| Autor: |
Harnain, C.M., Ahmad, N., Vitale, M., McCabe, S., Rozenblit, G., Maddineni, S., Zalvan, C. |
| Zdroj: |
Journal of Vascular & Interventional Radiology; Mar2014 Supplement, Vol. 25 Issue 3, pS202-S202, 1p |
| Abstrakt: |
Learning Objectives: A standard 24-French mushroom-retained gastrostomy tube (MRG) can be used as a replaceable stent in the treatment of benign esophageal stricture (BES). Background: Dilation with balloon or bougie is a common treatment for BES. Intraluminal stenting is an option with potentially serious adverse effects. Bare metal stents result in granulation tissue overgrowth and are difficult to remove or exchange. Covered metal stents and plastic stents may cause pain and are prone to migration. We present the use of a standard MRG as a stent in the treatment of BES. Clinical Findings/Procedure Details: IR was consulted regarding a patient with history of lye ingestion treated with colonic interposition and subsequent surgical revision. He presented to us with functional esophageal occlusion due to a stricture at the upper anastamosis. The patient could not swallow his saliva and was cachectic, being fed via a percutaneous gastrostomy tube. After cannulation and dilation of the stricture with an angioplasty balloon, the MRG was sized, cut to length, and loaded onto the balloon catheter with the mushroom bumper at the trailing end. This was introduced over an Amplatz wire with the partially inflated balloon serving as a tapered lead point. The MRG was positioned with the mushroom resting just above the stricture, precluding downward stent migration. Patency of the MRG was verified by injection of contrast. The patient was discharged home the same day and improved clinically over the ensuing weeks. He was able to swallow liquids easily without aspiration. Three months later the patient coughed up the MRG, which was uneventfully replaced using the same technique. Conclusion and/or Teaching Points: A MRG was used as a stent alternative for treating BES, allowing the patient to swallow secretions and improving his quality of life. The MRG is readily available, removable, well tolerated, can be customized and functions adequately. Downward stent migration is prevented by the mushroom, which has not interfered with epiglottal function in our case. Fixation of the caudal aspect of the tube, such as by tethering with a suture through a percutaneous gastrostomy, may be considered to prevent accidental upward migration in future cases. [Copyright &y& Elsevier] |
| Databáze: |
Supplemental Index |
| Externí odkaz: |
|
