Esophageal Stent, El Salvador Atlas of Gastrointestinal Video Endoscopy

El Salvador Atlas of Gastrointestinal VideoEndoscopy. A Large Database of Images and Video Clips with Cases Reported.

Videoendoscopic Sequence 1 of 14.

This 91-year-old male with adenocarcinoma of the cardias
In order to alleviate the malign dysphagia an esophageal
stent is placed without fluroscopy, a stent's retractable
delivery system was used.

No patient is more unfortunate than those than suffer a
malignant obstruction of the esophagus, because they die
of slow starvation” and cannot die with dignity without
being able to swallow”.

For more endoscopic details, download the video clips
by clicking on the endoscopic images. Wait to be
downloaded complete then Press Alt and Enter for full
screen.

All endoscopic images shown in this Atlas contain
video clips. We recommend seeing the video clips in full
screen mode.

Videoendoscopic Sequence 2 of 14.

The Antrum is infiltrated as well as the corpus and fundus
an extensive irregular ulceration at the gastric antrum that
could think about being lymphoma but the biopsies
ruled out.

Videoendoscopic Sequence 3 of 14.

The main lesion is in the gastric fundus that is constricted
and ulcerated seen at at retroflexion.

Videoendoscopic Sequence 4 of 14.

The second part of the duodenum observing a peculiar
pattern, The yellow patches of mucosa are Intestinal
Microvilli alternating with absence of them.

Videoendoscopic Sequence 5 of 14.

Papilla of Vater is observed with different morphology,
possibly by compression of carcinonomatosis.

Videoendoscopic Sequence 6 of 14.

A close up of thePapilla of Vater

Deployed a standard guidewire into the stomach. Then, withdrew the endoscope and repositioned it near the guidewire to visualize the proximal stricture margin.

Videoendoscopic Sequence 71 of 14.

The Beginning of the Procedure

Deployed a standard guidewire into the stomach. Then,
withdrew the endoscope and repositioned it near the
guidewire to visualize the proximal stricture margin.

Through the guide of Savari, the apparatus to place the Stent it is passed through the oro-pharynx, soon under direct vision with endoscope.

Videoendoscopic Sequence 8 of 14.

Controlled Release Esophageal Stent System

Through the guide of Savari, the apparatus to place the
Stent it is passed through the oro-pharynx, soon under
direct vision with endoscope.

Esophageal stent placement under endoscopic
control alone.

Videoendoscopic Sequence 9 of 14.

The stent was passed across the stricture and the white
mark was positioned near the proximal margin using direct
visualization. The stent then was released; placement was
confirmed by direct visualization.

Videoendoscopic Sequence 10 of 14.

More maneuvers to pass the Stent

During an esophageal stent placement procedure, a tiny
tube known as a stent is placed at a point of narrowing or
blockage to open up the esophagus to help the patient
swallow or drink more easily. These tubes are made out of
polyester(plastic), nitinol(metal) or hybrid material. Stents
may be used to treat patients suffering from a refractory
benign (non-cancerous) or malignant (cancerous) disease.

Videoendoscopic Sequence 11 of 14.

The Evolution stent's retractable delivery system
facilitates direct monitoring of the placement progress
throughout the procedure with it's “point-of-no-return”
indicator, allowing physicians more controlled placement
of the stent. With each squeeze of the stent's
trigger-based introducer, a proportional length of the stent
is deployed or recaptured. The directional button enables
seamless switching from deployment to recapture mode
and the “point-of-no-return” mark alerts the physician
when recapture is no longer available. However, even
after this point repositioning is still an option.

The Evolution Stent is designed with dual flanges that secure the stent, potentially reducing the risk of migration or stent movement after placement, thus eliminating the need for repeat procedures. It is also the only esophageal stent with an internal and external silicone coating, designed to resist tumor ingrowth into the stent and enhances the patients' ability to swallow food normally instead of eating through a tube.

Videoendoscopic Sequence 12 of 14.

A 12-cm stent was used for the stricture

The Evolution Stent is designed with dual flanges that
secure the stent, potentially reducing the risk of migration
or stent movement after placement, thus eliminating the
need for repeat procedures. It is also the only esophageal
stent with an internal and external silicone coating,
designed to resist tumor ingrowth into the stent and
enhances the patients' ability to swallow food normally
instead of eating through a tube.

In this video the deploying of the Stent is observed.

Videoendoscopic Sequence 13 of 14.

Stent with retractable delivery system

In this video the deploying of the Stent is observed

The esophageal stent maintaining esophageal lumen
patency in esophageal strictures caused by intrinsic or
extrinsic tumors.

Videoendoscopic Sequence 14 of 14.

Final Status of the stent placement

This technique should not be used in patients with
complicated anatomy or perforation when safety and
accuracy likely would be enhanced by fluoroscopy.

To see the complete endoscopic sequence of this case click here.

Endoscopic-placed stent to provide palliation of dysphagia.

The patient obtained a significant improvement in the
quality of life.

Successfully deployed Self-expanding stent in the
esophagus under fluroscopy control.
This image and the video clip were taken one week after
the procedure.

Esophageal Z-Stent with dua anti-reflux valve is used to
maintain patency of malignant esophageal strictures and
to decrease esophageal reflux and aspiration.

Effective method of palliating dysphagia related to stricture
caused by malignant esophageal lesions.

Esophageal balloon dilation and expandable stent
placement aresafe, minimally invasive, effective
treatments for esophageal malign strictures.

These procedures have brought the managementof
dysphagia due to esophageal strictures into the field of
interventional radiology. Esophageal dilation is usually
indicatedfor benign stenoses and is technically successful
in more than90% of cases. Most patients with esophageal
carcinoma are notcandidates for resection; thus, the main
focus of treatmentis palliation of malignant dysphagia.

Videoendoscopic Sequence 1 of 28.

Distal Esophageal Squamous Cell Carcinoma.

This 62 year-old female, presented with progresive disphagia to solid following to liquids.

Because the esophagus lacks a serosal covering,
esophageal carcinoma encounters few anatomic barriers to
local invasion.

Videoendoscopic Sequence 2 of 28.

Endoscopic views of an ulcerated mid-esophageal
squamous cell carcinoma causing lumenal stenosis are
seen in the endoscopic image as well as the video clip.

Risk factors for esophageal squamous carcinoma include
mainly smoking and alcoholism in the U.S. In other parts
of the world dietary factors may play a role. Cancer of the
esophagus remains a devastating disease because it is
usually not detected until it has progressed to an advanced
incurable stage.

At the time of diagnosis, weight loss and dysphagia are the
most common symptoms. Dysphagia usually occurs late in
the course of the disease when the esophageal lumen has
been narrowed by 50-75%. Less commonly, presenting
symptoms may be related to local invasion or metastases.

Videoendoscopic Sequence 3 of 28.

Retroflexed image, seen the tumor at the gastric cardias

Examples of signs and symptoms include stridor, cough,
and aspiration pneumonia as the result of erosion into the
tracheobronchial tree; hemoptysis or hematemesis
resulting from invasion of a mediastinal vessel; left vocal
cord paralysis resulting from recurrent laryngeal nerve
involvement by tumor or lymph node metastasis;
malignant pleural effusion; and diaphragmatic paralysis.
Jaundice and bone pain are systemic manifestations of
organ metastases.

The Stent was tried to be applied, and was placed above the tumor. This Stent was tried to be placed without fluroscopy under direct vision. The model of this manufacturer is relatively new, which is applied in a way, like the arms imitating a gun. We were excited when seeing the image of the stent that was being unrolled like a screw, but we didn't notice that we had passed from the zone of security of the stent of where it is possible to be dissuaded before being released. Therefore we had to leave it on top of the tumor and to reprogram, to place another one in a second intention, being placed under direct vision without fluroscopia like it is observed in the sequences of below. We at least gained a good case to place it in this atlas.

Videoendoscopic Sequence 4 of 28.

Failure to place the first Stent

Stent with retractable delivery system

The Stent was tried to be applied, and was placed above
the tumor. This Stent was tried to be placed without
fluroscopy under direct vision. The model of this
manufacturer is relatively new, which is applied in a way,
like the arms imitating a gun. We were excited when
seeing the image of the stent that was being unrolled like a
screw, but we didn’t notice that we had passed from the
zone of security of the stent of where it is possible to be
dissuaded before being released.
(With it's “point-of-no -return”) indicator Therefore we had
to leave it on top of the tumor and to reprogram, to place
another one in a second intention, being placed under
direct vision without fluroscopia like it is observed in the
sequences of below. We at least gained a good case to
place it in this atlas.

We used a Stent's retractable delivery system facilitates direct monitoring of the placement progress throughout the procedure with it's “point-of-no-return” indicator, allowing physicians more controlled placement of the stent.

Videoendoscopic Sequence 5 of 28.

Upper portion of stent

We used a Stent's retractable delivery system facilitates
direct monitoring of the placement progress throughout the
procedure with it's “point-of-no-return” indicator, allowing
physicians more controlled placement of the stent.

It is come to dilate the tumor with a hydrostatic balloon. The procedure is continued making an ablative therapy with argon plasma. Two weeks later another stent is placed. In this image and video, the first stent placed of the tumor, is observed.

Videoendoscopic Sequence 6 of 28.

The hydrostatic balloon is used to delated the tumor.

The procedure is continued performing with an ablative
therapy with argon plasma. Two weeks later another stent
is placed to overcome the stenosis caused by the neoplasia.
In this image and video clip, the first stent is placed
above of the tumor.

Videoendoscopic Sequence 7 of 28.

The procedure is continued performing ablative therapy with argon plasma.

Videoendoscopic Sequence 8 of 28.

Two weeks later another stent is place

In this image as well as the video clip is observed the first
stent placed above of the neoplasia.

Videoendoscopic Sequence 9 of 28.

A close up of the tumor

Palliation is directed at reducing esophageal obstruction
sufficiently to allow oral intake. Suffering caused by
esophageal obstruction can be significant, with salivation
and recurrent aspiration. Options include manual dilation
procedures (bougienage), orally inserted stents, radiation
therapy, laser photocoagulation, and photodynamic
therapy. In some cases, cervical esophagostomy with
feeding jejunostomy is required.

Videoendoscopic Sequence 10 of 28.

Deployed a standard guidewire into the stomach. Then,
withdrew the endoscope and repositioned it near the
guidewire to visualize the proximal stricture margin.

As with dilation, technological advances have driven the increased use of, and indications for, endolumenal stents in the alimentary canal. Expandable stent therapy has virtually supplanted conventional prosthesis placement in the esophagus, given the relative ease of placement and improved safety profi le during insertion. Nevertheless, critical evaluation of this technology suggests that the need for intervention actually may increase after placement of expandable esophageal stents. This reintervention is a direct consequence of stent design: uncovered stents elicit granulation tissue and allow tumor ingrowth, and completely covered prostheses have a penchant for migration. All prostheses have the capability of causing erosion with fi stulization, gastrointestinal bleeding, or occlusion by food bolus.

Videoendoscopic Sequence 11 of 28.

Another image and video clip of the first stent

As with dilation, technological advances have driven the
increased use of, and indications for, endolumenal stents
in the alimentary canal. Expandable stent therapy has
virtually supplanted conventional prosthesis placement in
the esophagus, given the relative ease of placement and
improved safety profi le during insertion. Nevertheless,
critical evaluation of this technology suggests that the
need for intervention actually may increase after
placement of expandable esophageal stents. This
reintervention is a direct consequence of stent design:
uncovered stents elicit granulation tissue and allow tumor
ingrowth, and completely covered prostheses have a
penchant for migration. All prostheses have the capability
of causing erosion with fi stulization, gastrointestinal
bleeding, or occlusion by food bolus.