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Self-expandable metallic stent-induced esophagorespiratory fistulas in patients with advanced esophageal cancer
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Iatagan R. Josino, Bruno C. Martins, Andressa A. Machado, Gustavo R. de A. Lima, Martin A. C. Cordero, Amanda A. M. Pombo, Rubens A. A. Sallum, Ulysses Ribeiro Jr, Todd H. Baron, Fauze Maluf-Filho
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Clin Endosc 2023;56(6):761-768. Published online July 25, 2023
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DOI: https://doi.org/10.5946/ce.2022.297
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Graphical Abstract
Abstract
PDFPubReaderePub
- 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.
Conclusions 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.
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Citations
Citations to this article as recorded by
- Clinical Implications of Circulating Tumor Cells in Patients with Esophageal Squamous Cell Carcinoma: Cancer-Draining Blood Versus Peripheral Blood
Dong Chan Joo, Gwang Ha Kim, Hoseok I, Su Jin Park, Moon Won Lee, Bong Eun Lee Cancers.2024; 16(16): 2921. CrossRef - How to reduce fistula formation after self-expandable metallic stent insertion for treating malignant esophageal stricture?
Kwang Bum Cho Clinical Endoscopy.2023; 56(6): 735. CrossRef
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Risk Stratification in Cancer Patients with Acute Upper Gastrointestinal Bleeding: Comparison of Glasgow-Blatchford, Rockall and AIMS65, and Development of a New Scoring System
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Matheus Cavalcante Franco, Sunguk Jang, Bruno da Costa Martins, Tyler Stevens, Vipul Jairath, Rocio Lopez, John J. Vargo, Alan Barkun, Fauze Maluf-Filho
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Clin Endosc 2022;55(2):240-247. Published online January 21, 2022
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DOI: https://doi.org/10.5946/ce.2021.115
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Abstract
PDFPubReaderePub
- Background
/Aims: Few studies have measured the accuracy of prognostic scores for upper gastrointestinal bleeding (UGIB) among cancer patients. Thereby, we compared the prognostic scores for predicting major outcomes in cancer patients with UGIB. Secondarily, we developed a new model to detect patients who might require hemostatic care.
Methods A prospective research was performed in a tertiary hospital by enrolling cancer patients admitted with UGIB. Clinical and endoscopic findings were obtained through a prospective database. Multiple logistic regression analysis was performed to gauge the power of each score.
Results From April 2015 to May 2016, 243 patients met the inclusion criteria. The AIMS65 (area under the curve [AUC] 0.85) best predicted intensive care unit admission, while the Glasgow-Blatchford score best predicted blood transfusion (AUC 0.82) and the low-risk group (AUC 0.92). All scores failed to predict hemostatic therapy and rebleeding. The new score was superior (AUC 0.74) in predicting hemostatic therapy. The AIMS65 (AUC 0.84) best predicted in-hospital mortality.
Conclusions The scoring systems for prognostication were validated in the group of cancer patients with UGIB. A new score was developed to predict hemostatic therapy. Following this result, future prospective research should be performed to validate the new score.
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Citations
Citations to this article as recorded by
- Endoscopic Management of Tumor Bleeding
Frances Dang, Marc Monachese Gastrointestinal Endoscopy Clinics of North America.2024; 34(1): 155. CrossRef - Clinical significance of D-dimer, antithrombin III, and Helicobacter pylori infection in acute upper gastrointestinal bleeding
Cong-Biao Cheng, Na Li World Chinese Journal of Digestology.2024; 32(7): 501. CrossRef - Comparative diagnostic utility of Rockall and Glasgow-Blatchford scores in non-variceal upper gastrointestinal bleeding: a systematic review and meta-analysis
Landon Kozai, Arvin Tan, Kevin Nebrejas, Yoshito Nishimura European Journal of Gastroenterology & Hepatology.2024;[Epub] CrossRef - The Accuracy of Pre-Endoscopic Scores for Mortality Prediction in Patients with Upper GI Bleeding and No Endoscopy Performed
Sergiu Marian Cazacu, Dragoș Ovidiu Alexandru, Răzvan-Cristian Statie, Sevastița Iordache, Bogdan Silviu Ungureanu, Vlad Florin Iovănescu, Petrică Popa, Victor Mihai Sacerdoțianu, Carmen Daniela Neagoe, Mirela Marinela Florescu Diagnostics.2023; 13(6): 1188. CrossRef - Progress in the Evaluation of Acute Upper Gastrointestinal Bleeding with AIMS65 Scoring System
莉 王 Advances in Clinical Medicine.2023; 13(05): 8163. CrossRef - Interpretations of the Role of Plasma Albumin in Prognostic Indices: A Literature Review
Kim Oren Gradel Journal of Clinical Medicine.2023; 12(19): 6132. CrossRef
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