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RISS 인기검색어
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- 저자 : Todd H. Baron (검색결과 2 건)
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Review : Management of Simultaneous Biliary and Duodenal Obstruction: The Endoscopic Perspective
( Todd H. Baron ) The Editorial Office of Gut and Liver 2010 Gut and Liver Vol.4 No.s1
Obstructive jaundice often develops in patients with unresectable malignancy in and around the head of the pancreas. Duodenal obstruction can also occur in these patients, and usually develops late in the disease course. Palliation of both malignant biliary and duodenal obstruction is traditionally performed with surgical diversion of the bile duct and stomach, respectively. With the advent of nonsurgical palliation of biliary obstruction using endoscopic transpapillary expandable metal stent placement, a similar approach can be used to palliate duodenal obstruction by placement of expandable metal gastroduodenal stents. Endoscopic palliation can be achieved in patients who require relief of both biliary obstruction and duodenal obstruction, although this can be technically difficult to achieve depending on the level of duodenal obstruction in relation to the major papilla. This article reviews the endoscopic approaches for combined palliative relief of malignant biliary and duodenal obstruction. (Gut Liver 2010;4(Suppl. 1):S50-56)
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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 대한소화기내시경학회 2023 Clinical Endoscopy Vol.56 No.6
Background/Aims: Self-expandable metallic stents (SEMSs) are widely adopted for the palliation of dysphagia in patients with malig-nant 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 withesophageal cancer. Methods: This retrospective study was performed at the Instituto do Cancer do Estado de São Paulo. All patients with malignantesophageal 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 28mm (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 chemotherapyand a 28 mm stent flare were associated with a higher risk of SEMS-ERF.
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