascular and Interventional Radiology | Issue 5/2012

Abstract

Purpose

Covered, self-expandable metallic stents (SEMS) have been enthusiastically adopted for the treatment of esophagotracheal fistula, but problems with stent migration have yet to be resolved. To overcome this problem, we have developed a new hanging-type esophageal stent designed to prevent migration, and we conducted an animal study to assess the efficacy of our method.

Methods

A total of six female pigs were used in this study. The main characteristic of our stent was the presence of a string tied to the proximal edge of the stent for fixation under the skin of the neck. The first experiment was performed to confirm technical feasibility in three pigs with esophagotracheal fistula. The second experiment was performed to evaluate stent migration and esophagotracheal fistula in three pigs.

Results

Creation of the esophagotracheal fistula and stent placement were technically successful in all pigs. In the first experiment, esophagotracheal fistula was sealed by stent placement. In the second experiment, no stent migration was seen 11 or 12 days after stent placement. Gross findings showed no fistulas on the esophageal or tracheal wall.

Conclusions

Our new hanging-type esophageal stent seems to offer a feasible method for preventing stent migration.

Tomaselli F, Maier A, Sankin O et al (2001) Successful endoscopic sealing of malignant esophageotracheal fistulae by using a covered self-expandable stenting system. Eur J Cardiothorac Surg 20:734–738PubMedCrossRef

Dougenis D, Petsas T, Bouboulis N et al (1997) Management of nonresectable malignant esophageal stricture and fistula. Eur J Cardiothorac Surg 11:38–45PubMedCrossRef

Bona D, Sarli D, Saino G et al (2007) Successful conservative management of benign gastro-bronchial fistula after intrathoracic esophagogastrostomy. Ann Thorac Surg 84:1036–1038PubMedCrossRef

Hsu HH, Chen JS, Huang PM et al (2004) Comparison of manual and mechanical cervical esophagogastric anastomosis after esophageal resection for squamous cell carcinoma: a prospective randomized controlled trial. Eur J Cardiothorac Surg 25:1097–1101PubMedCrossRef

Urschel JD (1995) Esophagogastrostomy anastomotic leaks complicating esophagectomy: a review. Am J Surg 169:634–640PubMedCrossRef

Shin JH, Song HY, Ko GY et al (2004) Esophagorespiratory fistula: long-term results of palliative treatment with covered expandable metallic stents in 61 patients. Radiology 232:252–259PubMedCrossRef

Sarper A, Oz N, Cihangir C et al (2003) The efficacy of self-expanding metal stents for palliation of malignant esophageal strictures and fistulas. Eur J Cardiothorac Surg 23:794–798PubMedCrossRef

Balazs A, Galambos Z, Kupcsulik PK (2009) Characteristics of esophagorespiratory fistulas resulting from esophageal cancers: a single-center study on 243 cases in a 20-year period. World J Surg 33:994–1001PubMedCrossRef

Murthy S, Gonzalez-Stawinski GV, Rozas MS et al (2007) Palliation of malignant aerodigestive fistulae with self-expanding metallic stents. Dis Esophagus 20:386–389PubMedCrossRef

10.

Abadal JM, Echenagusia A, Simo G et al (2001) Treatment of malignant esophagorespiratory fistulas with covered stents. Abdom Imaging 26:565–569PubMedCrossRef

11.

Balazs A, Kupcsulik PK, Galambos Z (2008) Esophagorespiratory fistulas of tumorous origin. Non-operative management of 264 cases in a 20-year period. Eur J Cardiothorac Surg 34:1103–1107PubMedCrossRef

12.

Manes G, Corsi F, Pallotta S et al (2008) Fixation of a covered self-expandable metal stent by means of a polypectomy snare: an easy method to prevent stent migration. Dig Liver Dis 40:791–793PubMedCrossRef

13.

Adler DG, Pleskow DK (2005) Closure of a benign tracheoesophageal fistula by using a coated, self-expanding plastic stent in a patient with a history of esophageal atresia. Gastrointest Endosc 61:765–768PubMedCrossRef

14.

Pennathur A, Chang AC, McGrath KM et al (2008) Polyflex expandable stents in the treatment of esophageal disease: initial experience. Ann Thorac Surg 85:1968–1973PubMedCrossRef

15.

Zhou JH, Jiang YG, Wang RW et al (2005) Management of corrosive esophageal burns in 149 cases. J Thorac Cardiovasc Surg 130:449–455PubMedCrossRef

16.

Fischer A, Thomusch O, Benz S et al (2006) Nonoperative treatment of 15 benign esophageal perforations with self-expandable covered metal stents. Ann Thorac Surg 81:467–472PubMedCrossRef

17.

Tsunoda S, Shimada Y, Watanabe G et al (2001) Covered metallic stent treatment of a patient with spontaneous rupture of the esophagus. Dis Esophagus 14:254–257PubMedCrossRef

18.

Petruzziello L, Tringali A, Riccioni ME et al (2003) Successful early treatment of Boerhaave’s syndrome by endoscopic placement of a temporary self-expandable plastic stent without fluoroscopy. Gastrointest Endosc 58:608–611PubMedCrossRef

19.

Freeman RK, Van Woerkom JM, Ascioti AJ (2007) Esophageal stent placement for the treatment of iatrogenic intrathoracic esophageal perforation. Ann Thorac Surg 83:2003–2008PubMedCrossRef

20.

Langer FB, Wenzl E, Prager G et al (2005) Management of postoperative esophageal leaks with the Polyflex self-expanding covered plastic stent. Ann Thorac Surg 79:398–404PubMedCrossRef

21.

Hunernbein M, Stroszynski C, Moesta KT et al (2004) Treatment of thoracic anastomotic leaks after esophagectomy with self-expanding plastic stents. Ann Surg 240:801–807CrossRef

22.

Kauer WK, Stein HJ, Dittler HJ et al (2008) Stent implantation as a treatment option in patients with thoracic anastomotic leaks after esophagectomy. Surg Endosc 22:50–53PubMedCrossRef

23.

Roy-Choudry SH, Nicholson AA, Wedgwood KR et al (2001) Symptomatic malignant gastroesophageal anastomotic leak: management with covered metallic esophageal stents. AJR Am J Roentgenol 176:161–165

24.

Freeman RK, Ascioti AJ, Wozniak TC (2007) Postoperative esophageal leak management with the Polyflex esophageal stent. J Thorac Cardiovasc Surg 133:333–338PubMedCrossRef

25.

Eubanks S, Edwards CA, Fearing NM et al (2008) Use of endoscopic stents to treat anastomotic complications after bariatric surgery. J Am Coll Surg 206:935–938PubMedCrossRef

26.

Nguyen NT, Mailey B, Hinojosa M et al (2008) Natural orifice management of anastomotic leaks after minimally invasive esophagogastrectomy. Surg Innov 15:249–252PubMedCrossRef

27.

Schubert D, Scheidbach H, Kuhn R et al (2005) Endoscopic treatment of thoracic esophageal anastomotic leaks by using silicone-covered, self-expanding polyester stents. Gastrointest Endosc 61:891–896PubMedCrossRef

28.

Wright G, Lewis H, Hogan B et al (2010) A self-expanding metal stent for complicated variceal hemorrhage: experience at a single center. Gastrointest Endosc 71:71–78PubMedCrossRef

29.

Cwikiel W, Stribeck H, Tranberg KG et al (1993) Malignant esophageal strictures: treatment with a self-expanding nitinol stent. Radiology 187:661–665PubMed

30.

Saxon RR, Barton RE, Rosch J (1994) Complications of esophageal stenting and balloon dilatation. Semin Intervent Radiol 11:276–282CrossRef

31.

Adam A, Morgan R, Ellul J et al (1998) A new design of the esophageal Wallstent endoprosthesis resistant to distal migration. AJR Am J Roentgenol 170:1477–1481PubMed

32.

Kato H, Fukuchi M, Miyazaki T et al (2007) Endoscopic clips prevent self-expandable metallic stent migration. Hepatogastroenterology 54:1388–1390PubMed

33.

Dirks K, Schulz T, Schellmann B et al (2002) Fatal hemorrhage following perforation of the aorta by a barb of the Gianturco-Rosch esophageal stent. Z Gastroenterol 40:81–84PubMedCrossRef

34.

Verschuur EM, Homs MY, Steyerberg EW et al (2006) A new esophageal stent design (Niti-S stent) for the prevention of migration: a prospective study in 42 patients. Gastrointest Endosc 63:134–140PubMedCrossRef

35.

Uitdehaag MJ, Siersema PD, Spaander MC et al (2010) A new fully covered stent with antimigration properties for the palliation of malignant dysphagia: a prospective cohort study. Gastrointest Endosc 71:600–605PubMedCrossRef

36.

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

37.

Repici A, Vleggaar FP, Hassan C et al (2010) Efficacy and safety of biodegradable stents for refractory benign esophageal strictures: the BEST (Biodegradable Esophageal Stent) study. Gastrointest Endosc 72:927–934PubMedCrossRef

38.

Kim EY, Shin JH, Jung YY et al (2010) A rat esophageal model to investigate stent-induced tissue hyperplasia. J Vasc Interv Radiol 21:1287–1291PubMedCrossRef

39.

Wagner HJ, Stinner B, Barth P et al (2000) Are covered stents really effective at closing esophagotracheal fistulas? Results of an animal study. Cardiovasc Intervent Radiol 23:291–297PubMedCrossRef

40.

Homann N, Noftz MR, Klingenberg-Noftz RD et al (2008) Delayed complications after placement of self-expanding stents in malignant esophageal obstruction: treatment strategies and survival rate. Dig Dis Sci 53:334–340PubMedCrossRef

Title: Development of a New Hanging-Type Esophageal Stent for Preventing Migration: A Preliminary Study in an Animal Model of Esophagotracheal Fistula
Authors: Masayuki Endo
Toshio Kaminou
Yasufumi Ohuchi
Kimihiko Sugiura
Shinsaku Yata
Akira Adachi
Tsuyoshi Kawai
Syohei Takasugi
Shuichi Yamamoto
Kensuke Matsumoto
Masayuki Hashimoto
Takashi Ihaya
Toshihide Ogawa
Publication date: 01-10-2012
Publisher: Springer-Verlag
Published in: CardioVascular and Interventional Radiology / Issue 5/2012
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-011-0240-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Development of a New Hanging-Type Esophageal Stent for Preventing Migration: A Preliminary Study in an Animal Model of Esophagotracheal Fistula

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 5/2012

Quantitative Discomanometry: Correlation of Intradiscal Pressure Values to Pain Reduction in Patients With Intervertebral Disc Herniation Treated With Percutaneous, Minimally Invasive, Image-Guided Techniques

Stereotactic Radiofrequency Ablation of Unresectable Intrahepatic Cholangiocarcinomas: A Retrospective Study

CT-Guided Percutaneous Biopsy of a Mass Lesion in the Upper Presacral Space: A Sacral Transneuroforaminal Approach

Targeted Endovascular Temporary Vessel Occlusion with a Reverse Thermosensitive Polymer for Near-Bloodless Partial Nephrectomy: Comparison to Standard Surgical Clamping Techniques

The Optional VenaTech™ Convertible™ Vena Cava Filter: Experimental Study in Sheep

Ultrasound-Guided High-Intensity Focused Ultrasound (USgHIFU) Ablation in Pancreatic Metastasis from Renal Cell Carcinoma