Self-expanding metal stent for refractory bleeding esophageal varices - single center experience

Abstract

Introduction: Bleeding esophageal varices (EV) is a severe and life threatening complication of portal hypertension (PH), while endoscopic failure to control hemorrhage is even a more dramatic situation. Aim: To assess self-expanding metal stent (SEMS) haemostatic efficacy in severe variceal hemorrhage in patients with bleeding EV and endoscopic treatment failure. Material and Methods: A total of 12 patients, (M=8) with the mean ±SD age - 46.92±3.09 (24-62 years) and liver cirrhosis induced bleeding EV (n=8) and esophageal post-banding ulcers (n=4) were enrolled in the study. The main selection criteria was endoscopic treatment failure. A removable covered SEMS (SX-ELLA stent Danis, 135x25 mm, ELLA-CS, Hradec-Kralove, Czech Republic) was used in all cases. The mean SEMS used per patient was 1.25±0.18 (1-3). All definitions were used according to Baveno Consensus (I-V) conferences. Results: Initial SEMS haemostatic efficacy was 100%. Partial distal stent migration was documented on X-ray and CT-scan in 5/12(41.6%) and stent reposition was achieved by second-look endoscopy. The 30-days mortality was 25% (3/12). Tanatogenesis was induced by hepatic failure (n=2) and bleeding EV distally to the stent distal end (n=l). Conclusions: The preliminary results demonstrate that stenting is an effective life-saving hemostatic procedure in high-risk patients with severe esophageal variceal bleeding and endoscopic hemostasis failure as well as postbanding esophageal ulcers. Final conclusions will be reached after gaining experience with this new method on larger series.