The Guidelines for Percutaneous Transhepatic Portal Vein Embolization: English Version.

Preoperative portal vein embolization is a beneficial option to reduce the risk of postoperative liver failure by promoting the growth of the future liver remnant. In particular, a percutaneous transhepatic procedure (percutaneous transhepatic portal vein embolization) has been developed as a less-invasive approach. Although percutaneous transhepatic portal vein embolization is widely recognized as a safe procedure, various complications, including rare but fatal adverse events, have been reported. Currently, there are no prospective clinical trials regarding percutaneous transhepatic portal vein embolization procedures and no standard guidelines for the PTPE procedure in Japan. As a result, various methods and various embolic materials are used in each hospital according to each physician's policy. The purpose of these guidelines is to propose appropriate techniques at present and to identify issues that should be addressed in the future for safer and more reliable percutaneous transhepatic portal vein embolization techniques.

Efficacy of Subtraction Computed Tomography Arteriography During Preoperative Embolization in Spinal Tumors.

Background: This study aimed to evaluate the efficacy of subtraction computed tomography arteriography (s-CTA) during preoperative embolization in spinal tumors. Methods: The study analyzed 17 vertebrae in 13 patients who underwent preoperative embolization before spinal fixation surgery for malignant spinal tumors to decrease blood loss at our hospital from 2019 to 2021. Their ages ranged from 56 to 88 years (average, 73.5 years). Metastatic bone tumors were most common, including five cases originating as lung carcinomas and three as renal cancers. After digital subtraction angiography of selected tumor-feeding arteries and non-subtraction CTA (ns-CTA) were performed, s-CTA was conducted using data obtained from both procedures. A clarity score of the boundary between the normal bone and tumor was derived for each patient, which was then classified into four grades (good, 3 points; fair, 2 points; faint, 1 point; poor, 0 points) by two experienced radiologists, followed by a comparison between the s-CTA and ns-CTA groups using the Wilcoxon signed-rank test. Results: Clarity scores were significantly higher in the s-CTA group than in the ns-CTA group (P < 0.001). The agreement of Cohen's coefficients between the two radiologists was κ = 0.724 in s-CTA scoring and κ = 0.622 in ns-CTA scoring, which were moderately matched. Seven arteries were not embolized due to insufficient tumor contrast enhancement and their poor relation to the surgical invasion zone. No complications were observed during or after embolization. Conclusion: S-CTA successfully distinguished between tumor and normal bone and may help avoid unnecessary embolization.

Hepatectomy for massive hepatic necrosis after transcatheter arterial embolization hemostasis for hepatic hemorrhage following hepatic trauma: A case report.

Key Clinical Message: Although partial hepatic necrosis often occurs following endovascular treatment for bleeding associated with hepatic trauma, it is relatively rare that additional treatment is required. However, invasive procedures such as hepatic resection should sometimes be considered when infection occurs over massive hepatic necrosis. Abstract: Although partial hepatic necrosis following endovascular treatment for bleeding associated with hepatic trauma is occasionally experienced, it is relatively rare for the necrotic area of the liver to require additional treatment. However, invasive procedures such as hepatic resection should sometimes be considered when infection occurs over massive hepatic necrosis.

Percutaneous ethanolamine oleate sclerotherapy for aggressive vertebral hemangioma: A case report.

Vertebral hemangiomas are the most common benign lesion of the spine which are often an asymptomatic incidental finding. However, a few hemangiomas are aggressive and characterized by bone expansion and extraosseous extension into the paraspinal and epidural spaces. We report the case of a patient presenting an aggressive vertebral hemangioma causing back pain and bilateral numbness of the legs. Among various treatment modalities, a minimally invasive percutaneous sclerotherapy procedure using ethanolamine oleate under computed tomography and fluoroscopic guidance was safely and successfully performed with good clinical outcomes.

Role of Aggressive Aneurysm Sac Embolization Before Endovascular Abdominal Aneurysm Repair in Preventing Type II Endoleak and Sac Expansion.

Background: This study aimed to evaluate the effect of aggressive embolization of side branches arising from the aneurysmal sac before endovascular aneurysm repair. Methods: This retrospective study included 95 patients who underwent endovascular infrarenal abdominal aortic aneurysm repair at Tottori University Hospital between October 2016 and January 2021. Of these, 54 underwent standard endovascular aneurysm repair (conventional group), and 41 underwent coiling of the inferior mesenteric and lumbar arteries before undergoing endovascular aneurysm repair (embolization group). The occurrence of type II endoleak, change in aneurysmal sac diameter, and reintervention rate due to type II endoleak during follow-up were evaluated. Results: Compared to the conventional group, the embolization group had a significantly lower incidence of type II endoleak, more frequent aneurysmal sac shrinkage, and lower aneurysmal sac growth related to type II endoleak. Conclusion: Our results demonstrated the effectiveness of aggressive aneurysmal sac embolization before endovascular aneurysm repair to prevent type II endoleak and the consequent long-term aneurysmal sac enlargement.

Coil-assisted retrograde transvenous obliteration of gastric varices by an inverted catheter tip technique via the pericardiophrenic vein.

A 70-year-old woman with liver cirrhosis was admitted to our hospital for treatment of growing gastric varices in the fundus. Computed tomography showed gastric varices continuously draining the pericardiophrenic vein via the inferior phrenic vein. Balloon-occluded retrograde transvenous obliteration by a transjugular approach was planned. However, a conventional balloon catheter or microballoon catheter could not be inserted into the efferent vein near the varices because of the narrowness and tortuosity of the vein. Hence, coil-assisted retrograde transvenous obliteration was performed by an inverted catheter tip technique using a single conventional microcatheter. This technique might be useful for cases in which it is difficult to insert a balloon catheter into the efferent vein.

A Case of Esophagojejunal Variceal Rupture after Total Gastrectomy and Esophagojejunostomy Successfully Treated with Percutaneous Transhepatic Obliteration under Dual-balloon Occlusion of Feeding and Draining Veins.

We present the case of a man in his 60s with bleeding esophagojejunal varices occurring after gastrectomy for gastric carcinoma. Percutaneous transhepatic portography depicted the esophagojejunal varices originated from the jejunal vein and drained into the azygos vein. A 5-French occlusion balloon catheter was wedged into the jejunal vein and a 3-French occlusion balloon catheter into one drainage channel of the esophagojejunal varices via the azygos vein. Selective antegrade jejunal venography under dual-balloon occlusion revealed entire esophagojejunal varices with good stagnated and well-opacified contrast medium. Subsequently, 12 mL of 5% ethanolamine oleate-contrast medium mixture was slowly injected into the esophagojejunal varices. He was discharged without complications one week after the procedure, and abdominal computed tomography demonstrated the disappearance of the esophagojejunal varices six months after the procedure.

A rare case of sigmoid colon cancer in which the lower limbs received collateral blood flow from the inferior mesenteric artery owing to peripheral artery disease.

BACKGROUND: Colorectal cancer and peripheral artery disease are common conditions in older adults and may coexist in this population. Lymph node dissection along the inferior mesenteric artery is a vital procedure in cases of left-sided colorectal cancer. However, the inferior mesenteric artery may show a collateral blood pathway in rare cases of peripheral artery disease. We report a case of advanced sigmoid colon cancer in which the lower limbs received inferior mesenteric artery flow owing to asymptomatic peripheral artery disease. The possibility of catastrophic lower-limb ischemia because of complete mesenteric excision with ligation of the inferior mesenteric artery was a matter of concern in this case. CASE PRESENTATION: A 73-year-old man with asymptomatic peripheral artery disease was diagnosed with stage IIIB advanced sigmoid colon cancer. Angiography using a balloon-occlusion catheter revealed that his lower limbs received prominent inferior mesenteric artery blood flow through a collateral pathway. Therefore, interventional radiologists and cardiovascular surgeons evaluated the indications for endovascular stents or bypass grafts. The patient also had dilated cardiomyopathy, so the cardiovascular physicians evaluated his tolerance in the worst-case scenario of a colorectal anastomotic leak. The patient underwent axillofemoral artery bypass and two-stage laparoscopic sigmoid colectomy without anastomosis. The postoperative course was uneventful, and he resumed his job within a month after the resection. CONCLUSIONS: Although collateral flow from the inferior mesenteric artery is rare in patients with peripheral artery disease, a few case reports have described fatal lower-limb ischemia following anterior resection. The perioperative multidisciplinary evaluation enabled us to understand the patient's condition and risks, and allowed successful cancer treatment without ischemia of the lower limbs.

Successful Interventional Radiology for Acute Median Arcuate Ligament Syndrome After Pancreaticoduodenectomy.

BACKGROUND: Median arcuate ligament (MAL) syndrome (MALS), also known as celiac artery (CA) compression syndrome and Dunbar syndrome, occurs because of extraluminal compression of the CA root by the MAL, which is part of the diaphragm. In MALS, a malposition of the MAL compresses the CA and causes nonspecific symptoms, including epigastric pain after eating, weight loss, nausea, and vomiting and can sometimes cause visceral aneurysms. Typically, in MALS, various chronic ischemic symptoms and visceral aneurysms due to changes in arterial blood flow are observed; however, in acute-onset MALS, acute organ failure due to ischemic changes may be problematic. Surgical treatment is the recommended treatment for MALS, but the optimal treatment of acute MALS that occurs after laparotomy remains controversial because of its rarity. Here, we present the first case of acute MALS, which occurred after pancreaticoduodenectomy (PD) that was successfully treated with interventional radiology (IVR) without reoperation. CASE PRESENTATION: A 75-year-old man presented with liver infarction after subtotal stomach-preserving PD using the Child method plus Braun enteroenterostomy. As a result of contrast-enhanced computed tomography for the investigation of elevated hepatic cytolysis-related enzymes on the first postoperative day, he was diagnosed with acute MALS resulting from gastrointestinal reconstruction after PD. The patient underwent IVR to restore blood flow of the CA, and an intraluminal stent was inserted. Despite the development of ischemic gastropathy, splenic infarction, and pancreatic fistula, the patient was eventually discharged on postoperative day 82 without any disability. CONCLUSION: Many studies have reported open, laparoscopic, and robot-assisted MAL incisions for MALS, but few reports have detailed the treatment for postoperative MALS. Here, we report the first case of acute MALS developed after PD that was successfully treated with endovascular CA stenting. For acute MALS after PD, early endovascular treatment may be more useful than re-laparotomy.

Treatment of pulmonary arteriovenous malformations: clinical experience using different embolization strategies.

PURPOSE: To evaluate embolization efficacy of pulmonary arteriovenous malformations (PAVM) using Amplatzer vascular plugs (AVP) and coils. MATERIALS AND METHODS: Eighty-eight embolized simple PAVMs in 38 patients were retrospectively analyzed by follow-up CT. Mean age was 50.2 ± 15.6 years and 22 (57.9%) patients were females. Mean follow-up interval was 38.2 ± 28.4 months (median 29.9 months). Embolization devices included AVP I, AVP II, AVP 4, and coils. Technical success was defined as no visualization of an early draining vein at angiography after embolization. Treatment success was defined as complete disappearance or decrease in size of the venous aneurysm ≥ 70% at follow-up CT. RESULTS: Technical success rate was 100% and treatment success rate evaluated by CT for the various embolization strategies was 100% for AVP I (n = 6), 100% for AVP I + coils (n = 5), 83.3% for AVP II (n = 6), 40.0% for AVP II + coils (n = 5), 87.5% for AVP 4 (n = 8), 50.0% for AVP 4 + coils (n = 8), and 78.0% for coils alone (n = 50). No statistically significant difference in embolization efficacy was seen between different devices (P = 0.083). Although not statistically significant, combination use of coils with AVPs demonstrated lower rates of clinical embolization success (P = 0.053). CONCLUSION: Embolization of PAVMs demonstrated high technical and treatment success rates with available embolic devices. No significant statistical differences were demonstrated between AVPs. However, the need for both coils and AVPs may suggest a more complicated underlying lesion at risk for recurrence.

Compressed Amplatzer Vascular Plug II Embolization of the Left Subclavian Artery for Thoracic Endovascular Aortic Repair is Efficient and Safety Method Comparable to Conventional Coil Embolization.

BACKGROUND: Left subclavian artery (LSA) embolization is occasionally required to prevent type II endoleak in the thoracic endovascular aortic repair (TEVAR) procedure. This is a retrospective study comparing compressed Amplatzer Vascular Plug II embolization (CAE) and conventional coil embolization (CCE) in preventing retrograde flow into the aneurysmal sac through the LSA after TEVAR. METHODS: We retrospectively reviewed the records of patients who underwent CAE or CCE of the LSA during TEVAR from June 2013 to March 2016 in our hospital. The efficacy, safety and cost of each method were compared between two groups. RESULTS: Thirty patients underwent LSA embolization during TEVAR. Six CCEs in 6 patients were performed from June 2013 to November 2013, while twenty-four CAEs in 24 patients were performed from December 2013 to March 2016. Technical success was achieved in all patients in both groups. No embolization-related complications or type II endoleaks from LSA were recorded during the follow-up period in all patients. In both groups, all embolic materials were detected in the proximal portion of the LSA from the LSA orifice to the vertebral artery origin and no vertebral artery occlusions were detected. The mean compression ratio of AVP II was 58 ± 5.9% of predicted length of standard procedure. In the CAE group, one AVP II was sufficient to achieve complete LSA occlusion in all patients. On the other hand, multiple coils (10.2 ± 2.7) were used in the CCE group (P < .01), resulting in a significantly lower cost incurred in the CAE group (CAE: 129,000 JPY vs. CCE: 639,600 ± 140,060 JPY; P < .01). CONCLUSION: The CAE is a useful and cost-effective procedure for TEVAR-related LSA embolization.

Portal Vein Stenting for Portal Vein Stenosis After Pancreatoduodenectomy: A Case Report.

Portal vein stenosis, which results in serious clinical conditions such as gastrointestinal variceal bleeding and liver failure, is caused by hepatobiliary pancreatic cancer or major postoperative complications after hepatobiliary pancreatic surgery. In recent years, portal vein stenting under interventional radiology has been applied as a more useful treatment method for portal vein stenosis than invasive surgery. We herein report the successful use of a vascular stent for portal vein stenosis after pancreatoduodenectomy. A 66-year-old man with distal cholangiocarcinoma underwent subtotal stomach-preserving pancreatoduodenectomy with resection of the portal vein because of direct invasion to the main portal vein at our hospital. The portal vein was reconstructed without a venous graft. He developed jejunal bleeding near the pancreatojejunostomy on postoperative day (POD) 2. Although embolization of the responsible vessel achieved hemostasis, an intraoperatively inserted drainage tube was needed for a long period of time postoperatively because the embolized afferent jejunum was perforated. He was discharged on POD 39 after removal of the drainage tube. On POD 282, he was readmitted with melena and severe fatigue. Computed tomography revealed an obstruction of the reconstructed portal vein and varices at the hepaticojejunostomy site. We diagnosed variceal bleeding and performed percutaneous transhepatic stenting in the obstructed portal vein. The patient was discharged in good clinical condition on day 15 after stenting. In conclusion, portal vein stenting is a useful and less invasive therapy for portal vein stenosis.

Non-Surgical Management of Bile Leakage After Hepatectomy: A Single-Center Study.

BACKGROUND: Bile leakage after hepatectomy is a common complication. The purpose of the present study was to retrospectively evaluate the usefulness of non-surgical management of bile leakage after hepatectomy, using 12-year data from a single center study. METHODS: Data from 15 patients (13 men, two women; mean age 67.1 ± 7.0 years) who had undergone non-surgical management for bile leakage between January 2005 and November 2017 were retrospectively reviewed. RESULTS: We categorized bile leakage as central (n = 5) or peripheral (n = 10) leakage based on communication with the biliary tree. Percutaneous bile leakage drainage and/or endoscopic naso-biliary drainage (ENBD) (n = 2) or the rendezvous technique (n = 3) was successfully performed in five central-type cases, while all peripheral-type cases were treated with drainage alone; only one case required additional ethanol ablation. Bacterial bile cultures were positive in 11 cases and negative in four cases. The drainage catheters were removed after complete resolution in 13 cases (86.7%), while two patients with cases of peripheral-type leakage died due to cancer progression while the drain was in place. No case needed conversion to reoperation. The mean duration of drainage therapy in all cases was 210.1 ± 163.0 days (range 17-531 days), with 316.8 ± 180.8 days in the central type and 156.7 ± 131.5 days in the peripheral type; this duration was not significantly different (P = 0.129). CONCLUSION: Non-surgical treatment is a minimally invasive and effective management strategy for postoperative bile leakage and the modality used depends on the type of bile leakage encountered.

Safety and Risk of Superselective Transcatheter Arterial Embolization for Acute Lower Gastrointestinal Hemorrhage with N-Butyl Cyanoacrylate: Angiographic and Colonoscopic Evaluation.

PURPOSE: To retrospectively evaluate the safety and risk of transcatheter arterial embolization (TAE) with N-butyl cyanoacrylate (NBCA) for urgent acute arterial bleeding control in the lower gastrointestinal tract by angiography and colonoscopy. MATERIALS AND METHODS: NBCA TAE was performed in 16 patients (mean age, 63.7 y) with lower gastrointestinal bleeding (diverticular hemorrhage, tumor bleeding, and intestinal tuberculosis). Angiographic evaluation was performed by counting the vasa recta filled with casts of NBCA and ethiodized oil (Lipiodol) after TAE. Patients were classified as follows: group Ia, with a single vas rectum with embolization of 1 branch (n = 6); group Ib, with a single vas rectum with embolization of ≥ 2 branches (n = 8); group II, with embolization of multiple vasa recta (n = 2). All patients underwent colonoscopy within 1 month, and ischemic complications (ulcer, scar, mucosal swelling, fibrinopurulent debris, and necrosis) were evaluated. RESULTS: The procedure was successful in all patients. No ischemic change was observed in any patients in group Ia and in two patients in group Ib. Ischemic changes were observed in six group Ib patients and both group II patients. Group Ib patients experienced ischemic complications that improved without treatment. One patient in group II underwent resection for intestinal perforation after embolization of three vasa recta. One patient in group II with sigmoid stricture with embolization of six vasa recta required prolonged hospitalization. CONCLUSIONS: NBCA embolization of ≥ 3 vasa recta can induce ischemic bowel damage requiring treatment. NBCA TAE of one vas rectum with ≥ 2 branches could also induce ischemic complications. However, these were silent and self-limited.

Coil embolization with side-holed catheter to preserve peripheral flow for visceral artery pseudoaneurysm: an experimental study in Swine.

PURPOSE: To evaluate the safety and efficacy of coil embolization with an indwelling catheter with side holes to control visceral artery bleeding while simultaneously preserving peripheral artery flow. MATERIALS AND METHODS: A 6-F anticoagulant-coated catheter with two symmetrically arranged side holes was used with coil embolization to induce hemostasis in the superior mesenteric artery (SMA) of 13 pigs. The SMA was punctured with a metal needle to induce bleeding. The catheter was advanced into the SMA immediately after the puncture, and the midpoint between its tip and side holes was adjusted to conform to the puncture site. The SMA was embolized by using microcoils placed around the catheter to achieve hemostasis. Hemostasis and gross ischemic changes of the intestine were visually observed during the abdominal surgery. Peripheral blood flow was assessed by using abdominal aortography for as long as 2 hours in 13 pigs and was assessed again at 7 days in three pigs. RESULTS: Antegrade peripheral artery flow through the indwelling catheter was preserved without stagnation for as long as 2 hours in all 13 pigs and at 7 days in two of three pigs. One catheter occlusion was seen at the 7-day time point. There were no observable instances of recurrent bleeding, ischemic changes in the intestine, or vascular adverse events during or after the procedure. CONCLUSIONS: The hemostatic method described here is a technically feasible method of controlling acute visceral artery bleeding while preserving peripheral artery flow and may be particularly useful in cases of absence of collateral circulation. Further experiments are warranted for clinical application.

Influence of ethanol-induced pulmonary embolism on hemodynamics in pigs.

AIMS AND OBJECTIVES: Ethanol is widely used for the embolization treatment of vascular malformations, but it can also cause serious complications such us pulmonary hypertension, cardiopulmonary collapse and death. The complications are considered secondary to pulmonary vasospasm and ethanol-induced sludge embolism, etc., We studied the hemodynamic effects of intravenous absolute ethanol injection and ethanol sludge injection in pigs. MATERIALS AND METHODS: A total of 5 pigs underwent intravenous injection of ex vivo generated ethanol-induced sludge in which residual ethanol was removed (Group S) and 4 pigs underwent intravenous injection of absolute ethanol (Group E). Hemodynamic parameters related to the pulmonary and systemic circulation were compared between the groups. RESULTS: Transient pulmonary hypertension was observed in both groups and the hemodynamic changes were similar in both groups. CONCLUSIONS: Sludge can induce transient pulmonary hypertension or cardiopulmonary collapse, without ethanol and may be the mechanism by which ethanol induces its adverse hemodynamic effects.

Transcatheter arterial embolization of acute arterial bleeding in the upper and lower gastrointestinal tract with N-butyl-2-cyanoacrylate.

PURPOSE: To assess the clinical utility and safety of transcatheter arterial embolization with N-butyl-2-cyanoacrylate (NBCA) for urgent control of acute arterial bleeding in the upper and lower gastrointestinal tract. MATERIALS AND METHODS: Therapeutic NBCA embolization was performed in 37 patients (39 cases; mean age, 67.8 years) with acute upper (n = 16) or lower (n = 23) gastrointestinal tract bleeding after endoscopic management had failed. Transcatheter arterial embolization was performed using 1:1 to 1:5 mixtures of NBCA and iodized oil. The most common etiologies of bleeding were colonic diverticulosis (n = 13), malignancy (n = 11), and benign ulcer (n = 7). Coagulopathy was present in 11 patients, and 23 patients were hemodynamically unstable before NBCA embolization. Histologic examination for bowel ischemia was also performed in five patients who underwent excision of the lesion after NBCA embolization. RESULTS: The technical success rate was 100%. Recurrent bleeding occurred in two patients. Complete hemostasis was achieved in all 11 patients with coagulopathy. Ulcers induced by transcatheter arterial embolization were noted in 6 of 20 patients who underwent endoscopic examination; the ulcers were successfully treated with conservative measures. Histologic examination revealed that despite inflammatory reactions in and around the vessels, no intestinal necrosis secondary to NBCA embolization was found. Hepatic abscess occurred in two cases, and ischemia of the lower limb occurred in one case; these complications were managed by percutaneous drainage and bypass surgery. CONCLUSIONS: Transcatheter arterial embolization with NBCA is a good treatment option with a high rate of complete hemostasis and a low recurrent bleeding rate, even in patients with coagulopathy.

Balloon-assisted coil embolization of the celiac trunk before endovascular aortic repair of thoracoabdominal aortic aneurysm.

PURPOSE: Celiac trunk coil embolization before thoracic endovascular aneurysm repair (TEVAR) of a thoracoabdominal aortic aneurysm involving the celiac trunk can prevent type II endoleaks. One disadvantage of conventional coil embolization is the risk of coil displacement. We performed coil embolization under balloon occlusion of the celiac trunk to address this issue. MATERIALS AND METHODS: Between December 2008 and January 2011, 5 patients (3 men and 2 women, mean age 76 years) were included in this study. For all patients, after confirming the collateral blood flow from the superior mesenteric artery via the pancreaticoduodenal arcades by using the balloon occlusion test, celiac trunk coil embolization proceeded under balloon occlusion of the proximal part of the celiac trunk. RESULTS: Balloon-assisted coil embolization of the celiac trunk was completed for all patients without any complications. All coils were deployed as planned in the short segment of the celiac trunk without displacement. Coil migration, ischemic complications, and endoleaks via the celiac trunk did not arise in any of the patients over a follow-up period of 77-637 (mean 258) days. CONCLUSIONS: Balloon-assisted coil embolization of the celiac trunk before TEVAR could be a feasible treatment option for suitable patients.

Development of a new hanging-type esophageal stent for preventing migration: a preliminary study in an animal model of esophagotracheal fistula.

PURPOSE: Covered, self-expandable metallic stents (SEMS) have been enthusiastically adopted for the treatment of esophagotracheal fistula, but problems with stent migration have yet to be resolved. To overcome this problem, we have developed a new hanging-type esophageal stent designed to prevent migration, and we conducted an animal study to assess the efficacy of our method. METHODS: A total of six female pigs were used in this study. The main characteristic of our stent was the presence of a string tied to the proximal edge of the stent for fixation under the skin of the neck. The first experiment was performed to confirm technical feasibility in three pigs with esophagotracheal fistula. The second experiment was performed to evaluate stent migration and esophagotracheal fistula in three pigs. RESULTS: Creation of the esophagotracheal fistula and stent placement were technically successful in all pigs. In the first experiment, esophagotracheal fistula was sealed by stent placement. In the second experiment, no stent migration was seen 11 or 12 days after stent placement. Gross findings showed no fistulas on the esophageal or tracheal wall. CONCLUSIONS: Our new hanging-type esophageal stent seems to offer a feasible method for preventing stent migration.