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  1. Article: Self-expandable metallic stent-induced esophagorespiratory fistulas in patients with advanced esophageal cancer.

    Josino, Iatagan R / Martins, Bruno C / Machado, Andressa A / de A Lima, Gustavo R / Cordero, Martin A C / Pombo, Amanda A M / Sallum, Rubens A A / Ribeiro, Ulysses / Baron, Todd H / Maluf-Filho, Fauze

    Clinical endoscopy

    2023  Volume 56, Issue 6, Page(s) 761–768

    Abstract: Background/aims: Self-expandable metallic stents (SEMSs) are widely adopted for the palliation of dysphagia in patients with malignant esophageal strictures. An important adverse event is the development of SEMS-induced esophagorespiratory fistulas ( ... ...

    Abstract Background/aims: Self-expandable metallic stents (SEMSs) are widely adopted for the palliation of dysphagia in patients with malignant esophageal strictures. An important adverse event is the development of SEMS-induced esophagorespiratory fistulas (SEMS-ERFs). This study aimed to assess the risk factors related to the development of SEMS-ERF after SEMS placement in patients with esophageal cancer.
    Methods: This retrospective study was performed at the Instituto do Cancer do Estado de São Paulo. All patients with malignant esophageal strictures who underwent esophageal SEMS placement between 2009 and 2019 were included in the study.
    Results: Of the 335 patients, 37 (11.0%) developed SEMS-ERF, with a median time of 129 days after SEMS placement. Stent flare of 28 mm (hazard ratio [HR], 2.05; 95% confidence interval [CI], 1.15-5.51; p=0.02) and post-stent chemotherapy (HR, 2.0; 95% CI, 1.01-4.00; p=0.05) were associated with an increased risk of developing SEMS-ERF, while lower-third tumors were a protective factor (HR, 0.5; 95% CI, 0.26-0.85; p=0.01). No difference was observed in overall survival.
    Conclusion: The incidence of SEMS-ERFs was 11%, with a median time of 129 days after SEMS placement. Post-stent chemotherapy and a 28 mm stent flare were associated with a higher risk of SEMS-ERF.
    Language English
    Publishing date 2023-07-25
    Publishing country Korea (South)
    Document type Journal Article
    ZDB-ID 2643507-X
    ISSN 2234-2443 ; 2234-2400
    ISSN (online) 2234-2443
    ISSN 2234-2400
    DOI 10.5946/ce.2022.297
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Impact of radiotherapy on adverse events of self-expanding metallic stents in patients with esophageal cancer.

    Machado, Andressa A / Martins, Bruno C / Josino, Iatagan R / Chen, André T C / Hong, Carlos B C / Santos, Alisson L D R / Lima, Gustavo R A / Cordero, Martin A C / Safatle-Ribeiro, Adriana V / Pennacchi, Caterina / Gusmon, Carla C / Paulo, Gustavo A / Lenz, Luciano / Lima, Marcelo S / Baba, Elisa R / Kawaguti, Fábio S / Uemura, Ricardo S / Sallum, Rubens A A / Ribeiro, Ulysses /
    Maluf-Filho, Fauze

    Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus

    2023  Volume 36, Issue 10

    Abstract: Self-expanding metallic stents (SEMS) are considered the treatment of choice for the palliation of dysphagia and fistulas in inoperable esophageal neoplasms. However, the safety of SEMSs in patients who received or who will be submitted to radiotherapy ( ... ...

    Abstract Self-expanding metallic stents (SEMS) are considered the treatment of choice for the palliation of dysphagia and fistulas in inoperable esophageal neoplasms. However, the safety of SEMSs in patients who received or who will be submitted to radiotherapy (RT) is uncertain. The study aimed to evaluate the impact of RT on adverse events (AEs) in patients with esophageal cancer with SEMSs. This is a retrospective study conducted at a tertiary cancer hospital from 2009 to 2018. We collected information regarding RT, the histological type of the tumor, the model of SEMSs and AEs after stent placement. Three hundred twenty-three patients with malignant stenosis or fistula were treated with SEMSs. The predominant histological type was squamous cell carcinoma (79.6%). A total of 282 partially covered and 41 fully covered SEMSs were inserted. Of the 323 patients, 182 did not received RT, 118 received RT before SEMS placement and 23 after. Comparing the group that received RT before stent insertion with the group that did not, the first one presented a higher frequency of severe pain (9/118 7.6% vs. 3/182 1.6%; P = 0.02). The group treated with RT after stent placement had a higher risk of global AEs (13/23 56.5% vs. 63/182 34.6%; P = 0.019), ingrowth/overgrowth (6/23 26.1% vs. 21/182 11.5%; P = 0.045) and gastroesophageal reflux (2/23 8.7% vs. 2/182 1.1%; P = 0.034). Treatment with RT before stent placement in patients with inoperable esophageal neoplasm prolongs survival and is associated with an increased risk of severe chest pain. Treatment with RT of patients with an esophageal stent increases the frequency of minor, not life-threatening AEs.
    MeSH term(s) Humans ; Retrospective Studies ; Treatment Outcome ; Stents/adverse effects ; Esophageal Neoplasms/therapy ; Esophageal Neoplasms/complications ; Deglutition Disorders/etiology ; Deglutition Disorders/therapy ; Palliative Care ; Self Expandable Metallic Stents/adverse effects ; Esophageal Stenosis/therapy
    Language English
    Publishing date 2023-05-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 639470-x
    ISSN 1442-2050 ; 1120-8694
    ISSN (online) 1442-2050
    ISSN 1120-8694
    DOI 10.1093/dote/doad019
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Endoscopic Dilation with Bougies versus Balloon Dilation in Esophageal Benign Strictures: Systematic Review and Meta-Analysis.

    Josino, Iatagan R / Madruga-Neto, Antônio C / Ribeiro, Igor B / Guedes, Hugo G / Brunaldi, Vitor O / de Moura, Diogo T H / Bernardo, Wanderley M / de Moura, Eduardo G H

    Gastroenterology research and practice

    2018  Volume 2018, Page(s) 5874870

    Abstract: Background: The use of bougies and balloons to dilate benign esophageal strictures (BES) is a consolidated procedure. However, the amount of evidence available in scientific literature supporting which is the best technique is very low, despite the ... ...

    Abstract Background: The use of bougies and balloons to dilate benign esophageal strictures (BES) is a consolidated procedure. However, the amount of evidence available in scientific literature supporting which is the best technique is very low, despite the great prevalence and importance of such pathology. This systematic review with meta-analysis aims at comparing both techniques, providing good quality of evidence.
    Methods: We searched for randomized clinical trials (RCTs) published from insertion to November 2017, using MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, LILACS, and grey literature. After the data extraction, a meta-analysis was performed. The main outcomes were symptomatic relief and recurrence rate. The secondary outcomes were bleeding, perforation, and postprocedure pain.
    Results: We included 5 randomized clinical trials (RCTs), totalizing 461 patients. Among them, 151 were treated with bougie dilation and 225 underwent balloon dilation. Regarding symptomatic relief, recurrence, bleeding, and perforation rates, there were no differences between the methods. Concerning postprocedure pain, patients submitted to balloon dilation had less intense pain (RD 0.27, 95% IC -0.42 to -0.07,
    Conclusion: We conclude that there is no difference between bougie and balloon dilation of BESs regarding symptomatic relief, recurrence rate at 12 months, bleeding, and perforation. Patients undergoing balloon dilation present less severe postprocedure pain.
    Language English
    Publishing date 2018-07-15
    Publishing country Egypt
    Document type Journal Article ; Review
    ZDB-ID 2435460-0
    ISSN 1687-630X ; 1687-6121
    ISSN (online) 1687-630X
    ISSN 1687-6121
    DOI 10.1155/2018/5874870
    Database MEDical Literature Analysis and Retrieval System OnLINE

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