Secondary uncovered versus fully-covered metal stents for the management of occluded stent in unresectable distal malignant biliary obstruction.

INTRODUCTION: Self-expandable metallic stents (SEMS) have been widely placed for unresectable distal malignant biliary obstruction (UDMBO). However, the dysfunction rate is 19-40% and its treatment is controversial. We aimed asses the efficacy and safety of a secondary biliary stents (uncovered (UC) versus fully-covered (FC) stent) for the management of occluded SEMS. PATIENTS AND METHODS: Between 2015 and June 2023, 41 patients with UDMBO underwent secondary biliary stent placement as "stent-in-stent" (20 FCSEMS and 21 UCSEMS). The primary outcomes were technical and clinical success of SEMS placement. Secondary outcomes included adverse events (AEs), patency and survival. Patients were prospectively followed until death or loss of follow-up. RESULTS: Technical (100% vs 85.5%) and clinical (100% vs 95.2%) success rates were similar in FCSEMS and UCSEMS groups. The median follow-up period was 510 days (range 290-630). The median duration of stent patency of FCSEMS (220 days, IQR 137.5-442.5) was longer than UCSEMS (150 days, IQR 110-362.5) (P=0.395), although stent dysfunction within 6 months was not different between groups. Multivariate analysis indicated that sex (HR=0.909, 0.852-0.970), antitumor treatment (HR=0.248, 0.032-0.441), stent patency (HR=0.992, 0.986-0.998) and clinical success (HR=0.133, 0.026-0.690) were significant factors for overall survival. There were no remarkable differences in AEs. CONCLUSIONS: The placement of additional biliary stent using the stent-in-stent method is an effective and safe rescue treatment for patients with UDMBO and occluded stent. In addition, the use of FCSEMS compared UCSEMS has unclear benefits regarding stent patency and overall survival.

Feasibility and Safety of Through-the-scope versus Over-the-wire Stents for the Palliation of Malignant Dysphagia. A Cohort Real- Life Study.

BACKGROUND AND AIMS: In the presence of malignant dysphagia in non-surgical candidates, a self-expanding metal stent (SEMS) represents a safe and effective approach. Recently, a through-the-scope (TTS) SEMS was launched. The aim of our study was to assess the feasibility and safety of the TTS versus over-the-wire (OTW) SEMS in patients with malignant dysphagia. METHODS: This single-center retrospective cohort study included patients with malignant dysphagia undergoing esophageal TTS and OTW-SEMS from 2012 to May-2022. The primary outcomes were the technical and the clinical success of the SEMS placement. Secondary outcomes included adverse events, patency, and survival. Patients were prospectively followed until death or loss of follow-up. RESULTS: A total of 98 patients were enrolled, including 34 patients in the TTS group and 64 patients in the OTW group. TTS and OTW SEMS placement were feasible in 33 (97.1%) and 64 (100%) procedures , respectively (p=0.118). Overall, 32 patients (94.1%) in the TTS group and 62 patients (96.9%) in the OTW group showed an improvement in Ogilvie score (p=0.432). Recurrent dysphagia occurred in 30 patients, 12 in TTS group and 18 in OTW group, due to migration (4 vs. 5), stent deformation (1 vs. 1), tissue ingrowth (5 vs. 5) and overgrowth (2 vs. 7). No patient died from a stent-related cause. Median survival was 123 days (IQR: 59-209) in TTS group and 113 days (IQR: 73-271) in OTW group (p=0.349). CONCLUSIONS: Placement of esophageal TTS and OTW stents resulted in similar technical and clinical outcomes, stent patency and survival in patients with malignant dysphagia.

Impact of the SARS-CoV-2 pandemic on pancreatic cancer: diagnosis and short-term survival.

INTRODUCTION: The COVID-19 pandemic has delayed medical consultation, possibly leading to the diagnosis of gastrointestinal cancer. The aim of the study was to analyze the impact of SARS-Cov-2 pandemic on new diagnosis and short-term survival of patients with pancreatic cancer (PC). METHODS: All consecutive patients who had a suspected diagnosis of pancreatic lesion before (from March to September 2019) and during COVID 19 pandemic (from March to September 2020). Demographics, clinical and treatment were collected and compared. Short-term survival was assessed. RESULTS: A total of 25 patients (n=13 men) with diagnosis of adenocarcinoma of the pancreas and a median age of 70 years (IQR 62-74) were included. An increase was observed in the number of patients with newly diagnosed PC (n= 12 [19.1%] versus n=13 [20.9%]; P= 0.603). The subgroup analysis revealed a tendency toward a longer diagnosis (11 versus 12 days; P= 0.219) and treatment (28 versus 44; P= 0.375) delay for patients with PC during COVID-19 pandemic. A significant increase was observed for number of cases of advanced stage III and IV (n=4 [30.8%] versus n=7 [53.8%]; P= 0.006). Palliative treatment was the most frequent approach during COVID-19 period. During 1-year follow-up, 6 (50%) and 7 (61.5%) deaths were observed among patients diagnosed before and after COVID-19 (P= 0.449), respectively. CONCLUSIONS: The COVID-19 pandemic has led to delays in diagnosis and treatment in PC, which translates into an advanced staging and a worse prognosis. These data should stimulate health care provider to facilitate procedures for detection pancreatic cancer.

EUS-guided drainage of postsurgical pelvic abscesses using lumen-apposing metal stents.

Endoscopic ultrasound (EUS) guided drainage of pelvic collections is an alternative to percutaneous or surgical drainage. We present our experience using lumen-apposing metal stents (LAMS) for the drainage of postoperative pelvic abscesses.