TITLE

A METHOD OF ACCURATELY SITING OESOPHAGEAL PROSTHESES WITHOUT RADIOLOGY

AUTHOR(S)
Kooner, P.; Aljabari, R.; Besherdos, K.; van Someren, N.
PUB. DATE
April 2003
SOURCE
Gut;Apr2003 Supplement 1, Vol. 52, pA76
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: Expanding metal oesophageal stents are an effective method of palliating noperable oesophageal carcinoma. Unlike colonic, duodenal, or biliary stents, oesophageal stents are deployed from an introducer whose diameter is too large to pass the biopsy channel of any endoscope. Such prostheses are usually placed using fluoroscopic guidance, and inaccurate stent placement is o frequent occurrence because of difficulties arising from correct identification of the tumour margins and stent radiopaque markings. We describe a method of deploying such stents under direct endoscopic vision with a high degree of accuracy. Methods: A preliminary survey of the proximal tumour margin and remaining oesophageal lumen is made using an endoscope. A stiff guidewire (eg 0.35" 'Tiger' wire) is passed through the oesophageal lumen until it Lies within the stomach. Often the endoscope will be too large to cross the stricture and enter the stomach, and free passage of the wire is the key to ensuring that the wire lies in the correct position. No dilatation of the stricture is necessary. The endoscope markings are used to gauge the length of the stricture, and a stent of appropriate length is selected. The endoscope is withdrawn, leaving the guidewire in situ, and then reintroduced alongside the guidewire. The stent with its introducer is passed over the guidewire, and into the stricture under direct endoscopic view. The stent is then deployed while viewing through the endoscope, and correct placement ensured. Results: We placed 24 oesophageal stents (Boston Scientific) between 2000 and 2002 using radiological guidance, and 25 using the direct view method. All stents were placed satisfactorily. Conclusions: The direct view method of oesophageal stent placement has results equivalent to fluoroscopically guided placement, and avoids the use of x rays. We also feel that the procedure is easier and takes less time.
ACCESSION #
9747793

 

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