Esophageal Stenting Flashcards
- Peptic esophagitis
- Barrett’s esophagus
- Gastroesophageal reflux disease (GERD)
- Anastomotic stricture
Why do we stent esophageal cancer?
Early cancer may be treated by minimally invasive treatments or immediate surgery to remove the diseased portion of the esophagus. Stent Treatment is usually palliative and intended to assist in restoring normal swallowing.
In which stage do we usually consider stenting the esophagus?
Stents are typically considered for Stages II to IV.
What is the TNM Cancer Staging System?
T - refers to the size and extent of the main tumor (This is usually the primary tumor)
N - refers to the number of nearby lymph nodes that have cancer
M - refers to whether the cancer has metastasized
When a benign esophageal stricture reoccurs even after multiple treatments, which is defined as 3 or more dilations within a 12-month period, it may be referred to as a ____?
Refractory Benign Stricture
What is a Tracheo-Esophageal Fistula?
A tracheo-esophageal fistula (TE) is an esophageal erosion into the trachea.
Treatment for TE fistulas may include surgery or stent placement. These fistulas are relatively uncommon.
* A malignant TE fistula is usually an incurable condition. Treatment, therefore, is usually palliative.
* A benign TE fistula is usually caused by prolonged inflammation of the proximal and mid-esophagus or trauma to the esophagus.
What are some reasons we would place an Esophageal Stent?
- Malignant strictures
- External compression of the GI tract
- Malignant GI perforations and fistula
- Support for patients undergoing chemoradiation therapy (to allow oral feeding of patients with dysphagia)
What are possible stent complications?
- Perforation
- Stent migration
- Dysphagia due to tumor overgrowth at the end of the stent
- Dysphagia/re-obstruction due to tumor in-growth through the stent
- Dysphagia due to food impaction
- Tracheal compression
- Bleeding
Why is Nitinol the prefered material for esophageal stents?
- Radiopaque material (Fluro visualization)
- Shape memory
- Super elasticity
- Constrainability and smaller delivery systems
What does it mean to say that stents need to be “biocompatible”?
Biocompatibility is the ability of the device to perform its intended function without eliciting any undesirable local or systemic effects in the host
A non-bio-compatible material could lead to body response, immune response, degradation, and malfunction of the implant
Demonstrating biocompatibility using the ISO 10993 Standards are a critical safety requirement
Small cell size and closed cell design may be favorable to prevent ___?
Tumor ingrowth
Stent migration is the most frequent adverse event. Some design features have been created to help prevent migration. Examples of anti-migration features include…?
- Flared ends
- Anchoring fins
- Varying Radial Forces
- Partially covered stents that allow for controlled tissue in-growth
What is the difference between partially & fully covered stents?
Partially covered stents have uncovered ends of the stent. Designed to allow for controlled tissue ingrowth, which may help to reduce stent migration.
The fully covered stent has a covering for the entire stent. This is designed to prevent tissue ingrowth. These can be removed.
Which Esophageal Stent is through-the-scope?
Agile
What are the stent body diameter options for WallFlex Esophageal?
18 - For both fully & partially covered
23 - For both fully & partially covered
