Danis stent for esophageal bleeding: for and against
A.Yu. ANISIMOV1, A.V. LOGINOV2
1Kazan State Medical Academy, 36 Butlerov Str., Kazan, Russian Federation, 420012
2Municipal Clinical Hospital №7, 54 Chuikov Str., Kazan, Russian Federation, 420103
Anisimov A.Yu. ― D. Med. Sc., Professor, Head of the Emergency Medical Care Department, tel. +7-987-297-16-54, e-mail: aanisimovbsmp@yandex.ru
Loginov A.V. ― surgeon of the Emergency Department, tel. +7-953-405-41-02, e-mail: 613310@bk.ru
The possibility of endoscopic hemostasis with self-expanding nitinol Danis stents as an alternative to balloon Sengstaken ― Blackmore tamponade in the complex treatment program of patients with acute bleeding from varicose esophageal veins. The own clinical experience is presented in treating 19 patients with high esophageal bleeding or high risk of its recurrence by self-expanding nitinol stent installation instead of the traditional Danish balloon Sengstaken ― Blackmore tamponade. The advantages of Danish stent include low trauma; good tolerance by the patient; providing the physiological drainage of saliva and the possibility of taking liquids and food through the mouth; repeated endoscopic inspection of the esophagus and stomach, after the introduction of the stent; reducing the risk of aspiration pneumonia; the impossibility of removal or displacement by the patient in a state of excitement. The disadvantages of self-expanding nitinol Danis stents, in addition to the risk of migration from the esophagus into the lumen of the stomach with loss of its plugging function, include the need for anesthesia during stent installation, and high probability of repeated bleeding after removal of the stent, and limitation of therapeutic effect only with varicose dilated esophagus veins, and development of small erosions or ulcers on the mucous membrane of the esophagus after the stent removal. Endoscopic hemostasis by self-expanding nitinol Danis stents can be regarded as a reasonable alternative to balloon Sengstaken ― Blackmore tamponade in patients with varicose esophageal bleeding.
Key words: portal hypertension, bleeding from esophageal varicose veins, endoscopic hemostasis, Danis stent, Sengstaken ― Blackmore probe-obturator.
REFERENCES
- Kitsenko E.A., Anisimov A.Yu., Andreev A.I. The current state of the problem of bleeding from varicose veins of the esophagus and stomach. Vestnik sovremennoy klinicheskoy meditsiny, 2014, 7 (5), pp. 89-98 (in Russ.).
- Shertsinger A.G., Chzhao A.V., Ivashkin V.T. et al. Treatment of bleeding esophageal varices and gastric. Annaly khirurgicheskoy gepatologii, 2013, 18 (3), pp. 110-129 (in Russ.).
- Cook D., Laine L. Indications, technique, and complications of balloon tamponade for variceal gastrointestinal bleeding. Journal of Intensive Care Medicine, 1992, 7 (4), pp. 212-218.
- Escorsell A., Bosch J. Self-expandable metal stents in the treatment of acute esophageal variceal bleeding. Gastroenterology Research and Practice, 2011, DOI: 10.1155/2011/910986.
- Matull W.R., Cross T.J., Yu D. et al. A removable covered self-expanding metal stent for the management of Sengstaken ― Blakemore tube-induced esophageal tear and variceal hemorrhage. Gastrointestinal Endoscopy, 2008, 68 (4), pp. 767-768; discussion 768. DOI: 10.1016/j.gie.2008.03.1078.
- Hubmann R., Czompo M., Benko L. Pouzitie ezofagoveho sten- tu — prve skusenosti v liecbe krvacajucich varixov pazeraka. Lekarsky Obz, 2004, 53 (12), pp. 458-461.
- Hubmann R., Bodlaj G., Czompo M. The use of self-expanding metal stents to treat acute esophageal variceal bleeding. Endoscopy, 2006, 38 (9), pp. 896-901.
- Zehetner J., Shamiyeh A., Wayand W., Hubmann R. Results of a new method to stop acute bleeding from esophageal varices: implantation of a self-expanding stent. Surgical Endoscopy and Other Interventional Techniques, 2008, 22 (10), pp. 2149-52, DOI: 10.1007/s00464-008-0009-7.
- Dechene A., El Fouly A.H., Bechmann L.P. Acute management of refractory variceal bleeding in liver cirrhosis by self-expanding metal stents. Digestion Copy, 2012, 85 (3), P. 185-91, DOI: 10.1159/000335081.
- Ghidirim Gh.P., Mishin I.V., Dolghii A.N., et al. Self-expanding metal stent for the management of bleeding esophageal varices — single center experience. Klіnіchna anatomіya ta operativna khіrurgіya, 2012, 11 (4), pp. 100-103.
- Holster I.L., Kuipers E.J., van Buuren H.R. et al. Self-expandable metal stents as definitive treatment for esophageal variceal bleeding. Endoscopy, 2013, 45 (6), P. 485-8, DOI: 10.1055/s-0032-1326227.
- Fejfar T., Safka V., Jirkovsky V., Hulek P. Danis oesophageal stent in treatment of variceal bleeding. Gastroenterol. Hepatol, 2013, 67 (2), pp. 98-103.
- Maufa F., Al-Kawas F.H. Role of self-expandable metal stents in acute variceal bleeding. Int. J. Hepatol, 2012, DOI: 10.1155/2012/418369.
- Wong Kee Song L.M., Banerjee S., Barth B.A. Emerging technologies for endoscopic hemostasis. Gastrointest Endosc, 2012, 75 (5), pp. 933-7, DOI: 10.1016/j.gie.2012.01.024.
- Safka V., Hulek P. Current Practice of Danis Stent, print H.R.G. Litomysl, 2014. 136.
- Shertsinger A.G. Patogenez, diagnostika, profilaktika i lechenie krovotecheniy iz varikozno rasshirennykh ven pishchevoda i zheludka u bol’nykh s portal’noy gipertenziey: avtoref. dis. … d-ra med. nauk [The pathogenesis, diagnosis, prevention and treatment of bleeding esophageal varices and stomach in patients with portal hypertension. Synopsis of dis. Dr med. sciences]. Moscow, 1986. 31 p.
- Gorbashko A.I. Ostrye zheludochno-kishechnye krovotecheniya [Acute gastrointestinal bleeding]. Leningrad, 1974. 250 p.
- Dechene A., Adamzik M., Gerken G., Canbay A. Acute bronchial obstruction following esophageal stent implantation for variceal bleeding. Endoscopy, 2009, 41, El 46-El 47, DOI: 10.1055/s-0028-1119725.