• Esophageal stent
• Esophageal stent migration
• Gastrointestinal stent migration

• Humans
• Foreign-Body Migration/prevention & control
• Foreign-Body Migration/epidemiology
• Foreign-Body Migration/etiology
• Stents/adverse effects
• Risk Factors
• Esophageal Stenosis/prevention & control
• Esophageal Stenosis/etiology
• Esophageal Neoplasms/surgery
• Prosthesis Failure
• Esophagus/surgery

• Esophageal cancer
• Esophageal perforation
• Esophageal stent
• Esophageal stricture
• SEMS
• Segmented esophageal stent
• Tracheo-esophageal fistula
• Upper GI bleeding

• Humans
• Retrospective Studies
• Male
• Female
• Self Expandable Metallic Stents
• Case-Control Studies
• Middle Aged
• Esophageal Stenosis/etiology
• Esophageal Stenosis/therapy
• Esophageal Stenosis/surgery
• Aged
• Treatment Outcome
• Prosthesis Design
• Adult
• Aged, 80 and over

• corrosive injury of the esophagus
• esophageal sems
• esophageal stenosis
• esophagus and gastric cancer surgery
• gastroesophageal disease
• gastroesophageal surgery
• general surgery
• lumen-apposing self-expanding metal stents
• upper endoscopy

• Case report
• Endoscopic balloon dilation
• Endoscopic incision method
• Esophageal stent placement
• Esophagotracheal fistula
• Extreme corrosive esophageal stenosis

• biodegradable esophageal stents
• drug-eluting stents
• esophageal cancer
• esophageal stricture
• magnesium alloy
• poly (L-lactic-acid)
• polydioxanone

• Colonic obstruction
• Endoscopic stenting
• Esophageal obstruction
• Gastric outlet obstruction

• Adverse events
• Endoscopy
• Esophageal neoplasms
• Self-expandable metal stents

• Humans
• Dilatation/adverse effects
• Stents/adverse effects
• Treatment Outcome

• dysphagia
• endoscopically stenting
• esophageal cancer
• esophageal constriction
• malignant constriction of the esophagus
• palliative stenting

• Esophageal stent
• Interventional radiology
• Inversion
• Removal

• Alloys
• Device Removal/methods
• Esophageal Stenosis/etiology
• Fluoroscopy
• Humans
• Metals
• Retrospective Studies
• Stents/adverse effects
• Treatment Outcome

• Colon
• Esophagus
• Fluoroscopy
• Gastrointestinal tract
• Small bowel
• Stents
• Stomach

• endoscopic balloon dilation
• endoscopic incision
• endoscopic stent replacement
• endoscopic treatment
• esophageal atresia
• esophageal stenosis

The incidence of esophageal fibrosis and benign esophageal stricture (BES) has increased in recent years due to the curative therapy for early-stage esophageal carcinoma, including partial esophagectomy and esophageal endoscopic submucosal dissection (ESD). The aim of the present study was to identify key genes and associated pathways of esophageal fibrosis after the ESD procedure. During the esophageal ESD procedure, the esophageal tissue in the remaining submucosal layer, referred to as normal esophageal (NE) tissue, was collected, and 1 week thereafter, post-operative esophageal (PE) tissue was obtained. High-throughput sequencing was used to identify dysregulated microRNAs (miRNAs/miRs) between NE and PE tissues. According to the differentially expressed (DE) miRNAs, putative target genes were predicted. Gene Ontology, Kyoto Encyclopedia of Genes and Genomes enrichment analysis and DEmiRNA interaction network analysis were performed. Reverse transcription-quantitative PCR (RT-qPCR) was performed to validate the RNA-sequencing results. A total of 199 miRNAs were determined to be DE between NE and PE tissues. Compared with the expression in the NE group, 83 miRNAs were significantly upregulated, while 116 miRNAs were significantly downregulated. According to these DE miRNAs, forkhead box O1 (FOXO1), paired box 6 (PAX6), phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA) and adrenoceptor β1 (ADRB1) were DE genes regulated by five DE miRNAs, including miR-223-3p, miR-142-5p, miR-582-5p, miR-21-3p and miR-218-5p. The results suggested that certain pathways were markedly dysregulated, including FOXO, MAPK, AMP-activated protein kinase and signaling pathways regulating the pluripotency of stem cells and proteoglycans in cancer. According to the RT-qPCR results, the expression levels of FOXO1, PAX6, ADRB1, miR-223-3p, miR-582-5p, miR-21-3p and miR-218-5p were consistent with the integrated analysis. In conclusion, FOXO1, PAX6, PIK3CA and ADRB1 may have a role in esophageal fibrosis, regulated by miR-223-3p, miR-142-5p, miR-582-5p, miR-21-3p and miR-218-5p. The present results provided an improved understanding of the changes in the microenvironment during the process of esophageal fibrosis, as well as novel potential targets for the treatment of esophageal fibrosis and BES.

• benign esophageal stricture
• differentially expressed genes
• differentially expressed microRNAs
• esophageal fibrosis
• high-throughput sequencing

Chronic strictures following Roux-en-Y Gastric Bypass (RYGB) are a troublesome complication that can lead to significant morbidity. The use of stents has been described but the need for X-ray and risk of migration have meant limited use in the management of these strictures. Lumen apposing metal stents (LAMS) have traditionally been used for management of pancreatic pseudocysts. They don’t require X-ray and are easy to deploy with a short learning curve. This paper explores the use of LAMS to treat post RYGB strictures and explores their safety and efficacy.

A prospective study over a 4-year period looking at 14 patients with post RYGB strictures. These patients were privately insured patients operated within a tertiary Private facility. The patients were followed up for between 1 and 3 years. We have prospectively collected data on the efficacy and safety of LAMS in these patients. Patients were followed up until stent removal or definitive surgery to correct a stricture.

421 patients underwent RYGB in the study period. 14 (3.3%) of these patients developed a stricture that resulted in insertion of LAMS. There was no immediate complications and 12 patients had complete resolution of their stricture. There were no reoperations due to migration related issues although a migration rate of 19% was noted. 2 patients required surgery to correct refractory strictures not relieved by a LAMS stent, both of these were strictures associated with marginal ulceration of the gastro jejunostomy.

LAMS are a safe and effective method to manage post RYGB strictures. They have a high rate of resolution of strictures and can be safely deployed across strictures with no immediate complication. Migration does still appear to be a problem, however, does not appear to affect patient outcome or increase morbidity. Insertion is straightforward and doesn’t appear to be associated with a long learning curve.

• Anastomotic stricture
• Endoscopy
• Esophageal stents
• Obesity
• Roux-en-Y Gastric Bypass

• Endoscopy
• Radiation
• Stricture

• Cervical stent
• Esophagus
• Hypopharynx
• Refractory benign strictures

• Endoscopic dilation
• Esophageal benign stricture
• Stent

• Anastomotic stricture
• Balloon dilation
• Bougie dilation
• Caustic stricture
• Dilation
• Endoscopy
• Esophageal refractory stricture
• Esophageal stricture
• Esophagus
• Peptic stricture

• Case-Control Studies
• Dilatation/methods
• Esophageal Stenosis/etiology
• Esophageal Stenosis/surgery
• Humans
• Retrospective Studies
• Treatment Outcome

• Deglutition disorders
• Endoscopy

Benign esophageal strictures are one of the common clinical conditions managed by endoscopists. Nearly 90% of the benign esophageal strictures respond to endoscopic dilation. However, a small percentage of patients progress to recalcitrant strictures. The benign recalcitrant esophageal strictures are difficult to manage both medically and endoscopically as they do not respond to conventional treatment with proton pump inhibitors and esophageal dilations. Patients with benign recalcitrant esophageal strictures are at a high risk of developing debilitating malnutrition and morbidity due to severe dysphagia. This condition is associated with psychological trauma to patients as treatments are usually prolonged with poor outcomes. Also, this can be a financial burden on the healthcare industry due to several sessions of treatment. In this article, we discuss the classification of benign esophageal strictures, evidence-based treatment strategies, endoscopic procedural techniques, and complications of endoscopic interventions. We aim to guide providers in managing benign esophageal strictures with a focus on endoscopic management of benign recalcitrant esophageal strictures.

• Benign recalcitrant esophageal strictures
• IT knife
• esophageal stent
• intralesional steroid injection
• mitomycin C

• Acute esophageal necrosis
• Black esophagus
• Bypass operation
• Esophagectomy
• Indocyanine green fluorescence imaging

The use of fully covered lumen-apposing metal stents (LAMS) for benign short gastrointestinal (GI) strictures has been reported. This study aimed to evaluate the safety and efficacy of LAMS for refractory GI strictures.

A retrospective analysis was performed of patients who underwent LAMS placement for benign GI strictures in 8 United States centers. The primary outcomes were technical success and initial clinical response. Secondary outcomes were reintervention rate and adverse events.

A total of 51 patients underwent 61 LAMS placement procedures; 33 (64.7%) had failed previous treatments. The most common stricture location was the pylorus (n=17 patients). Various sizes of stents were used, with 15-mm LAMS placed in 45 procedures, 20-mm LAMS in 14 procedures, and 10-mm LAMS in 2 procedures. The overall technical success, short-term clinical response and reintervention rate after stent removal were 100%, 91.8% and 31.1%, respectively. Adverse events were reported in 17 (27.9%) procedures, with stent migration being the most common (13.1%). In subgroup analysis, both 15 mm and 20 mm stents had comparable short-term clinical response and adverse event rates. However, stent migration (15.6%) was the most common adverse event with 15-mm LAMS while pain (14.3%) was the most common with 20-mm LAMS. The reintervention rate was 80% at 200-day follow up after stent removal.

Using LAMS for treatment of short benign GI strictures is safe and effective. Larger LAMS, such as the new 20 mm in diameter, may have a lower stent migration rate compared to smaller diameter LAMS.

• Lumen-apposing metal stent
• gastrointestinal stricture
• stent migration

• Biodegradable stent
• benign esophageal stenosis

The advent of lumen apposing metal stents (LAMS) has revolutionized the management of many complex gastroenterological conditions that previously required surgical or radiological interventions. These procedures have garnered popularity due to their minimally invasive nature, higher technical and clinical success rate and lower rate of adverse events. By virtue of their unique design, LAMS provide more efficient drainage, serve as conduit for endoscopic access, are associated with lower rates of leakage and are easy to be removed. Initially used for drainage of pancreatic fluid collections, the use of LAMS has been extended to gallbladder and biliary drainage, treatment of luminal strictures, creation of gastrointestinal fistulae, pancreaticobiliary drainage, improved access for surgically altered anatomy, and drainage of intra-abdominal and pelvic abscesses as well as post-surgical fluid collections. As new indications of endosonographic techniques and LAMS continue to evolve, this review summarizes the current role of LAMS in the management of these various complex conditions and also highlights clinical pearls to guide successful placement of LAMS.

• Lumen apposing metal stents
• Walled off necrosis
• Gallbladder drainage
• Biliary drainage
• Gastric access temporary for endoscopy
• Gastric outlet obstruction
• Therapeutic endoscopy

• Drainage/instrumentation
• Drainage/methods
• Endoscopy/instrumentation
• Endoscopy/methods
• Endosonography
• Fluoroscopy
• Gastrointestinal Diseases/therapy
• Humans
• Stents

Malignant esophageal strictures often require stent placement to alleviate dysphagia and improve quality of life. We present a novel application of a lumen-apposing metal stent to bypass a malignant esophageal stricture in the setting of altered gastric anatomy.

• Achalasia
• Aging
• Eosinophilic esophagitis
• Esophageal dysphagia
• Esophageal strictures
• Functional dysphagia
• High resolution esophageal manometry

Current research has identified several risk factors for refractory benign esophageal strictures (RBES), but research is scarce on the prediction of RBES in benign esophageal strictures patients. Meanwhile, the long-term outcomes of RBES remain unclear. The aim of this study was to develop and validate a model to determine the progression of RBES in patients with benign esophageal strictures. And we also explored the long-term outcomes and safety in patients with RBES.

To develop and validate a model to determine the progression of RBES in patients with benign esophageal strictures, based on the demographic data and endoscopic findings.

A total of 507 benign esophageal stricture patients treated by dilation alone or in combination with stenting were retrospectively enrolled between January 2009 and February 2018. The primary outcome was to establish a risk-scoring model predicting RBES in benign esophageal strictures. The secondary outcome was to explore the clinical effectiveness and adverse events in patients with RBES.

In the study, age, etiology, and number and length of strictures were the independent risk factors for the refractory performance of benign esophageal strictures. According to risk factors of benign esophageal strictures, a risk-scoring model for predicting RBES in benign esophageal strictures was established: The risk score ranged from 0 to 8 points, and the risk scores were divided into low risk (0-2 points), intermediate risk (3-5 points), and high risk (6-8 points). The proportions of RBES in the corresponding risk categories were 1.0%, 12.2%, and 76.0%, respectively. Among 507 patients, 57 had RBES (39 males; median age, 60 years). The success rate of dilation treatment (51.2%, 21/41) was higher than that of stent placement (37.5%, 6/16).

In this study, 11.3% (57/507) patients had RBES at our hospital. The risk-scoring model predicting RBES in benign esophageal strictures could predict the long-term outcome of patients with strictures ahead.

• Refractory benign esophageal strictures
• Esophageal dilation
• Esophageal stents
• Long-term outcomes
• Retrospective analysis

The outcomes of patients with refractory benign esophageal strictures (RBES) are unclear, and the clinical efficacy of dilation versus stent placement is lacking. Our objective was to explore the role of endoscopic dilation and stents placement in the management of RBES.

RBES patients treated with dilation and stents in our hospital between January 2009 and December 2017 were included in this study. The primary outcomes were to assess clinical effectiveness and adverse events. The secondary outcome was to identify factors that predicted the dysphagia-free period.

Among 75 RBES patients (54 male; median age 59 years), 39 (52%), 20 (26.7%), 3 (4%), 10 (13.3%), and 3 (4%), were postsurgical, post-ESD, achalasia of cardia, caustic and mixed etiology, respectively. The median number of endoscopic therapy was 5 times (range 3, 21). Endoscopic therapy was successful in 46 patients (61.3%). Patients treated with dilation showed a higher success rate (70.9%, 39/55) than that treated with stents (35%, 7/20). Fifteen patients died during follow-up. Nineteen patients had adverse events after endoscopic therapy. In total, the mean dysphagia-free period was 3.4 months (95% CI, 2.5–4.3). The patients treated with dilation demonstrated a dysphagia-free period of 3.7 months (95% CI, 2.7–5), while patients treated with stents displayed a dysphagia-free period of 2.3 months (95% CI, 1.5–3). The dysphagia-free period had a linear growth trend over time, with an increase of 12 days per endoscopic therapy.

The dysphagia-free period increased by 12 days per endoscopic therapy, so the endoscopic therapy tended to be effective in patients with RBES by increasing the dysphagia-free period. However, compared to dilation therapy, stent therapy was not effective in increasing the dysphasia-free period and reducing the times and frequency of dilation. In addition, univariate and multivariate analyses also indicated that etiology may predict the endoscopic therapy outcome.

This study was retrospectively registered and approved by the Ethics Committee of West China Hospital of Sichuan University (IRB number: ChiCTR1800016321).

• Esophageal dilation
• Esophageal stents
• Long-term outcomes
• Refractory benign esophageal strictures
• Retrospective analysis

Complete esophageal obstruction (CEO) due to occlusive proximal stricture occurs after chemoradiation for head and neck cancers. A combined antegrade and retrograde endoscopic technique with controlled recanalization and dilation (CARD) has been shown to be an effective and safe method for regaining and maintaining esophageal luminal patency in the short term.

We conducted a comprehensive search of multiple electronic databases and conference proceedings, including PubMed, EMBASE, and Web of Science databases (from inception through November 2018), to identify studies that reported the outcomes of CARD. The primary outcomes were the pooled rates of technical and clinical success, specifically improvement in dysphagia and independence from percutaneous endoscopic gastrostomy (PEG)-tube feeds. The secondary outcomes were the need for repeat dilations and the risks of complications, such as pneumomediastinum, perforation, and death.

From a total of 19 studies (229 cases and 251 procedures) the calculated technical success rate was 88.9% (95% confidence interval [CI] 83.9-92.5, I²=0). The rates of improvement in dysphagia and being PEG-tube free were 58.4% (95%CI 50-66.3, I²=12.6) and 43.5% (95%CI 34.1-53.4, I²=30.6), respectively. The pooled rate of repeat dilatations was 78.9% (95%CI 69.7-85.8, I²=15.2). The risks of pneumomediastinum, perforation and death were 9.9% (95%CI 6.2-15.6, I²=0), 8% (95%CI 4.8-13, I²=0), and 6.8% (95%CI 3.4-13.1, I²=0), respectively. Minimal heterogeneity was noted in the analysis.

The CARD procedure for CEO has a high technical success rate, but also a high rate of repeat dilations. Given its complexity and associated adverse events, this procedure should be restricted to centers with a high level of expertise.

• Combined antegrade retrograde esophageal dilation
• complete esophageal obstruction
• meta-analysis
• systematic review

• Biodegradable stent
• oesophageal stents
• peptic stricture
• resistant oesophageal stricture

• Dysphagia
• esophageal stents
• lung cancer

• oesophageal
• refractory
• stricture

The management of short-segment benign gastrointestinal (GI) strictures refractory to currently available endoscopic treatments (endoscopic balloon dilation, intralesional steroid injection, incisional therapy and fully covered self-expanding metal stents) proves to be challenging. Lumen-apposing metal stents (LAMS), originally developed for access to and drainage of pancreatic fluid collections, are being used in an off-label manner for the treatment of short GI luminal strictures. The short length and wide flanges make LAMS potentially suitable for this indication and may reduce complications and improve patient tolerance. In this article we review the published literature, including 138 patients from 4 retrospective studies and 13 case reports who received a LAMS for the treatment of a short GI luminal stricture. In the reviewed literature only 2 of the 138 cases had immediate adverse events warranting hospitalization: perforation and postoperative GI bleed. A total adverse event rate of 32.5% (45 of 138 cases) was reported. Migration was the most common adverse event, accounting for 40% of the total. Nearly 58% of reported patients had symptom and stricture resolution after stent removal in the reviewed studies. Follow up varied from 28-352 days after stent removal. Although more data are needed to determine their long-term safety and efficacy, LAMS represent an important alternative to traditional endoscopic options when approaching patients with short GI luminal strictures.

• Lumen-apposing metal stent
• benign strictures
• gastrointestinal strictures

To evaluate the clinical and economical efficacy of lumen apposing metal stent (LAMS) in the treatment of benign foregut strictures.

A single center retrospective database of patients who underwent endoscopic treatment of benign foregut strictures between January 2014 and May 2017 was analyzed. A control group of non-stented patients who underwent three endoscopic dilations was compared to patients who underwent LAMS placement. Statistical tests performed included independent t-tests and five-parameter regression analysis

Nine hundred and ninety-eight foregut endoscopic dilations were performed between January 2014 and May 2017. 15 patients underwent endoscopic LAMS placement for treatment of benign foregut stricture. Thirty-six patients with recurrent benign foregut strictures underwent three or more endoscopic dilations without stent placement. The cost ratio of endoscopic dilation to LAMS (stent, placement and retrieval) is 5.77. Cost effective analysis demonstrated LAMS to be economical after three endoscopic dilation overall. LAMS was cost effective after two dilations in the Post-surgical stricture subgroup.

Endoscopists should consider LAMS for the treatment of benign foregut strictures if symptoms persist past three endoscopic dilations. Post-surgical strictures may benefit from LAMS if symptoms persist after two dilations in a post-surgical. Early intervention with LAMS appears to be a clinically and economically viable option for durable symptomatic relief in patients with these strictures.

• Benign esophageal stricture
• Endoscopy economics
• Stent economics
• Self expandable metallic stents
• Esophageal diseases

• achalasia
• dysphagia
• oesophageal strictures
• oesophagitis

• Biodegradable stent
• Endoscopic stenting
• Gastrointestinal complications
• Postoperative leaks
• Postoperative strictures

• Absorbable Implants
• Adult
• Aged
• Aged, 80 and over
• Anastomotic Leak/therapy
• Constriction, Pathologic/etiology
• Constriction, Pathologic/therapy
• Endoscopy, Gastrointestinal
• Female
• Follow-Up Studies
• Gastrointestinal Diseases/etiology
• Gastrointestinal Diseases/therapy
• Humans
• Male
• Middle Aged
• Postoperative Complications/therapy
• Postoperative Period
• Retrospective Studies
• Stents
• Treatment Outcome

• Benign esophageal perforations
• Esophageal carcinoma
• Esophageal stents
• Esophago-respiratory fistula
• Refractory benign esophageal stricture
• Stent migration

• Benign esophageal strictures
• Endoscopic dilation
• Endoscopic therapy
• Esophageal dysphagia
• Esophagus
• Self-dilation

To investigate technical feasibility, outcomes and adverse events of the lumen-apposing metal stent (LAMS) for benign gastrointestinal (GI) tract strictures.

Between July 2015 and January 2017, patients undergoing treatment by LAMS for benign GI strictures at three tertiary referral centers were included in this study. Primary outcomes included technical success, short-term clinical success, long-term clinical success, and adverse events. Short-term clinical success was defined as symptom resolution at 30 d after stent placement. Long-term clinical success was defined by symptom resolution at 60 d in patients who continued to have indwelling stent, or continued symptom resolution at 30 d after elective stent removal.

A total of 21 patients (mean age 62.6 years, 47.6% males) underwent placement of LAMS for benign GI strictures. A 15 mm × 10 mm LAMS was placed in 16 patients, a 10 mm × 10 mm LAMS was placed in 2 patients, and a 16 mm × 30 mm LAMS was placed in 3 patients. Technical success was obtained in all cases. Short-term clinical success was achieved in 19 out of 21 cases (90.5%), and long-term clinical success was achieved in 12 out of 18 (66.7%). Mean (range) stent indwell time was 107.2 (28-370) d. After a mean (range) dwell time of 104.3 (28-306) d, 9 LAMSs were removed due to the following complications: ulceration at stent site (n = 1), angulation (n = 2), migration (n = 4) and stricture overgrowth (n = 2). Migration occurred in 4 cases (19.0%), and it was associated with stricture resolution in one case. Median (range) follow-up period was 119 (31-422) d.

Utilization of LAMS for benign strictures has shown to be technically feasible and safe, but adverse events highlight the need for further study of its indications.

• Endoscopy
• Stent
• Gastrointestinal diseases
• Stricture
• Biomedical technology

• Acute esophageal necrosis
• Esophageal bypass
• Esophageal stricture

• Balloon dilator
• Bougie dilator
• Endoscopic incisional therapy
• Eosinophilic esophagitis
• Esophageal A-ring
• Esophageal dilation
• Esophageal ring
• Esophageal stenosis
• Esophageal stent
• Esophageal stricture
• Esophageal web
• Intralesional steroid injection
• Mitomycin C
• Radiation stricture

• adjuvant treatments
• anastomotic strictures
• balloon dilators
• bougie dilators
• esophageal atresia
• esophageal dilation
• esophageal stenting
• refractory and recurrent strictures