Endoscopy 2020; 52(S 01): S172
DOI: 10.1055/s-0040-1704530
ESGE Days 2020 ePoster Podium presentations
Friday, April 24, 2020 11:00 – 11:30 Variceal bleeding ePoster Podium 6
© Georg Thieme Verlag KG Stuttgart · New York

DANIS STENT: A CASE SERIES OF PATIENTS WITH REFRACTORY OESOPHAGEAL VARICEAL BLEEDING

MM Saeidinejad
1   Salford Royal Hospital, Manchester, United Kingdom
2   Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, United Kingdom
,
N Prasad
3   Wrightington Wigan and Leigh NHS Foundation Trust, Gastroenterology, Wigan, United Kingdom
,
R Keld
3   Wrightington Wigan and Leigh NHS Foundation Trust, Gastroenterology, Wigan, United Kingdom
,
CS Lee
3   Wrightington Wigan and Leigh NHS Foundation Trust, Gastroenterology, Wigan, United Kingdom
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Publikationsdatum:
23. April 2020 (online)

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Aims To assess the safety and efficacy of DANIS self-expandable metal stent (SEMS) in treatment of refractory variceal oesophageal bleeding.

Methods A retrospective observational study in a district general hospital from December 2015 to Oct 18.

Results We identified 12 admissions.

The median Child-Pugh (CP) score was 7.5 (IQR 2.5, Range = 6–11) and a median Model for End-Stage Liver Disease (MELD) score of 12.5 (IQR 6.5, Range 9–35).

All patients had evidence of OVB on endoscopy and failed band ligation therapy.

SEMS was successfully deployed in 75% (N = 9) of the cases and achieved immediate haemostasis.

The median dwell time of SEMS stent was 13 days (IQR = 18, Range 1–202).

8 patients had no further bleeding during their admission (Median stent dwell time = 14 days [IQR = 18.5]). From these 2 patients were transferred to a tertiary centre and received trans-jugular intrahepatic portosystemic shunt (TIPS) before removal of SEMS.

3 (25%) patients rebled. Further endoscopic treatment was successful in 1 patient and the other 2 died from uncontrollable bleeding.

Post treatment complications occurred in 6 (50%) patients. 4 patients (33%) had stent migration,1 patient developed right sided chest pain (resolved after stent removal) and 1 patient developed stent-related ulceration and stricture formation.

The overall 30-day mortality was 25% (3/12) with a 1-year mortality of 42% (5/12). 2 patients died from uncontrolled bleeding within the first 5 days of admission. Another patient died from complications of alcoholic liver disease 30 days after SEMS insertion. One died 4 months post SEMS insertion from hepatocellular carcinoma (HCC) and one died 6 months post SEMS insertion from recurrence of gastrointestinal bleeding.

Conclusions DANIS stent (SEMS) is effective in controlling refractory oesophageal variceal bleeding. It may also serve as a bridging therapy to allow transfer for further intervention.

We recommend timely removal of DANIS stents to minimise complications.