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DOI: 10.1055/s-0037-1603387
Outcome after SX-ELLA Danis bleeding stent implantation for refractory variceal bleeding – a Vienna Multicenter Experience
Publikationsverlauf
Publikationsdatum:
16. Mai 2017 (online)
Background:
Bleeding stents may be superior to balloon tamponade for refractory esophageal variceal bleeding (EVB), however, data on safety and efficacy after the use of SX-ELLA “Danis-Stents” are limited.
Methods:
Retrospective multicenter study including cirrhotic patients receiving Danis-Stents for massive/refractory EVB at 4 tertiary care centers in Vienna. Bleeding control (5days), bleeding-related mortality (6weeks) and overall mortality were assessed.
Results:
Among 35 patients, 13 patients had an unsuccessful band ligation prior to Danis-Stent placement. Danis-Stent controlled EVB in 80% (28/35) of patients. In the remaining n = 7 patients, n = 4 died of uncontrolled EVB, n = 2 experienced bleeding-related mortality, and only 1 patient achieved a successful long-term bleeding control. In total, early-rebleeding within 6 weeks occurred in 14.3% (including n = 1 while Danis-Stent was still in place and n = 5 after Danis-Stent was removed). Moreover, among n = 14 patients without early rebleeding within 6 weeks, only n = 3 (21.4%) showed rebleeding later during follow-up. Only n = 11 (31.4%) patients did not experience any rebleeding after Danis-Stent removal, while n = 8 patients died with the Danis-Stent in situ. Notably, no “early-TIPS” was performed in this study, but 4 (11.4%) received an elective TIPS during follow-up. N = 6 patients (17.1%) died due to uncontrolled bleeding (≤5days) and n = 10 died within 6 weeks (bleeding-related mortality: 28.6%). Overall, n = 22/35 (62.9%) patients died. The median survival was 10.5 (IQR82) days after Danis-Stent placement. Median Danis-Stents dwell time was 5 (range: 0 – 13) days. The most common adverse events were stent dislocations (n = 13; 37.1%), while ulcers/necrosis of the esophageal mucosa were seen in only 4 (11.4%) patients.
Conclusions:
Danis-Stent controlled refractory/massive EVB in 80% of patients but bleeding-related mortality was as high as 45%. While stent dislocations are frequent, ulcers/necrosis of the esophagus were rare with a dwell time of 5 days. The implementation of an early-TIPS strategy might improve the overall outcome after Danis-Stent placement.
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Die Autoren geben an, dass kein Interessenkonflikt besteht.