- Email: [email protected]
Esophageal placement of a lumen-apposing metal stent in a patient with a chronic anastomotic stricture
Accepted Manuscript Esophageal placement of a lumen-apposing metal stent in a patient with a chronic anastomotic stricture Douglas G. Adler, MD, FASGE PII:
S0016-5107(16)30634-4
DOI:
10.1016/j.gie.2016.09.034
Reference:
YMGE 10262
To appear in:
Gastrointestinal Endoscopy
Received Date: 25 June 2016 Accepted Date: 27 September 2016
Please cite this article as: Adler DG, Esophageal placement of a lumen-apposing metal stent in a patient with a chronic anastomotic stricture, Gastrointestinal Endoscopy (2016), doi: 10.1016/j.gie.2016.09.034. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
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Douglas G. Adler MD, FASGE
Salt Lake City, Utah 84132
Please address all correspondence to:
M AN U
University of Utah School of Medicine Gastroenterology and Hepatology
EP
TE D
Douglas G. Adler MD, FACG, AGAF, FASGE Professor of Medicine Director of Therapeutic Endoscopy Director, GI Fellowship Program Gastroenterology and Hepatology University of Utah School of Medicine Huntsman Cancer Center 30N 1900E 4R118 Salt Lake City, Utah 84132 801-581-7878 Fax-801-581-8007 [email protected]
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Esophageal placement of a lumen-apposing metal stent in a patient with a chronic anastomotic stricture
ACCEPTED MANUSCRIPT
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RI PT
In 2010, a 59-year-old man developed adenocarcinoma of the distal esophagus, which involved periesophageal and mediastinal nodes. He received cisplatin/paclitaxel with radiation. He subsequently underwent transhiatal esophagectomy and has been without evidence of cancer since then. Postoperatively, he developed a chronic anastomotic stricture with dysphagia as well as several chronic trachea-esophageal fistulas treated with esophageal and airway stents. In the intervening years, the patient has undergone multiple rounds of esophageal stenting for dysphagia with fully covered stents, but these were removed due to coughing, discomfort, and mucous production. Without an esophageal stent, the patient requires a dilation to 12 to 15 mm every 2 to 3 weeks.
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Recent EGD again showed a tight anastomotic stricture with a diameter of 6 mm, less than 1 cm long (A). Given the short length of the stricture and his overall history, we offered to place a lumen-apposing metal stent (LAMS) (Axios, Boston Scientific, Natick, Mass) in an off-label manner and the patient agreed. A 10 x 15 mm LAMS was deployed across the stricture under endoscopic and fluoroscopic guidance with a therapeutic EGD scope (B and C). After placement, the patient could not feel the stent in place and has done well, tolerating a soft mechanical diet.
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This case shows that the LAMS may be an appropriate choice for short segment refractory benign esophageal strictures. This use is novel, and potential adverse events in this off-label usage remain unknown, including rates of migration or esophageal injury.
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ACCEPTED MANUSCRIPT
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M AN U
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ACCEPTED MANUSCRIPT
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M AN U
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ACCEPTED MANUSCRIPT
S0016-5107(16)30634-4
DOI:
10.1016/j.gie.2016.09.034
Reference:
YMGE 10262
To appear in:
Gastrointestinal Endoscopy
Received Date: 25 June 2016 Accepted Date: 27 September 2016
Please cite this article as: Adler DG, Esophageal placement of a lumen-apposing metal stent in a patient with a chronic anastomotic stricture, Gastrointestinal Endoscopy (2016), doi: 10.1016/j.gie.2016.09.034. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
SC
Douglas G. Adler MD, FASGE
Salt Lake City, Utah 84132
Please address all correspondence to:
M AN U
University of Utah School of Medicine Gastroenterology and Hepatology
EP
TE D
Douglas G. Adler MD, FACG, AGAF, FASGE Professor of Medicine Director of Therapeutic Endoscopy Director, GI Fellowship Program Gastroenterology and Hepatology University of Utah School of Medicine Huntsman Cancer Center 30N 1900E 4R118 Salt Lake City, Utah 84132 801-581-7878 Fax-801-581-8007 [email protected]
AC C
RI PT
Esophageal placement of a lumen-apposing metal stent in a patient with a chronic anastomotic stricture
ACCEPTED MANUSCRIPT
SC
RI PT
In 2010, a 59-year-old man developed adenocarcinoma of the distal esophagus, which involved periesophageal and mediastinal nodes. He received cisplatin/paclitaxel with radiation. He subsequently underwent transhiatal esophagectomy and has been without evidence of cancer since then. Postoperatively, he developed a chronic anastomotic stricture with dysphagia as well as several chronic trachea-esophageal fistulas treated with esophageal and airway stents. In the intervening years, the patient has undergone multiple rounds of esophageal stenting for dysphagia with fully covered stents, but these were removed due to coughing, discomfort, and mucous production. Without an esophageal stent, the patient requires a dilation to 12 to 15 mm every 2 to 3 weeks.
M AN U
Recent EGD again showed a tight anastomotic stricture with a diameter of 6 mm, less than 1 cm long (A). Given the short length of the stricture and his overall history, we offered to place a lumen-apposing metal stent (LAMS) (Axios, Boston Scientific, Natick, Mass) in an off-label manner and the patient agreed. A 10 x 15 mm LAMS was deployed across the stricture under endoscopic and fluoroscopic guidance with a therapeutic EGD scope (B and C). After placement, the patient could not feel the stent in place and has done well, tolerating a soft mechanical diet.
AC C
EP
TE D
This case shows that the LAMS may be an appropriate choice for short segment refractory benign esophageal strictures. This use is novel, and potential adverse events in this off-label usage remain unknown, including rates of migration or esophageal injury.
AC C
EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
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EP
TE D
M AN U
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RI PT
ACCEPTED MANUSCRIPT
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ACCEPTED MANUSCRIPT