Outcomes after placement of a SX‐ELLA oesophageal stent for refractory variceal bleeding—A national multicentre study. (17th October 2018)

• Record Type: Journal Article
• Authors: Pfisterer, Nikolaus; Riedl, Florian; Pachofszky, Thomas; Gschwantler, Michael; König, Kurt; Schuster, Benjamin; Mandorfer, Mattias; Gessl, Irina; Illiasch, Constanze; Fuchs, Eva‐Maria; Unger, Lukas; Dolak, Werner; Maieron, Andreas; Kramer, Ludwig; Madl, Christian; Trauner, Michael; Reiberger, Thomas
• Editors: Tacke, Frank
• Is Part Of: Liver international. Volume 39:Number 2(2019)
• Page Start: 290
• Page End: 298
• Publication Date: 2018-10-17
• Subjects: cirrhosis -- portal hypertension -- self‐expandable metal stent -- variceal bleeding; Liver -- Periodicals; Liver -- Diseases -- Periodicals; 616.362
• DOI: 10.1111/liv.13971
• Languages: English
• ISSNs: 1478-3223

Abstract

Abstract: Background: Current guidelines favour the use of bleeding stents over balloon tamponade (BT) for refractory variceal bleeding (VB) from oesophageal varices. However, data on the efficacy and safety of self‐expandable metal SX‐ELLA Danis stents (SEMS) are limited. Methods: Cirrhotic patients receiving SEMS for VB at four tertiary care centres were included in this retrospective multicentre study. Rates of failure‐to‐control bleeding (within 5 days) and bleeding‐related mortality (6 weeks) were assessed. Results: SEMS controlled VB in 79.4% (27/34) of patients. In the rest of patients, other rescue treatments including endoscopic band ligation (EBL, n = 3), SEMS renewed (n = 2) or Linton (n = 2) were applied; however, VB was only controlled in one patient. Early rebleeding within six weeks occurred in 17.6% (6/34) patients. Median SEMS dwell time was three (IQR:6) days. Overall n = 13/34 (38.2%) patients died with SEMS in situ. After SEMS removal, rebleeding and bleeding‐related death occurred in n = 7 (35%) and n = 5 (14.7%) patients respectively. Only 32.4% (10/34) patients did not experience any rebleeding within six weeks after SEMS removal. Bleeding‐related mortality was 47.1% (n = 16/34) and the median survival after SEMS placement was 2.1 months. Notably, no patient received an early transjugular intrahepatic portosystemic shunt (TIPS). The most common adverse events were stent dislocations (n = 13; 38.2%), while ulcers/necrosis of the oesophageal mucosa was seen in only four (11.8%) patients. Conclusion: SEMS controlled refractory VB in most patients. However, bleeding‐related mortality remained high. While SEMS dislocations were frequent, ulcers/necrosis of the oesophagus was rare. Further studies should investigate whether the wider use of early TIPS reduces bleeding‐related mortality after SEMS placement.