Outcomes after placement of a SX‐ELLA oesophageal stent for refractory variceal bleeding—A national multicentre study
Background Current guidelines favour the use of bleeding stents over balloon tamponade (BT) for refractory variceal bleeding (VB) from oesophageal varices. However, data on the efficacy and safety of self‐expandable metal SX‐ELLA Danis stents (SEMS) are limited. Methods Cirrhotic patients receiving...
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| Veröffentlicht in: | Liver international 2019-02, Vol.39 (2), p.290-298 |
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| creator | Pfisterer, Nikolaus Riedl, Florian Pachofszky, Thomas Gschwantler, Michael König, Kurt Schuster, Benjamin Mandorfer, Mattias Gessl, Irina Illiasch, Constanze Fuchs, Eva‐Maria Unger, Lukas Dolak, Werner Maieron, Andreas Kramer, Ludwig Madl, Christian Trauner, Michael Reiberger, Thomas Tacke, Frank |
| description | Background
Current guidelines favour the use of bleeding stents over balloon tamponade (BT) for refractory variceal bleeding (VB) from oesophageal varices. However, data on the efficacy and safety of self‐expandable metal SX‐ELLA Danis stents (SEMS) are limited.
Methods
Cirrhotic patients receiving SEMS for VB at four tertiary care centres were included in this retrospective multicentre study. Rates of failure‐to‐control bleeding (within 5 days) and bleeding‐related mortality (6 weeks) were assessed.
Results
SEMS controlled VB in 79.4% (27/34) of patients. In the rest of patients, other rescue treatments including endoscopic band ligation (EBL, n = 3), SEMS renewed (n = 2) or Linton (n = 2) were applied; however, VB was only controlled in one patient. Early rebleeding within six weeks occurred in 17.6% (6/34) patients. Median SEMS dwell time was three (IQR:6) days. Overall n = 13/34 (38.2%) patients died with SEMS in situ. After SEMS removal, rebleeding and bleeding‐related death occurred in n = 7 (35%) and n = 5 (14.7%) patients respectively. Only 32.4% (10/34) patients did not experience any rebleeding within six weeks after SEMS removal. Bleeding‐related mortality was 47.1% (n = 16/34) and the median survival after SEMS placement was 2.1 months. Notably, no patient received an early transjugular intrahepatic portosystemic shunt (TIPS). The most common adverse events were stent dislocations (n = 13; 38.2%), while ulcers/necrosis of the oesophageal mucosa was seen in only four (11.8%) patients.
Conclusion
SEMS controlled refractory VB in most patients. However, bleeding‐related mortality remained high. While SEMS dislocations were frequent, ulcers/necrosis of the oesophagus was rare. Further studies should investigate whether the wider use of early TIPS reduces bleeding‐related mortality after SEMS placement. |
| doi_str_mv | 10.1111/liv.13971 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6587452</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2112188904</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4431-8799812787b3f56431fe6d17ef7563d20e8a77063878d81051144ff6e02aab2e3</originalsourceid><addsrcrecordid>eNp1kcFu1DAQhiMEoqXlwAsgS1zaw7YeO4mdC9KqaqFSpB6gVW-WNxlvUznxYjuLcusjcOAJ-yR4u2UFSPhia_7Pv2bmz7J3QE8gnVPbrU-AVwJeZPuQCznjjMPL3ZvxvexNCPeUQlUV8Drb45TlkrF8P5uuxti4HgPRJqInK6sb7HGIxBmiyZfbx4cf53U9Jw6DW93pJWpLQtwAxnni0XjdROcnsta-azbqwiK23bB8fPg5J4OOnRtStR9tTPoQPab_YzsdZq-MtgHfPt8H2fXF-dezz7P66tPl2byeNXnOYSZFVUlgQooFN0WZSgbLFgQaUZS8ZRSlFoKWXArZSqAFQJ4bUyJlWi8Y8oPs49Z3NS56bJ9a0FatfNdrPymnO_W3MnR3aunWqiykyAuWDI6eDbz7NmKIqu9Cg9bqAd0YFANgIGVF84R--Ae9d6NP428owWgJaY5EHW-pxrsQ0gp3zQBVm0BVClQ9BZrY9392vyN_J5iA0y3wvbM4_d9J1Zc3W8tfmFutJw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2172061787</pqid></control><display><type>article</type><title>Outcomes after placement of a SX‐ELLA oesophageal stent for refractory variceal bleeding—A national multicentre study</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Pfisterer, Nikolaus ; Riedl, Florian ; Pachofszky, Thomas ; Gschwantler, Michael ; König, Kurt ; Schuster, Benjamin ; Mandorfer, Mattias ; Gessl, Irina ; Illiasch, Constanze ; Fuchs, Eva‐Maria ; Unger, Lukas ; Dolak, Werner ; Maieron, Andreas ; Kramer, Ludwig ; Madl, Christian ; Trauner, Michael ; Reiberger, Thomas ; Tacke, Frank</creator><creatorcontrib>Pfisterer, Nikolaus ; Riedl, Florian ; Pachofszky, Thomas ; Gschwantler, Michael ; König, Kurt ; Schuster, Benjamin ; Mandorfer, Mattias ; Gessl, Irina ; Illiasch, Constanze ; Fuchs, Eva‐Maria ; Unger, Lukas ; Dolak, Werner ; Maieron, Andreas ; Kramer, Ludwig ; Madl, Christian ; Trauner, Michael ; Reiberger, Thomas ; Tacke, Frank</creatorcontrib><description>Background
Current guidelines favour the use of bleeding stents over balloon tamponade (BT) for refractory variceal bleeding (VB) from oesophageal varices. However, data on the efficacy and safety of self‐expandable metal SX‐ELLA Danis stents (SEMS) are limited.
Methods
Cirrhotic patients receiving SEMS for VB at four tertiary care centres were included in this retrospective multicentre study. Rates of failure‐to‐control bleeding (within 5 days) and bleeding‐related mortality (6 weeks) were assessed.
Results
SEMS controlled VB in 79.4% (27/34) of patients. In the rest of patients, other rescue treatments including endoscopic band ligation (EBL, n = 3), SEMS renewed (n = 2) or Linton (n = 2) were applied; however, VB was only controlled in one patient. Early rebleeding within six weeks occurred in 17.6% (6/34) patients. Median SEMS dwell time was three (IQR:6) days. Overall n = 13/34 (38.2%) patients died with SEMS in situ. After SEMS removal, rebleeding and bleeding‐related death occurred in n = 7 (35%) and n = 5 (14.7%) patients respectively. Only 32.4% (10/34) patients did not experience any rebleeding within six weeks after SEMS removal. Bleeding‐related mortality was 47.1% (n = 16/34) and the median survival after SEMS placement was 2.1 months. Notably, no patient received an early transjugular intrahepatic portosystemic shunt (TIPS). The most common adverse events were stent dislocations (n = 13; 38.2%), while ulcers/necrosis of the oesophageal mucosa was seen in only four (11.8%) patients.
Conclusion
SEMS controlled refractory VB in most patients. However, bleeding‐related mortality remained high. While SEMS dislocations were frequent, ulcers/necrosis of the oesophagus was rare. Further studies should investigate whether the wider use of early TIPS reduces bleeding‐related mortality after SEMS placement.</description><identifier>ISSN: 1478-3223</identifier><identifier>EISSN: 1478-3231</identifier><identifier>DOI: 10.1111/liv.13971</identifier><identifier>PMID: 30248224</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Adult ; Aged ; Austria ; Balloon treatment ; Bleeding ; cirrhosis ; Cirrhosis and Liver Failure ; Dislocations ; Dwell time ; Endoscopy, Gastrointestinal ; Esophageal and Gastric Varices - etiology ; Esophageal and Gastric Varices - mortality ; Esophageal and Gastric Varices - therapy ; Esophagus ; Female ; Gastrointestinal Hemorrhage - etiology ; Gastrointestinal Hemorrhage - mortality ; Gastrointestinal Hemorrhage - therapy ; Humans ; Implants ; Liver Cirrhosis - complications ; Male ; Middle Aged ; Mortality ; Mucosa ; Necrosis ; Patients ; Placement ; portal hypertension ; Portasystemic Shunt, Transjugular Intrahepatic ; Retrospective Studies ; self‐expandable metal stent ; Stents ; Stents - adverse effects ; Surgical implants ; Tamponade ; Tips ; Treatment Outcome ; Ulcers ; variceal bleeding</subject><ispartof>Liver international, 2019-02, Vol.39 (2), p.290-298</ispartof><rights>2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd</rights><rights>2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.</rights><rights>2019 John Wiley & Sons A/S</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4431-8799812787b3f56431fe6d17ef7563d20e8a77063878d81051144ff6e02aab2e3</citedby><cites>FETCH-LOGICAL-c4431-8799812787b3f56431fe6d17ef7563d20e8a77063878d81051144ff6e02aab2e3</cites><orcidid>0000-0002-4590-3583 ; 0000-0003-2330-0017 ; 0000-0002-2523-1708 ; 0000-0001-5772-1886 ; 0000-0003-1336-7250</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fliv.13971$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fliv.13971$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30248224$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pfisterer, Nikolaus</creatorcontrib><creatorcontrib>Riedl, Florian</creatorcontrib><creatorcontrib>Pachofszky, Thomas</creatorcontrib><creatorcontrib>Gschwantler, Michael</creatorcontrib><creatorcontrib>König, Kurt</creatorcontrib><creatorcontrib>Schuster, Benjamin</creatorcontrib><creatorcontrib>Mandorfer, Mattias</creatorcontrib><creatorcontrib>Gessl, Irina</creatorcontrib><creatorcontrib>Illiasch, Constanze</creatorcontrib><creatorcontrib>Fuchs, Eva‐Maria</creatorcontrib><creatorcontrib>Unger, Lukas</creatorcontrib><creatorcontrib>Dolak, Werner</creatorcontrib><creatorcontrib>Maieron, Andreas</creatorcontrib><creatorcontrib>Kramer, Ludwig</creatorcontrib><creatorcontrib>Madl, Christian</creatorcontrib><creatorcontrib>Trauner, Michael</creatorcontrib><creatorcontrib>Reiberger, Thomas</creatorcontrib><creatorcontrib>Tacke, Frank</creatorcontrib><title>Outcomes after placement of a SX‐ELLA oesophageal stent for refractory variceal bleeding—A national multicentre study</title><title>Liver international</title><addtitle>Liver Int</addtitle><description>Background
Current guidelines favour the use of bleeding stents over balloon tamponade (BT) for refractory variceal bleeding (VB) from oesophageal varices. However, data on the efficacy and safety of self‐expandable metal SX‐ELLA Danis stents (SEMS) are limited.
Methods
Cirrhotic patients receiving SEMS for VB at four tertiary care centres were included in this retrospective multicentre study. Rates of failure‐to‐control bleeding (within 5 days) and bleeding‐related mortality (6 weeks) were assessed.
Results
SEMS controlled VB in 79.4% (27/34) of patients. In the rest of patients, other rescue treatments including endoscopic band ligation (EBL, n = 3), SEMS renewed (n = 2) or Linton (n = 2) were applied; however, VB was only controlled in one patient. Early rebleeding within six weeks occurred in 17.6% (6/34) patients. Median SEMS dwell time was three (IQR:6) days. Overall n = 13/34 (38.2%) patients died with SEMS in situ. After SEMS removal, rebleeding and bleeding‐related death occurred in n = 7 (35%) and n = 5 (14.7%) patients respectively. Only 32.4% (10/34) patients did not experience any rebleeding within six weeks after SEMS removal. Bleeding‐related mortality was 47.1% (n = 16/34) and the median survival after SEMS placement was 2.1 months. Notably, no patient received an early transjugular intrahepatic portosystemic shunt (TIPS). The most common adverse events were stent dislocations (n = 13; 38.2%), while ulcers/necrosis of the oesophageal mucosa was seen in only four (11.8%) patients.
Conclusion
SEMS controlled refractory VB in most patients. However, bleeding‐related mortality remained high. While SEMS dislocations were frequent, ulcers/necrosis of the oesophagus was rare. Further studies should investigate whether the wider use of early TIPS reduces bleeding‐related mortality after SEMS placement.</description><subject>Adult</subject><subject>Aged</subject><subject>Austria</subject><subject>Balloon treatment</subject><subject>Bleeding</subject><subject>cirrhosis</subject><subject>Cirrhosis and Liver Failure</subject><subject>Dislocations</subject><subject>Dwell time</subject><subject>Endoscopy, Gastrointestinal</subject><subject>Esophageal and Gastric Varices - etiology</subject><subject>Esophageal and Gastric Varices - mortality</subject><subject>Esophageal and Gastric Varices - therapy</subject><subject>Esophagus</subject><subject>Female</subject><subject>Gastrointestinal Hemorrhage - etiology</subject><subject>Gastrointestinal Hemorrhage - mortality</subject><subject>Gastrointestinal Hemorrhage - therapy</subject><subject>Humans</subject><subject>Implants</subject><subject>Liver Cirrhosis - complications</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Mucosa</subject><subject>Necrosis</subject><subject>Patients</subject><subject>Placement</subject><subject>portal hypertension</subject><subject>Portasystemic Shunt, Transjugular Intrahepatic</subject><subject>Retrospective Studies</subject><subject>self‐expandable metal stent</subject><subject>Stents</subject><subject>Stents - adverse effects</subject><subject>Surgical implants</subject><subject>Tamponade</subject><subject>Tips</subject><subject>Treatment Outcome</subject><subject>Ulcers</subject><subject>variceal bleeding</subject><issn>1478-3223</issn><issn>1478-3231</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>EIF</sourceid><recordid>eNp1kcFu1DAQhiMEoqXlwAsgS1zaw7YeO4mdC9KqaqFSpB6gVW-WNxlvUznxYjuLcusjcOAJ-yR4u2UFSPhia_7Pv2bmz7J3QE8gnVPbrU-AVwJeZPuQCznjjMPL3ZvxvexNCPeUQlUV8Drb45TlkrF8P5uuxti4HgPRJqInK6sb7HGIxBmiyZfbx4cf53U9Jw6DW93pJWpLQtwAxnni0XjdROcnsta-azbqwiK23bB8fPg5J4OOnRtStR9tTPoQPab_YzsdZq-MtgHfPt8H2fXF-dezz7P66tPl2byeNXnOYSZFVUlgQooFN0WZSgbLFgQaUZS8ZRSlFoKWXArZSqAFQJ4bUyJlWi8Y8oPs49Z3NS56bJ9a0FatfNdrPymnO_W3MnR3aunWqiykyAuWDI6eDbz7NmKIqu9Cg9bqAd0YFANgIGVF84R--Ae9d6NP428owWgJaY5EHW-pxrsQ0gp3zQBVm0BVClQ9BZrY9392vyN_J5iA0y3wvbM4_d9J1Zc3W8tfmFutJw</recordid><startdate>201902</startdate><enddate>201902</enddate><creator>Pfisterer, Nikolaus</creator><creator>Riedl, Florian</creator><creator>Pachofszky, Thomas</creator><creator>Gschwantler, Michael</creator><creator>König, Kurt</creator><creator>Schuster, Benjamin</creator><creator>Mandorfer, Mattias</creator><creator>Gessl, Irina</creator><creator>Illiasch, Constanze</creator><creator>Fuchs, Eva‐Maria</creator><creator>Unger, Lukas</creator><creator>Dolak, Werner</creator><creator>Maieron, Andreas</creator><creator>Kramer, Ludwig</creator><creator>Madl, Christian</creator><creator>Trauner, Michael</creator><creator>Reiberger, Thomas</creator><creator>Tacke, Frank</creator><general>Wiley Subscription Services, Inc</general><general>John Wiley and Sons Inc</general><scope>24P</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>7T5</scope><scope>7U9</scope><scope>8FD</scope><scope>FR3</scope><scope>H94</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-4590-3583</orcidid><orcidid>https://orcid.org/0000-0003-2330-0017</orcidid><orcidid>https://orcid.org/0000-0002-2523-1708</orcidid><orcidid>https://orcid.org/0000-0001-5772-1886</orcidid><orcidid>https://orcid.org/0000-0003-1336-7250</orcidid></search><sort><creationdate>201902</creationdate><title>Outcomes after placement of a SX‐ELLA oesophageal stent for refractory variceal bleeding—A national multicentre study</title><author>Pfisterer, Nikolaus ; Riedl, Florian ; Pachofszky, Thomas ; Gschwantler, Michael ; König, Kurt ; Schuster, Benjamin ; Mandorfer, Mattias ; Gessl, Irina ; Illiasch, Constanze ; Fuchs, Eva‐Maria ; Unger, Lukas ; Dolak, Werner ; Maieron, Andreas ; Kramer, Ludwig ; Madl, Christian ; Trauner, Michael ; Reiberger, Thomas ; Tacke, Frank</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4431-8799812787b3f56431fe6d17ef7563d20e8a77063878d81051144ff6e02aab2e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Austria</topic><topic>Balloon treatment</topic><topic>Bleeding</topic><topic>cirrhosis</topic><topic>Cirrhosis and Liver Failure</topic><topic>Dislocations</topic><topic>Dwell time</topic><topic>Endoscopy, Gastrointestinal</topic><topic>Esophageal and Gastric Varices - etiology</topic><topic>Esophageal and Gastric Varices - mortality</topic><topic>Esophageal and Gastric Varices - therapy</topic><topic>Esophagus</topic><topic>Female</topic><topic>Gastrointestinal Hemorrhage - etiology</topic><topic>Gastrointestinal Hemorrhage - mortality</topic><topic>Gastrointestinal Hemorrhage - therapy</topic><topic>Humans</topic><topic>Implants</topic><topic>Liver Cirrhosis - complications</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Mucosa</topic><topic>Necrosis</topic><topic>Patients</topic><topic>Placement</topic><topic>portal hypertension</topic><topic>Portasystemic Shunt, Transjugular Intrahepatic</topic><topic>Retrospective Studies</topic><topic>self‐expandable metal stent</topic><topic>Stents</topic><topic>Stents - adverse effects</topic><topic>Surgical implants</topic><topic>Tamponade</topic><topic>Tips</topic><topic>Treatment Outcome</topic><topic>Ulcers</topic><topic>variceal bleeding</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pfisterer, Nikolaus</creatorcontrib><creatorcontrib>Riedl, Florian</creatorcontrib><creatorcontrib>Pachofszky, Thomas</creatorcontrib><creatorcontrib>Gschwantler, Michael</creatorcontrib><creatorcontrib>König, Kurt</creatorcontrib><creatorcontrib>Schuster, Benjamin</creatorcontrib><creatorcontrib>Mandorfer, Mattias</creatorcontrib><creatorcontrib>Gessl, Irina</creatorcontrib><creatorcontrib>Illiasch, Constanze</creatorcontrib><creatorcontrib>Fuchs, Eva‐Maria</creatorcontrib><creatorcontrib>Unger, Lukas</creatorcontrib><creatorcontrib>Dolak, Werner</creatorcontrib><creatorcontrib>Maieron, Andreas</creatorcontrib><creatorcontrib>Kramer, Ludwig</creatorcontrib><creatorcontrib>Madl, Christian</creatorcontrib><creatorcontrib>Trauner, Michael</creatorcontrib><creatorcontrib>Reiberger, Thomas</creatorcontrib><creatorcontrib>Tacke, Frank</creatorcontrib><collection>Wiley Online Library Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Liver international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pfisterer, Nikolaus</au><au>Riedl, Florian</au><au>Pachofszky, Thomas</au><au>Gschwantler, Michael</au><au>König, Kurt</au><au>Schuster, Benjamin</au><au>Mandorfer, Mattias</au><au>Gessl, Irina</au><au>Illiasch, Constanze</au><au>Fuchs, Eva‐Maria</au><au>Unger, Lukas</au><au>Dolak, Werner</au><au>Maieron, Andreas</au><au>Kramer, Ludwig</au><au>Madl, Christian</au><au>Trauner, Michael</au><au>Reiberger, Thomas</au><au>Tacke, Frank</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes after placement of a SX‐ELLA oesophageal stent for refractory variceal bleeding—A national multicentre study</atitle><jtitle>Liver international</jtitle><addtitle>Liver Int</addtitle><date>2019-02</date><risdate>2019</risdate><volume>39</volume><issue>2</issue><spage>290</spage><epage>298</epage><pages>290-298</pages><issn>1478-3223</issn><eissn>1478-3231</eissn><abstract>Background
Current guidelines favour the use of bleeding stents over balloon tamponade (BT) for refractory variceal bleeding (VB) from oesophageal varices. However, data on the efficacy and safety of self‐expandable metal SX‐ELLA Danis stents (SEMS) are limited.
Methods
Cirrhotic patients receiving SEMS for VB at four tertiary care centres were included in this retrospective multicentre study. Rates of failure‐to‐control bleeding (within 5 days) and bleeding‐related mortality (6 weeks) were assessed.
Results
SEMS controlled VB in 79.4% (27/34) of patients. In the rest of patients, other rescue treatments including endoscopic band ligation (EBL, n = 3), SEMS renewed (n = 2) or Linton (n = 2) were applied; however, VB was only controlled in one patient. Early rebleeding within six weeks occurred in 17.6% (6/34) patients. Median SEMS dwell time was three (IQR:6) days. Overall n = 13/34 (38.2%) patients died with SEMS in situ. After SEMS removal, rebleeding and bleeding‐related death occurred in n = 7 (35%) and n = 5 (14.7%) patients respectively. Only 32.4% (10/34) patients did not experience any rebleeding within six weeks after SEMS removal. Bleeding‐related mortality was 47.1% (n = 16/34) and the median survival after SEMS placement was 2.1 months. Notably, no patient received an early transjugular intrahepatic portosystemic shunt (TIPS). The most common adverse events were stent dislocations (n = 13; 38.2%), while ulcers/necrosis of the oesophageal mucosa was seen in only four (11.8%) patients.
Conclusion
SEMS controlled refractory VB in most patients. However, bleeding‐related mortality remained high. While SEMS dislocations were frequent, ulcers/necrosis of the oesophagus was rare. Further studies should investigate whether the wider use of early TIPS reduces bleeding‐related mortality after SEMS placement.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>30248224</pmid><doi>10.1111/liv.13971</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-4590-3583</orcidid><orcidid>https://orcid.org/0000-0003-2330-0017</orcidid><orcidid>https://orcid.org/0000-0002-2523-1708</orcidid><orcidid>https://orcid.org/0000-0001-5772-1886</orcidid><orcidid>https://orcid.org/0000-0003-1336-7250</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Liver international, 2019-02, Vol.39 (2), p.290-298 |
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| language | eng |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Adult Aged Austria Balloon treatment Bleeding cirrhosis Cirrhosis and Liver Failure Dislocations Dwell time Endoscopy, Gastrointestinal Esophageal and Gastric Varices - etiology Esophageal and Gastric Varices - mortality Esophageal and Gastric Varices - therapy Esophagus Female Gastrointestinal Hemorrhage - etiology Gastrointestinal Hemorrhage - mortality Gastrointestinal Hemorrhage - therapy Humans Implants Liver Cirrhosis - complications Male Middle Aged Mortality Mucosa Necrosis Patients Placement portal hypertension Portasystemic Shunt, Transjugular Intrahepatic Retrospective Studies self‐expandable metal stent Stents Stents - adverse effects Surgical implants Tamponade Tips Treatment Outcome Ulcers variceal bleeding |
| title | Outcomes after placement of a SX‐ELLA oesophageal stent for refractory variceal bleeding—A national multicentre study |
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