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Outcomes after placement of a SX-ELLA esophageal stent for refractory variceal bleeding : a national multicentre study
Verfasser / VerfasserinReiberger, Thomas ; Pfisterer, Nikolaus ; Riedl, Florian ; Pachofszky, Thomas ; Gschwantler, Michael ; König, Kurt ; Schuster, Benjamin ; Mandorfer, Mattias ; Gessl, Irina ; Illiasch, Constanze ; Fuchs, Eva-Maria ; Unger, Lukas ; Dolak, Werner ; Maieron, Andreas ; Kramer, Ludwig ; Madl, Christian ; Trauner, Michael
Erschienen in
Liver International, 2019, Jg. 2, H. 39, S. 290-298
ErschienenWiley-Blackwell, 2019
SpracheEnglisch
DokumenttypAufsatz in einer Zeitschrift
Schlagwörter (EN)cirrhosis / portal hypertension / selfexpandable metal stent / variceal bleeding
URNurn:nbn:at:at-ubmuw:3-784 Persistent Identifier (URN)
DOI10.1111/liv.13971 
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 Das Werk ist frei verfügbar
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Outcomes after placement of a SX-ELLA esophageal stent for refractory variceal bleeding [0.69 mb]
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Zusammenfassung (Englisch)

Background

Current guidelines favour the use of bleeding stents over balloon tamponade (BT) for refractory variceal bleeding (VB) from oesophageal varices. However, data on the efficacy and safety of selfexpandable metal SXELLA Danis stents (SEMS) are limited.

Methods

Cirrhotic patients receiving SEMS for VB at four tertiary care centres were included in this retrospective multicentre study. Rates of failuretocontrol bleeding (within 5 days) and bleedingrelated mortality (6 weeks) were assessed.

Results

SEMS controlled VB in 79.4% (27/34) of patients. In the rest of patients, other rescue treatments including endoscopic band ligation (EBL, n = 3), SEMS renewed (n = 2) or Linton (n = 2) were applied; however, VB was only controlled in one patient. Early rebleeding within six weeks occurred in 17.6% (6/34) patients. Median SEMS dwell time was three (IQR:6) days. Overall n = 13/34 (38.2%) patients died with SEMS in situ. After SEMS removal, rebleeding and bleedingrelated death occurred in n = 7 (35%) and n = 5 (14.7%) patients respectively. Only 32.4% (10/34) patients did not experience any rebleeding within six weeks after SEMS removal. Bleedingrelated mortality was 47.1% (n = 16/34) and the median survival after SEMS placement was 2.1 months. Notably, no patient received an early transjugular intrahepatic portosystemic shunt (TIPS). The most common adverse events were stent dislocations (n = 13; 38.2%), while ulcers/necrosis of the oesophageal mucosa was seen in only four (11.8%) patients.

Conclusion

SEMS controlled refractory VB in most patients. However, bleedingrelated mortality remained high. While SEMS dislocations were frequent, ulcers/necrosis of the oesophagus was rare. Further studies should investigate whether the wider use of early TIPS reduces bleedingrelated mortality after SEMS placement.

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