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Palliation With Endoluminal Stents

Palliation With Endoluminal Stents. Todd H. Baron, M.D., F.A.C.P. Professor of Medicine Gastroenterology & Hepatology Mayo Clinic College of Medicine. Enteral Stents. Malignant Gastric Outlet Obstruction. Clinical Situations. Unresectable CA pancreatic, GB, Cholangio Metastatic disease

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Palliation With Endoluminal Stents

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  1. Palliation With Endoluminal Stents Todd H. Baron, M.D., F.A.C.P. Professor of Medicine Gastroenterology & Hepatology Mayo Clinic College of Medicine

  2. Enteral Stents

  3. Malignant Gastric Outlet Obstruction

  4. Clinical Situations • Unresectable CA pancreatic, GB, Cholangio • Metastatic disease • Local invasion - colon • Gastric CA • primary • Recurrent

  5. SEMS: Overview • May be placed endoscopically or radiologically • Non-TTS difficult but possible • TTS placement - can be placed beyond ligament of Treitz - uncovered

  6. Wallstent • Delivery diameter: 10F • Deployed diameter: 20mm 22mm • TTS

  7. Cost of Palliation: Pancreatic CA ENDO GASTRO-J p Number of patients 12 15 Median survival (days) 94 92 NS Median charges incurred $9921 $28,173 < 0.005 Median hospitalization stay required (days) 4 14 < 0.005 Number requiring repeat procedures and hospitalization 7 (58.3%) 15 (100%) Yim, et al., GIE, 2001

  8. Malignant Colorectal Obstruction

  9. Metal Colonic Stents • Wilson-Cook Z stent • Microvasive Wallstent • Precision Ultraflex Colonic • OTHER • Ultraflex Esophageal Stent

  10. Colonic Z-Stent • Delivery diameter: 10mm (30F) • Deployed diameter: 35/25mm

  11. Indications for Colorectal Stents • Pre-operative • Palliative • Indeterminate

  12. Potential Benefits ofPre-operative Colon Stents • One-stage operation • Reduced costs • Improved QOL • Elective operation • Pre-operative assessment tumor resectability patient operability

  13. Complications of Enteral Stents • Tumor ingrowth/overgrowth • Migration • Perforation immediate delayed • Impaction • Bleeding • Pain/Tenesmus

  14. Conclusions • SEMS are effective for closing TEF and treating all forms of malignant esophageal obstruction • SEMS are cost-effective for palliation of malignant GOO for pancreatic CA • SEMS can be used for both pre-operative and palliative treatment of malignant colonic obstruction

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