Self-Expanding Metal Stent (SEMS): an Innovative Rescue Therapy for Refractory Acute Variceal Bleeding

Overview

Journal Endosc Int Open

Specialty Gastroenterology

Date 2015 Jul 3

PMID 26135101

Citations 2

Authors

Kinesh Changela

Mel A Ona

Sury Anand

Sushil Duddempudi

Affiliations

Soon will be listed here.

Abstract

Background: Acute variceal bleeding (AVB) is a life-threatening complication of liver cirrhosis or less commonly splenic vein thrombosis. Pharmacological and endoscopic interventions are cornerstones in the management of variceal bleeding but may fail in 10 - 15 % of patients. Rescue therapy with balloon tamponade (BT) or transjugular intrahepatic portosystemic shunt (TIPS) may be required to control refractory acute variceal bleeding effectively but with some limitations. The self-expanding metal stent (SEMS) is a covered, removable tool that can be deployed in the lower esophagus under endoscopic guidance as a rescue therapy to achieve hemostasis for refractory AVB.

Aims: To evaluate the technical feasibility, efficacy, and safety of SEMS as a rescue therapy for AVB.

Methods: In this review article, we have performed an extensive literature search summarizing case reports and case series describing SEMS as a rescue therapy for AVB. Indications, features, technique, deployment, success rate, limitations, and complications are discussed.

Results: At present, 103 cases have been described in the literature. Studies have reported 97.08 % technical success rates in deployment of SEMS. Most of the stents were intact for 4 - 14 days with no major complications reported. Stent extraction had a success rate of 100 %. Successful hemostasis was achieved in 96 % of cases with only 3.12 % found to have rebleeding after placement of SEMS. Stent migration, which was the most common complication, was observed in 21 % of patients.

Conclusion: SEMS is a safe and effective alternative approach as a rescue therapy for refractory AVB.

Citing Articles

Emergent Transjugular Intrahepatic Portosystemic Shunt Creation in Acute Variceal Bleeding.

Pandhi M, Kuei A, Lipnik A, Gaba R Semin Intervent Radiol. 2020; 37(1):3-13.

PMID: 32139965 PMC: 7056345. DOI: 10.1055/s-0039-3402015.

Innovative Approach of Using Esophageal Stent for Refractory Post-Band Ligation Esophageal Ulcer Bleed Following Living Donor Liver Transplantation.

Choudhary N, Puri R, Saigal S, Saraf N, Sud R, Soin A J Clin Exp Hepatol. 2016; 6(2):149-50.

PMID: 27493462 PMC: 4963324. DOI: 10.1016/j.jceh.2016.01.003.

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