Endoscopy 2012; 44(04): 422-424
DOI: 10.1055/s-0031-1291590
Case report/series
© Georg Thieme Verlag KG Stuttgart · New York

Transnasal endoscopy for direct visual control of esophageal stent placement without fluoroscopy

M. Borgulya
Department of Internal Medicine II, Dr. Horst Schmidt Kliniken, Wiesbaden (Medical School of the University of Mainz), Germany
,
C. Ell
Department of Internal Medicine II, Dr. Horst Schmidt Kliniken, Wiesbaden (Medical School of the University of Mainz), Germany
,
J. Pohl
Department of Internal Medicine II, Dr. Horst Schmidt Kliniken, Wiesbaden (Medical School of the University of Mainz), Germany
› Author Affiliations
Further Information

Publication History

submitted 06 March 2011

accepted after revision 25 October 2011

Publication Date:
09 March 2012 (online)

Placement of self-expanding metal stents (SEMSs) is a well-established treatment for esophageal stenosis and postoperative anastomotic leaks. Conventional endoscopic procedures for SEMS placement require fluoroscopic guidance, but transnasal endoscopy (TNE) with ultraslim endoscopes may allow precise stent release under direct visual control without the need for fluoroscopy. This prospectively collected data investigated the feasibility and safety of TNE-guided SEMS placement without fluoroscopy. Between March 2009 and February 2011, 20 consecutive patients underwent TNE-guided SEMS placement without fluoroscopy. The technical success rate was 100 % and no fluoroscopy was required during the procedures. Five patients underwent SEMS placement as a bedside procedure in the intensive care unit. The mean intervention time was 13.4 minutes (range 6 – 26) and there were no early complications. In summary, TNE-guided SEMS placement allows precise stent placement without fluoroscopic control and can therefore be performed as a simple bedside procedure.

 
  • References

  • 1 Baron TH. Expandable metal stents for the treatment of cancerous obstruction of the gastrointestinal tract. N Engl J Med 2001; 344: 1681-1687
  • 2 Kauer WK, Stein HJ, Dittler HJ et al. Stent implantation as a treatment option in patients with thoracic anastomotic leaks after esophagectomy. Surg Endosc 2008; 22: 50-53
  • 3 Dai YY, Gretschel S, Dudeck O et al. Treatment of oesophageal anastomotic leaks by temporary stenting with self-expanding plastic stents. Brit J Surg 2009; 96: 887-891
  • 4 Schubert D, Scheidbach H, Kuhn R et al. Endoscopic treatment of thoracic esophageal anastomotic leaks by using silicone-covered, self-expanding polyester stents. Gastrointest Endosc 2005; 61: 891-896
  • 5 Raijman I, Kortan P, Haber GB et al. Contrast injection to identify tumor margins during esophageal stent placement. Gastrointest Endosc 1994; 40: 222-224
  • 6 White RE, Mungatana C, Topazian M. Esophageal stent placement without fluoroscopy. Gastrointest Endosc 2001; 53: 348-351
  • 7 Wilkes EA, Jackson LM, Cole AT et al. Insertion of expandable metallic stents in esophageal cancer without fluoroscopy is safe and effective: a 5-year experience. Gastrointest Endosc 2007; 65: 923-929
  • 8 Austin AS, Khan Z, Cole AT et al. Placement of esophageal self-expanding metallic stents without fluoroscopy. Gastrointest Endosc 2001; 54: 357-359
  • 9 Ben Soussan EE, Antonietti M, Lecleire S et al. Palliative esophageal stent placement using endoscopic guidance without fluoroscopy. Gastroenterol Clin Biol 2005; 29: 785-788
  • 10 Lee KM, Shin SJ, Hwang JC et al. Proximal-releasing stent insertion under transnasal endoscopic guidance in patients with postoperative esophageal leakage. Gastrointest Endosc 2010; 72: 180-185
  • 11 Gelbmann CM, Ratiu NL, Rath HC et al. Use of self-expandable plastic stents for the treatment of esophageal perforations and symptomatic anastomotic leaks. Endoscopy 2004; 36: 695-699
  • 12 Therasse E, Oliva VL, Lafontaine E et al. Balloon dilation and stent placement for esophageal lesions: indications, methods, and results. Radiographics 2003; 23: 89-105
  • 13 Alanezi K, Urschel JD. Mortality secondary to esophageal anastomotic leak. Ann Thorac Cardiovasc Surg 2004; 10: 71-75
  • 14 Moon JH, Ko BM, Choi HJ et al. Intraductal balloon-guided direct peroral cholangioscopy with an ultraslim upper endoscope. Gastrointest Endosc 2009; 70: 297-302
  • 15 Külling D, Bauerfeind P, Fried M. Transnasal versus transoral endoscopy for the placement of nasoenteral feeding tubes in critically ill patients. Gastrointest Endosc 2000; 52: 506-510
  • 16 Frieling T, Schindler P, Kuhlbusch-Zicklam R et al. Krefeld CONTRA study: conventional peroral esophago-gastro-duodenoscopy (EGD) vs. transnasal EGD – a prospective and randomised study with independent evaluation of conscious sedation, endoscope diameter, and access path. . Z Gastroenterol 2010; 48: 818-824
  • 17 Yagi J, Adachi K, Arima N et al. A prospective randomized comparative study on the safety and tolerability of transnasal esophagogastroduodenoscopy. Endoscopy 2005; 37: 1226-1231