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Gastrointestinal Stent Uygulamaları: Tek merkez deneyimi

Yıl 2021, Cilt: 12 Sayı: 42, 5 - 9, 15.04.2021
https://doi.org/10.17944/mkutfd.804229

Öz

Giriş ve Amaç
Gastrointestinal (Gİ) stentler gastrointestinal kanaldaki malign veya benign darlıklarda ve akciğer kanseri gibi komşu organ maligniteleri ile ilişkili bası veya fistüllerde ya da operasyonlardan sonraki darlık veya kaçaklarda palyatif amaçla kullanılmaktadır. Biz kliniğimizde taktığımız Gİ stentlerin takılma nedenlerini ve seyrini değerlendirerek Gİ stentlerle ilgili klinik deneyimimizi paylaşmayı amaçladık.

Materyal ve Metod
2014-2019 yılları arasında kliniğimizde çeşitli nedenlerle Gİ stent takılan olgular çalışmaya dâhil edilmiştir. Retrospektif olarak stent takılma nedeni, stent çeşidi, komplikasyon olup olmaması, komplikasyonların yönetimi ve hastaların yaşam süreleri incelendi. Özellikle ileri evre kanserlerde stentlerin palyatif tedavide etkinliği ve yaşam süresine katkısı değerlendirildi.

Bulgular
Bu süreçte toplam 36 hastaya Gİ stent takılmıştı. Hastalarımızın 24 (%67)’ü erkek ve 12 (%33)’si kadındı. Erkeklerin yaş ortalaması 67±13,8, kadınların yaş ortalaması 45,6±11,5 idi. Malign sebeplerle stent takılanların; %44,5’i özofagus kanseri, %19,5’i mide kanseri, %16,6’sında akciğer kanseri ve %5,5’una da rektum kanseri nedeniyle stent takılmıştı. Benign nedenlerle stent takılanların %11,1’ine fistül, %2,8’ine de evre d özofajit nedeniyle stent takılmıştı. Hepsine SEMS takılmıştı. Hastalarımızın %27’si halen yaşamaktaydı. Hastalarımızın %73’ü ölmüş olup ortalama yaşam süresine baktığımızda 109,6±101 gün olarak saptadık.

Tartışma ve Sonuç
Sonuç olarak, ameliyat edilemeyen sindirim sistemi darlığı olan hastaların palyasyonunda stent kullanımının, mortalitesinin olmaması ve sınırlı morbiditesi ile kısa dönemde kaliteli bir palyasyon için etkin bir yöntem olduğu kanısındayız. Kendiliğinden genişleyen metal stentler kullanılarak malign ve benign disfajinin hafiflemesi sağlanabilir.

Kaynakça

  • Lambert R. An overview of the management of cancer of the esophagus. Gastrointest Endosc Clin N Am 1998; 8: 415-34. https://doi.org/10.1016/S1052-5157(18)30270-8
  • Domschke W, Foerster EC, Matek W, Rodl W. Self-expanding mesh stent for esophageal cancer stenosis. Endoscopy 1990; 22: 134-136. https://doi.org/10.1055/s-2007-1012818
  • Giral A, Kalaycı C. Özofagusun kanser dışı hastalıklarında cerrahi tedavi. In Yüksel M, Başoğlu A. ed. Özofagus Hastalıklarının Tıbbi ve Cerrahi Tedavisi. 2002: 309-320.
  • Tan BS, Mason RC, Adam A. Minimally invasive therapy for advanced oesophageal malignancy. Clin Radiol 1996; 51: 828-836. https://doi.org/10.1016/S0009-9260(96)80078-X
  • Eroglu A, Turkyılmaz A, Aydın Y. Özofagus hastalıklarında stent uygulamaları. Turkiye Klinikleri J Thor Surg-Special Topics 2009; 2: 95-99.
  • Radecke K, Gerken G, Treichel U. Impact of a self-expanding, plastic esophageal stent on various esophageal stenoses, fistulas, and leakages: a single-center experience in 39 patients. Gastrointest Endosc 2005; 61: 812-8. https://doi.org/10.1016/S0016-5107(05)00290-7
  • Sandha GS, Marcon NE. Expandable metal stents for benign esophageal obstruction. Gastrointest Endosc Clin North Am 1999; 9: 437-46. https://doi.org/10.1016/S1052-5157(18)30187-9
  • Boulis NM, Armstrong WS, Chandler WF, et al. Epidural abscess: A delayed complication of esophageal stenting for benign stricture. Ann Thorac Surg 1999; 68: 568-70. https://doi.org/10.1016/S0003-4975(99)00591-3
  • Adam A, Ellul J, Watkinson AF, et al. Palliation of inoperable esophageal carcinoma: A prospective randomised trial of laser therapy and stent placement. Radiology 1997; 202: 344-348. https://doi.org/10.1148/radiology.202.2.9015054
  • Cwikiel W, Tranberg KG, Cwikiel M, et al. Malignant dysphagia: Palliation with oesophageal stents-long term results in 100 patients. Radiology 1998; 207: 513-518. https://doi.org/10.1148/radiology.207.2.9577503
  • Sharma P, Kozarek R, Practice Parameters Committee of American College of Gastroenterology. Role of esophageal stents in benign and malignant diseases. Am J Gastroenterol 2010; 105:258. https://doi.org/10.1038/ajg.2009.684
  • Wang MQ, Sze DY, Wang ZP, et al. Delayed complications after esophageal stent placement for treatment of malignant esophageal obstructions and esophagorespiratory fistulas. J Vasc Interv Radiol. 2001; 12: 465-474. https://doi.org/10.1016/S1051-0443(07)61886-7
  • Kocher M, Dlouhy M, Neoral C, et al. Esophageal stent with antireflux valve for tumors involving the cardia: work in progress. J Vasc Interv Radiol 1998; 9: 1007-1010. https://doi.org/10.1016/S1051-0443(98)70441-5
  • Watkinson A, Ellul J, Entwisle K, et al. Oesophageal carcinoma: initial results with covered self expanding endoprostheses. Radiology 1995;195:821-827. https://doi.org/10.1148/radiology.195.3.7538682
  • Turkyilmaz, A, Eroglu A, Aydin Y, et al. Complications of metallic stent placement in malignant esophageal stricture and their management. Surg Laparosc Endosc Percutan Tech. 2010; 20; 10-15. https://doi.org/10.1097/SLE.0b013e3181cdebf4
  • Homann N, Noftz MR, Klingenberg-Noftz RD, et al. Delayed complications after placement of self-expanding stents in malignant esophageal obstruction: treatment strategies and survival rate. Dig Dis Sci. 2008; 53: 334- 340. https://doi.org/10.1007/s10620-007-9862-9
  • Shimi SM. Self-expanding metallic stents in the management of advanced esophageal cancer: a review. Semin Laparosc. Surg. 2000; 7: 9-21. https://doi.org/10.1177/155335060000700103

Gastrointestinal Stent Applications: Single center experience

Yıl 2021, Cilt: 12 Sayı: 42, 5 - 9, 15.04.2021
https://doi.org/10.17944/mkutfd.804229

Öz

Introduction and purpose
Gastrointestinal (GI) stents are used for palliative purposes in malignant or benign strictures in the gastrointestinal tract and pressure or fistulas associated with neighboring organ malignancies such as lung cancer, or stenosis or leakage after operations. We aimed to share our clinical experience with GI stents by evaluating the reasons and course of GI stents we used in our clinic.
Materials and Methods
Patients who had a GI stent in our clinic between 2014 and 2019 were included in the study. Retrospectively, the reason for stent insertion, the type of stent, the presence or absence of complications, the management of the complications and the life span of the patients were analyzed. Especially in advanced stage cancers, the effectiveness of stents in palliative treatment and their contribution to life span were evaluated.
Results
During this period, a total of 36 patients had GI stents implanted. 24 (67%) of our patients were male and 12 (33%) were female. The mean age of men was 67 ± 13.8, and the mean age of women was 45.6 ± 11.5. Those who are stented for malign reasons; A stent was implanted for 44.5% esophageal cancer, 19.5% stomach cancer, 16.6% lung cancer and 5.5% rectal cancer. Of those who were stented for benign reasons, 11.1% had a fistula, and 2.8% had a stent due to stage d esophagitis. SEMS was attached to all of them. 27% of our patients were still alive. 73% of our patients died and when we looked at the average life span, we found it as 109.6 ± 101 days.
Discussion and Conclusion
In conclusion, we believe that the use of stents in palliation of patients with inoperable digestive system stenosis is an effective method for a quality palliation in the short term, with no mortality and limited morbidity. By using self-expanding metal stents, malignant and benign dysphagia can be alleviated.

Kaynakça

  • Lambert R. An overview of the management of cancer of the esophagus. Gastrointest Endosc Clin N Am 1998; 8: 415-34. https://doi.org/10.1016/S1052-5157(18)30270-8
  • Domschke W, Foerster EC, Matek W, Rodl W. Self-expanding mesh stent for esophageal cancer stenosis. Endoscopy 1990; 22: 134-136. https://doi.org/10.1055/s-2007-1012818
  • Giral A, Kalaycı C. Özofagusun kanser dışı hastalıklarında cerrahi tedavi. In Yüksel M, Başoğlu A. ed. Özofagus Hastalıklarının Tıbbi ve Cerrahi Tedavisi. 2002: 309-320.
  • Tan BS, Mason RC, Adam A. Minimally invasive therapy for advanced oesophageal malignancy. Clin Radiol 1996; 51: 828-836. https://doi.org/10.1016/S0009-9260(96)80078-X
  • Eroglu A, Turkyılmaz A, Aydın Y. Özofagus hastalıklarında stent uygulamaları. Turkiye Klinikleri J Thor Surg-Special Topics 2009; 2: 95-99.
  • Radecke K, Gerken G, Treichel U. Impact of a self-expanding, plastic esophageal stent on various esophageal stenoses, fistulas, and leakages: a single-center experience in 39 patients. Gastrointest Endosc 2005; 61: 812-8. https://doi.org/10.1016/S0016-5107(05)00290-7
  • Sandha GS, Marcon NE. Expandable metal stents for benign esophageal obstruction. Gastrointest Endosc Clin North Am 1999; 9: 437-46. https://doi.org/10.1016/S1052-5157(18)30187-9
  • Boulis NM, Armstrong WS, Chandler WF, et al. Epidural abscess: A delayed complication of esophageal stenting for benign stricture. Ann Thorac Surg 1999; 68: 568-70. https://doi.org/10.1016/S0003-4975(99)00591-3
  • Adam A, Ellul J, Watkinson AF, et al. Palliation of inoperable esophageal carcinoma: A prospective randomised trial of laser therapy and stent placement. Radiology 1997; 202: 344-348. https://doi.org/10.1148/radiology.202.2.9015054
  • Cwikiel W, Tranberg KG, Cwikiel M, et al. Malignant dysphagia: Palliation with oesophageal stents-long term results in 100 patients. Radiology 1998; 207: 513-518. https://doi.org/10.1148/radiology.207.2.9577503
  • Sharma P, Kozarek R, Practice Parameters Committee of American College of Gastroenterology. Role of esophageal stents in benign and malignant diseases. Am J Gastroenterol 2010; 105:258. https://doi.org/10.1038/ajg.2009.684
  • Wang MQ, Sze DY, Wang ZP, et al. Delayed complications after esophageal stent placement for treatment of malignant esophageal obstructions and esophagorespiratory fistulas. J Vasc Interv Radiol. 2001; 12: 465-474. https://doi.org/10.1016/S1051-0443(07)61886-7
  • Kocher M, Dlouhy M, Neoral C, et al. Esophageal stent with antireflux valve for tumors involving the cardia: work in progress. J Vasc Interv Radiol 1998; 9: 1007-1010. https://doi.org/10.1016/S1051-0443(98)70441-5
  • Watkinson A, Ellul J, Entwisle K, et al. Oesophageal carcinoma: initial results with covered self expanding endoprostheses. Radiology 1995;195:821-827. https://doi.org/10.1148/radiology.195.3.7538682
  • Turkyilmaz, A, Eroglu A, Aydin Y, et al. Complications of metallic stent placement in malignant esophageal stricture and their management. Surg Laparosc Endosc Percutan Tech. 2010; 20; 10-15. https://doi.org/10.1097/SLE.0b013e3181cdebf4
  • Homann N, Noftz MR, Klingenberg-Noftz RD, et al. Delayed complications after placement of self-expanding stents in malignant esophageal obstruction: treatment strategies and survival rate. Dig Dis Sci. 2008; 53: 334- 340. https://doi.org/10.1007/s10620-007-9862-9
  • Shimi SM. Self-expanding metallic stents in the management of advanced esophageal cancer: a review. Semin Laparosc. Surg. 2000; 7: 9-21. https://doi.org/10.1177/155335060000700103
Toplam 17 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Original Articles
Yazarlar

Mustafa Zanyar Akkuzu 0000-0002-9908-6881

Orhan Sezgin 0000-0002-6704-4716

Fehmi Ates 0000-0003-2527-414X

Osman Özdoğan 0000-0002-8299-5341

Serkan Yaraş 0000-0003-1404-7515

Ferzan Aydın 0000-0003-0464-2003

Hatice Rızaoğlu Balcı 0000-0002-5366-4535

Enver Üçbilek 0000-0002-2935-5580

Engin Altintas 0000-0003-0796-1456

Yayımlanma Tarihi 15 Nisan 2021
Gönderilme Tarihi 2 Ekim 2020
Kabul Tarihi 11 Mart 2021
Yayımlandığı Sayı Yıl 2021 Cilt: 12 Sayı: 42

Kaynak Göster

Vancouver Akkuzu MZ, Sezgin O, Ates F, Özdoğan O, Yaraş S, Aydın F, Rızaoğlu Balcı H, Üçbilek E, Altintas E. Gastrointestinal Stent Uygulamaları: Tek merkez deneyimi. mkutfd. 2021;12(42):5-9.