Esophageal Stent
Esophageal Stent Placement

Video Endoscopic Sequence 1 of 14.

Esophageal Stent Placement

This 91-year-old male with adenocarcinoma of the cardias In order to alleviate the malign dysphagia an esophageal stent is placed without fluroscopy, a stent's retractable delivery system was used.

No patient is more unfortunate than those than suffer a malignant obstruction of the esophagus, because they die of slow starvation” and cannot die with dignity without being able to swallow
.

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All endoscopic images shown in this Atlas contain video clips. We recommend seeing the video clips in full screen mode.

Esophageal Stent Placement

Video Endoscopic Sequence 2 of 14.

Esophageal Stent Placement

The Antrum is infiltrated as well as the corpus and fundus an extensive irregular ulceration at the gastric antrum that could think about being lymphoma but the biopsies ruled out.

Esophageal stents are widely used to treat a variety of problems, most commonly malignant dysphagia. Malignant dysphagia can be present in patients with unresectable, resectable, and potentially resectable cancer. Esophageal stents are also utilized to treat esophageal strictures, fistulas, perforations, and leaks. Stent placement usually requires both endoscopic and fluoroscopic guidances, but can be done with either modality safely. Most stents are placed distally and across the gastroesophageal junction, but proximal stent placement (which requires more precise placement) can also be performed. Complications include bleeding and perforation (which are rare) as well as migration, tumor overgrowth, and tumor ingrowth (which are more common).


Esophageal Stent Placement

Video Endoscopic Sequence 3 of 14.

Esophageal Stent Placement

The main lesion is in the gastric fundus that is constricted and ulcerated seen at at retroflexion.

Esophageal Stent Placement

Videoendoscopic Sequence 4 of 14.

Esophageal Stent Placement

The second part of the duodenum observing a peculiar pattern, The yellow patches of mucosa are Intestinal Microvilli alternating with absence of them.

 

 


Esophageal Stent Placement

Video Endoscopic Sequence 5 of 14.

A close up of the Papilla of Vater.

 

 

Esophageal Stent Placement

Video Endoscopic Sequence 6 de 14.

A close up of the Papilla of Vater.

 

 

Esophageal Stent Placement

Videoendoscopic Sequence 7 of 14.

The Beginning of the Procedure.

Deployed a standard guidewire into the stomach. Then, withdrew the endoscope and repositioned it near the
guidewire to visualize the proximal stricture margin.

Esophageal stents are important tools for palliative treatment of inoperable esophageal malignancies. With the development of multiple self-expandable stents, there are now several therapeutic options for managing benign and malignant esophageal diseases. This paper discusses the various types of esophageal stents currently available, indications for their placement, challenges and complications that gastroenterologists face when placing these stents, and some of the innovations that will become available in the near future.

Esophageal Stent Placement

Videoendoscopic Sequence 8 of 14.

Controlled Release Esophageal Stent System

Through the guide of Savari, the apparatus to place the Stent it is passed through the oro-pharynx, soon under direct vision with endoscope.

Esophageal stent placement under endoscopic control alone.

 

Esophageal Stent Placement

Videoendoscopic Sequence 9 of 14.

Endoscopy of Esophageal Stent Placement

The stent was passed across the stricture and the white mark was positioned near the proximal margin using direct visualization. The stent then was released; placement was confirmed by direct visualization.

The stent was passed across the stricture and the white mark was positioned near the proximal margin using direct visualization. The stent then was released; placement was confirmed by direct visualization.

Videoendoscopic Sequence 10 of 14.

More maneuvers to pass the Stent

During an esophageal stent placement procedure, a tiny tube known as a stent is placed at a point of narrowing or blockage to open up the esophagus to help the patient swallow or drink more easily.

These tubes are made out of polyester(plastic), nitinol(metal) or hybrid material. Stents may be used to treat patients suffering from a refractory benign (non-cancerous) or malignant (cancerous) diseas.

Endoscopy of Esophageal Stent Placement

Videoendoscopic Sequence 11 of 14.

The Evolution stent's retractable delivery system facilitates direct monitoring of the placement progress throughout the procedure with it's “point-of-no-return” indicator, allowing physicians more controlled placement of the stent. With each squeeze of the stent's trigger-based introducer, a proportional length of the stent is deployed or recaptured.

The directional button enables seamless switching from deployment to recapture mode and the “point-of-no-return” mark alerts the physician when recapture is no longer available. However, even after this point repositioning is still an option.

Endoscopy of Esophageal Stent Placement

Video Endoscopic Sequence 12 of 14.

A 12-cm stent was used for the stricture

The Evolution Stent is designed with dual flanges that secure the stent, potentially reducing the risk of migration or stent movement after placement, thus eliminating the need for repeat procedures. It is also the only esophageal stent with an internal and external silicone coating, designed to resist tumor ingrowth into the stent and enhances the patients' ability to swallow food normally instead of eating through a tubet.

Endoscopy of Esophageal Stent Placement

Video Endoscopic Sequence 13 of 14.

Endoscopy of Esophageal Stent Placement

Stent with retractable delivery system.
in this video the deploying of the Stent is observed.

The esophageal stent maintaining esophageal lumen. Patency in esophageal strictures caused by intrinsic or extrinsic tumors.

 

Endoscopy of Esophageal Stent Placement

Videoendoscopic Sequence 14 of 14.

Final Status of the stent placement

This technique should not be used in patients with complicated anatomy or perforation when safety and accuracy likely would be enhanced by fluoroscopy.


Endoscopic-placed stent to provide palliation of dysphagia

 

Endoscopic-placed stent to provide palliation of dysphagia.

The patient obtained a significant improvement in the quality of life.

Successfully deployed Self-expanding stent in the esophagus under fluroscopy control.This image and the video clip were taken one week after the procedure.

Esophageal Z-Stent with dua anti-reflux valve is used to maintain patency of malignant esophageal strictures and to decrease esophageal reflux and aspiration.

Effective method of palliating dysphagia related to stricture caused by malignant esophageal lesions

Esophageal balloon dilation and expandable stent placement are safe, minimally invasive, effective treatments for esophageal malign strictures. These procedures have brought the management of dysphagia due to esophageal strictures into the field of interventional radiology. Esophageal dilation is usually indicated for benign stenoses and is technically successful in more than 90% of cases. Most patients with esophageal carcinoma are not candidates for resection; thus, the main focus of treatment is palliation of malignant dysphagia.

Distal Esophageal Squamous Cell Carcinoma

Video Endoscopic Sequence 1 of 28.

Distal Esophageal Squamous Cell Carcinoma.

This 62 year-old female, presented with progresive disphagia to solid following to liquids.

Because the esophagus lacks a serosal covering,
esophageal carcinoma encounters few anatomic barriers to
local invasion.


Endoscopic views of an ulcerated mid-esophageal

Video Endoscopic Sequence 2 of 28.

Endoscopic views of an ulcerated mid-esophageal squamous cell carcinoma causing lumenal stenosis are seen in the endoscopic image as well as the video clip.

Risk factors for esophageal squamous carcinoma include mainly smoking and alcoholism in the U.S. In other parts of the world dietary factors may play a role. Cancer of the esophagus remains a devastating disease because it is usually not detected until it has progressed to an advanced incurable stage.

At the time of diagnosis, weight loss and dysphagia are the most common symptoms. Dysphagia usually occurs late in the course of the disease when the esophageal lumen has been narrowed by 50-75%. Less commonly, presenting symptoms may be related to local invasion or metastases.


Endoscopy of Distal Esophageal Squamous Cell Carcinom

Video Endoscopic Sequence 3 of 28.

Endoscopy of Distal Esophageal Squamous Cell Carcinoma

Retroflexed image, seen the tumor at the gastric cardias.

Examples of signs and symptoms include stridor, cough, and aspiration pneumonia as the result of erosion into the tracheobronchial tree; hemoptysis or hematemesis resulting from invasion of a mediastinal vessel; left vocal cord paralysis resulting from recurrent laryngeal nerve involvement by tumor or lymph node metastasis; malignant pleural effusion; and diaphragmatic paralysis.

Jaundice and bone pain are systemic manifestations of organ metastases.



Failure to place the first Stent.

Video Endoscopic Sequence 4 of 28.

 Failure to place the first Stent.

Stent with retractable delivery system.

The Stent was tried to be applied, and was placed above the tumor. This Stent was tried to be placed without fluroscopy under direct vision.

The model of this manufacturer is relatively new, which is applied in a way, like the arms imitating a gun. We were excited when seeing the image of the stent that was being unrolled like a screw, but we didn’t notice that we had.

Passed from the zone of security of the stent of where it is possible to be dissuaded before being released. (With it's “point-of-no -return”) indicator Therefore we had to leave it on top of the tumor and to reprogram, to place another one in a second intention, being placed under direct vision without fluroscopia like it is observed in the sequences of below. We at least gained a good case to place it in this atlas.


Upper portion of stent.

Video Endoscopic Sequence 5 of 28.

Upper portion of stent.

We used a Stent's retractable delivery system facilitates direct monitoring of the placement progress throughout the procedure with it's “point-of-no-return” indicator, allowing physicians more controlled placement of the stent.

The hydrostatic balloon is used to delated the tumor.

Video Endoscopic Sequence 6 of 28.

The hydrostatic balloon is used to delated the tumor.

The procedure is continued performing with an ablative therapy with argon plasma. Two weeks later another stent is placed to overcome the stenosis caused by the neoplasia.

In this image and video clip, the first stent is placed above of the tumor.

 


argon plasma

Video Endoscopic Sequence 7 of 28.

The procedure is continued performing ablative therapy with argon plasma.

stent esophagus

Video Endoscopic Sequence 8 of 28.

Two weeks later another stent is place.

In this image as well as the video clip is observed the first stent placed above of the neoplasia.

Palliation is directed at reducing esophageal obstruction sufficiently to allow oral intake

Video Endoscopic Sequence 9 of 28.

A close up of the tumor.

Palliation is directed at reducing esophageal obstruction sufficiently to allow oral intake.

Suffering caused by esophageal obstruction can be significant, with salivation and recurrent aspiration. Options include manual dilation procedures (bougienage), orally inserted stents, radiation therapy, laser photocoagulation, and photodynamic therapy. In some cases, cervical esophagostomy with feeding jejunostomy is required.

 


Deployed a standard guidewire into the stomach

Video Endoscopic Sequence 10 of 28.

Deployed a standard guidewire into the stomach.

Withdrew the endoscope and repositioned it near the guidewire to visualize the proximal stricture margin.


Another image and video clip of the first stent .

Videoendoscopic Sequence 11 of 28.

Another image and video clip of the first stent .

As with dilation, technological advances have driven the increased use of, and indications for, endolumenal stents in the alimentary canal. Expandable stent therapy has virtually supplanted conventional prosthesis placement in the esophagus, given the relative ease of placement and improved safety profi le during insertion.

Nevertheless, critical evaluation of this technology suggests that the need for intervention actually may increase after placement of expandable esophageal stents. This reintervention is a direct consequence of stent design: uncovered stents elicit granulation tissue and allow tumor ingrowth, and completely covered prostheses have a penchant for migration.
All prostheses have the capability of causing erosion with fi stulization, gastrointestinal bleeding, or occlusion by food bolus.

 


Begins to place the second stent.

Videoendoscopic Sequence 12 of 28.

Begins to place the second stent.

 

 

The procedure with the apparatus to place the stent is being performed delivering the second stent.

Video Endoscopic Sequence 13 of 28.

The procedure with the apparatus to place the stent is being performed delivering the second stent.












 

 

 

 

 

Esophageal Stent

Video Endoscopic Sequence 14 of 28.

Esophageal Stent Placement

Taking care of terminal patients with an advanced esophageal cancer is a difficult task, both from a clinical perspective and a psychological one.



Esophageal Stent

Video Endoscopic Sequence 15 of 28.

Controlled Release Esophageal Stent System.

The deliver of the second stent is being iniciated.

Esophageal Stent Placement

Video Endoscopic Sequence 16 of 28.

Esophageal Stent Placement

 

Esophageal Stent Placement

Video Endoscopic Sequence 17 of 28.

Esophageal Stent Placement

Esophageal Stent

Videoendoscopic Sequence 18 of 28.

Esophageal Stent Placement

The stent got immediately lodged under the inferior gastroesophageal sphincter.

 

Esophageal Stent Placement

Videoendoscopic Sequence 19 of 28.

Esophageal Stent Placement

The image as well as the video clip show the distal part of the stent just below of the inferior gastroesophageal sphincter, retroflexed image.

Esophageal Stent Placement

Videoendoscopic Sequence 20 of 28.

Esophageal Stent Placement

View through the stent.


Esophageal Stent Placement

Videoendoscopic Sequence 21 of 28.

Esophageal Stent Placement

View through the stent.


 



Video Endoscopic Sequence 22 of 28.

Esophageal Stent Placement

View through the stent.

 

 

Esophageal Stent Placement

Video Endoscopic Sequence 23 of 28.

Esophageal Stent Placement

The improvement of the symptoms was remarkable, the patient overcame her dysphagia managing to pass its solid foods without difficulty.

Esophageal Squamous Cell Carcinoma.

Video Endoscopic Sequence 24 of 28.

Esophageal Squamous Cell Carcinoma.

Video Endoscopic Sequence 25 of 28.

Esophageal Squamous Cell Carcinoma.

 

Esophageal Squamous Cell Carcinoma.

Video Endoscopic Sequence 26 of 28.

Esophageal Squamous Cell Carcinoma.

 

Esophageal Squamous Cell Carcinoma.

Videoendoscopic Sequence 27 of 28.

This fragment of the tumor fell off when placing first stent.



Videoendoscopic Sequence 28 of 28.

More image of the fragment.

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