An Internist’s Illustrated Guide to Gastrointestinal Surgery - part 3

Ngoài ra để quản lý tắc nghẽn intraluminal và fistulas esophagorespiratory, SEM có thể được sử dụng trong việc quản lý tắc nghẽn do bên ngoài thực quản đến các khối u trung thất nén (9,10). Chống chỉ định bao gồm tổng số đoạn tắc nghẽn luminal cấm của một dây dẫn | 58 Nazareno Lamptey-Mills and Benson Fig. 1. Barium swallow showing obstructing esophageal carcinoma. esophageal cancer. Because of the design and ease of insertion they are less traumatic and may be placed in an outpatient setting. Immediate relief of dysphagia is achieved with fewer complications 8 . INDICATIONS AND CONTRAINDICATIONS In addition to management of intraluminal obstruction and esophagorespiratory fistulas SEMS can be utilized in the management of extrinsic esophageal obstruction owing to compressive mediastinal tumors 9 10 . Contraindications include total luminal obstruction prohibiting passage of a guide wire extremely limited life expectancy actively bleeding lesions and significant airway compression 11 . TYPES OF ESOPHAGEAL STENTS Currently there are three esophageal stents used in the United States. They are as follows Table 1 . Gianturco Z-stents are made from stainless steel wire bent in a zig-zag fashion to form segments 2-cm long which are connected using nonabsorbable suture to form lengths -from-6 to 44 - nt s 1b mm jni-ts internal -diameter with the proximal and distal ends f sed oi .5 tA wASbtOAfjlly covered and Chapter 6 Esophageal Stents 59 Table 1 Gianturco-Z stent1 Ultraflex2 3 Wallstent II Material Stainless steel Nickel titanium Elgiloy Nitinol Covering Yes Yes Yes Design Zig-zag configuration Mesh Mesh Self-expanding Diameter before Implantation 28F 16F 18F Shaft diameter Post implantation 18 mm 18 23 mm 20 mm Flange diameter 21 25 mm 23 28 mm 28 mm Degree of Shortening 0 -10 30 -40 30 Radial force Fistula Closure Yes Yes Yes 1Gianturco Z-Stent Wilson-Cook Medical Winston-Salem NC 2Ultraflex stent Microvasive Inc. Natick MA 3Wallstent II Microvasive Fig. 2. Esophageal stents. A Covered Gianturco Z-Stent Wilson-Cook Medical Winston-Salem NC . B Uncovered Gianturco Z-Stent Wilson-Cook Medical Winston-Salem NC . C Ultraflex stent Microvasive Inc. Natick MA . D Wallstent II Microvasive .