Endoscopy 2006; 38(9): 896-901
DOI: 10.1055/s-2006-944662
Original article
© Georg Thieme Verlag KG Stuttgart · New York

The use of self-expanding metal stents to treat acute esophageal variceal bleeding

R.  Hubmann1 , G.  Bodlaj1 , M.  Czompo2 , L.  Benkö3 , P.  Pichler4 , S.  Al-Kathib4 , P.  Kiblböck4 , A.  Shamyieh5 , G.  Biesenbach1
  • 12nd Dept. of Internal Medicine, Linz General Hospital, Linz, Austria
  • 2Institute of Pathology and Microbiology, Linz General Hospital, Linz, Austria
  • 3Ludwig Boltzmann Institute of Operative Endoscopy and Laparoscopy, Linz General Hospital, Linz, Austria
  • 4Institute of Radiology, Linz General Hospital, Linz, Austria
  • 52nd Dept. of Surgery, Ludwig Boltzmann Institute of Operative Endoscopy and Laparoscopy, Linz General Hospital, Linz, Austria
Further Information

Publication History

Submitted 26 February 2006

Accepted after revision 9 June 2006

Publication Date:
18 September 2006 (online)

Preview

Background and study aims: Acute variceal bleeding is a life-threatening complication of liver cirrhosis. Essential factors for survival after variceal bleeding are the rapidity and efficacy of initial primary hemostasis. Endoscopic and vasoactive therapy is the gold standard in the management of acute variceal hemorrhage. The primary aim of this study was to evaluate the use of self-expandable metallic stents to arrest uncontrollable acute variceal bleeding.
Patients and methods: Between November 2002 and May 2005, esophageal stents were implanted in 20 patients (18 men, two women; mean age 52, range 27 - 87) with massive ongoing bleeding from esophageal varices, as an alternative treatment to balloon tamponade. The patients had not been successfully managed with prior pharmacologic or endoscopic therapy. They had had one to five previous bleeding episodes (mean 2.4). Eight of the patients were in Child-Pugh grade B and 12 in grade C. A new type of stent with special introducers was developed that allowed placement without radiographic assistance.
Results: The stents were successfully placed in all of the patients and were left in place for 2 - 14 days. Bleeding from the esophageal varices ceased immediately after implantation of the stent in all cases. While the stent was in place, further diagnostic steps were carried out to optimize management of the patients’ illness and portal hypertension. No recurrent bleeding, morbidity, or mortality occurred during treatment with the esophageal stent. All of the stents were extracted without any complications after definitive treatment had been started.
Conclusions: In this pilot study, the new method of implantation of an esophageal stent was found to be a safe and effective treatment for massive bleeding from esophageal varices in patients with liver cirrhosis. These initial clinical results will of course have to be confirmed in comparative studies including a large number of patients.

References

R. Hubmann, M. D.

2nd Dept. of Internal Medicine

Allgemeines Krankenhaus der Stadt Linz · Krankenhausstraße 9 · 4020 Linz · Austria

Fax: +43-732-7806-747228

Email: rainer.hubmann@akh.linz.at